Use of oral immunoglobulins to treat diarrhea in pediatric kidney transplant recipients—Single-center experience and review of the literature

Sarah J. Kizilbash*, Boris Sudel, Jessica A. Anderson, Priya S. Verghese

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Effective treatment modalities for diarrhea in solid organ transplant recipients are lacking. We evaluated the effect of oral IgG on clinical course of diarrhea in pediatric kidney transplant recipients. We retrospectively studied all pediatric kidney transplant recipients who required hospitalization for diarrhea between January 1, 2015, and December 31, 2017. We divided the recipients into two groups based on whether they had received oral IgG to treat diarrhea. Sixteen pediatric kidney transplant recipients required hospitalization for diarrhea over 3 years. Median age at admission was 9.25 years (IQR:12.54). Fifty-six percent of recipients were male, and 81% were white. Four patients received oral IgG for prolonged diarrhea. Oral IgG recipients had longer diarrheal duration before admission (median (days) 14.5 vs1; P.02), a trend for greater weight loss at admission (median (kilogram) 1.4 vs 0.2; P.3), and a trend for higher acute kidney injury (>75% reduction in glomerular filtration rate: 100% vs 42%; P.36). Diarrhea resolved completely in 3 (75%) oral IgG recipients and 7 (58%) non-oral IgG patients by discharge (P.99). One oral IgG recipient showed partial improvement but also had biopsy evidence of mycophenolate-induced colitis. All patients tolerated oral IgG well. No patients required re-hospitalization within 30 days of discharge. Oral IgG may be used safely and effectively to treat prolonged diarrhea in pediatric kidney transplant recipients. A larger, randomized, prospective study is needed to further assess the efficacy of oral IgG in the treatment of diarrhea.

Original languageEnglish (US)
Article numbere13582
JournalPediatric transplantation
Volume23
Issue number8
DOIs
StatePublished - Dec 1 2019

Keywords

  • diarrhea
  • oral immunoglobulins
  • pediatric kidney transplant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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