Post Liver Transplantation Diarrhea: Etiology, Evaluation and Treatment

Diarrhea is a frequent post-operative complication following liver transplantation. It occurs frequently in the initial 3-4 months. Common etiologic factors include immunosuppressive drugs (Mycophenolate mofetil, Tacrolimus and Cyclosporine) and infection (Clostridium difficile, Cytomegalovirus and Rotavirus infection). Inflammatory bowel disease, malignancy and graft versus host disease are infrequent but important causes. Actual incidence of Diarrhea among liver transplant recipients remains elusive as it is often under-reported. However, as per the current literature, it occurs in 10-40 percent of recipients. It can result in dehydration, dyselectrolytemia, derangement of renal profile and even graft loss. The alteration in immunosuppressive drugs in early post-operative period may predispose graft rejection. High index of suspicion and systematic evaluation is pertinent for timely diagnosis. The review summarizes the important causes, epidemiology, recent updates, evaluation and management of the of post liver transplant diarrhea.