To evaluate the risk factors and clinical diagnosis and treatment strategies for post-kidney-transplantation diarrhea in the Northwest China.

A retrospective analysis was conducted among 230 kidney transplant recipients from the Department of Urology, the First Affiliated Hospital of Air Force Medical University from January 2019 to December 2024. Recipients were divided into the diarrhea group (n=72) and non-diarrhea group (n=158). General information and treatment of the recipients were recorded. Comparisons were made using the group t-test for normally distributed continuous variables, and the chi-square test was used for categorical variables. Variables significant at P<0.05 in univariate analysis were included in multivariate Logistic regression analysis. Statistical significance was set at P<0.05.

Among the 67 recipients (93.1%) with acute diarrhea, overall renal impact and clinical outcomes were relatively mild. Of these acute cases, 2 had SARS-CoV-2 infection, 1 had CMV infection, and 1 had positive fecal transferrin. Chronic diarrhea occurred in 5 cases (6.9%): 1 recipient died of severe hypokalemia; 3 recipients experienced deterioration of renal function, with 2 developed focal segmental glomerulosclerosis and IgA nephropathy recurrence who gradually leading to graft failure and returning to dialysis; 1 maintained stable serum creatinine of 200-300 μmol/L; 1 achieved completely recovery after treatment. Among the 5 cases with chronic diarrhea, 1 had CMV infection, 2 had positive fecal occult blood, and 1 had clostridioides difficile infection. Diarrhea occurred beyond the first year posttransplant in 12 cases (16.7%), while the remaining cases manifested within the first year after transplantation. Significant differences were observed between groups in duration of hospital stay, body mass index, presence of hyperlipidemia, operation time, complicated with delayed graft function (DGF) after transplantation, last preoperative serum potassium and creatinine, mycophenolic acid type and smoking history (t/χ²=4.100, 2.441, 2.548, 3.688, 4.076, -2.197, 2.755, 7.530 and -2.135, all P<0.05). The results of multivariate Logistic regression analysis showed that hospital stay (OR=1.062, 95% CI: 1.008-1.118), hyperlipidemia (OR=2.796, 95% CI: 1.427-5.478), operation time (OR=1.023, 95% CI: 1.010-1.036), postoperative DGF (OR=3.057, 95% CI: 1.414-6.607), last preoperative serum potassium (OR=0.556, 95% CI: 0.372-0.830), last preoperative serum creatinine (OR=1.002, 95% CI: 1.001-1.003), application of mycophenolate mofetil (OR=7.493, 95% CI: 3.528-15.913), and smoking history (OR=2.167, 95% CI: 1.102-4.259) were all independent risk factors for diarrhea after kidney transplantation (all P<005).

Post-kidney transplantation diarrhea is influenced by multiple complex factors in Northwest China. In-depth understanding of these factors may facilitate the development of targeted and precise prevention and treatment strategies.