Kidney Week

Abstract: TH-PO0939

Multiplex Polymerase Chain Reaction (PCR) Diagnosis of Diarrhea in Kidney Transplant Patients: Etiological Spectrum and Association with Acute Graft Dysfunction

Session Information

• Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Gupta, Anurag, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Anurag Gupta, MD, DrMed, MBBS, FASN

• Sharma, Yogita, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Yogita Sharma, MD, MBBS

• Rana, Devinder S., Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Devinder S. Rana, MD

• Bhalla, Anil, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Anil Bhalla, MD, FASN

• Gupta, Ashwani, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Ashwani Gupta, MD, MBBS

• Malik, Manish, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Manish Malik, MD, MBBS

• Bhargava, Vinant, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Vinant Bhargava, MD, MBBS, FASN

• Tiwari, Vaibhav, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Vaibhav Tiwari, MD, MBBS, DM, FASN

• Saha, Rajdeb, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Rajdeb Saha, MD

• Jaiswal, Akhilesh, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, Delhi, India

Akhilesh Jaiswal, PhD

Background

Diarrhea is a frequent complication after renal transplantation, potentially leading to poor health, graft injury, or even rejection. Causes include infections (e.g., Campylobacter, E. coli, Salmonella, C. difficile, Giardia, Norovirus, Rotavirus) and immunosuppressive medications. This study aimed to determine the etiological spectrum of diarrhea in renal transplant recipients using stool multiplex PCR and evaluate the impact of diarrheal episodes on graft function.

Methods

This single-center prospective study included renal transplant recipients admitted with diarrhea from April 2022 to January 2024, whose stool underwent multiplex PCR testing. Serum CMV RT-PCR and colonoscopy were performed when clinically indicated. Renal function was tracked using serum creatinine during the diarrheal episode and one month after recovery.

Results

Of 100 renal transplant recipients recruited, stool multiplex PCR identified pathogens in 90%. Norovirus was the most frequent isolate, followed by Giardia lamblia. Enteroaggregative E. coli (EAEC) was the most common bacterial cause, and Norovirus/EAEC co-infection was prevalent. (Figure 1) CMV viremia occurred in 11%, and CMV colitis was diagnosed by biopsy in two individuals. Mycophenolate mofetil (MMF) was implicated as the cause of diarrhea in 4%. Significantly, acute graft dysfunction occurred in 70% of patients during their diarrheal episode.

Conclusion

Diarrhea in renal transplant recipients is strongly associated with acute graft dysfunction. Stool multiplex PCR offers a high diagnostic yield, enabling prompt etiological identification. This study facilitates targeted treatment, optimization of antimicrobial use, and helps avoid unnecessary immunosuppression adjustments, and may ultimately improve graft outcomes.

Figure 1. Commonly isolated pathogens on the FilmArray GI panel test in renal transplant recipients with diarrhea

Funding

• Clinical Revenue Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025va1n6qm4