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Duodenal villous atrophy: a cause of chronic diarrhea after solid-organ transplantation

H Weclawiak1, A Ould-Mohamed, B Bournet

  • 1Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, Toulouse, France.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|February 9, 2011
PubMed

Insights

Persistent diarrhea after solid organ transplantation (SOT) is often linked to duodenal villous atrophy (DVA). Mycophenolic acid (MPA) therapy is the primary cause, with symptoms resolving upon MPA dose adjustment or cessation.

Area of Science:

  • Gastroenterology
  • Transplantation Medicine
  • Pharmacology

Background:

  • Persistent diarrhea is a common complication following solid organ transplantation (SOT).
  • Duodenal villous atrophy (DVA) has been anecdotally linked to mycophenolate mofetil (MMF) in kidney transplant recipients.

Purpose of the Study:

  • To determine the incidence and characteristics of DVA in SOT patients experiencing chronic diarrhea.
  • To identify the primary causes of DVA in this patient population.

Main Methods:

  • One hundred thirty-two SOT patients with chronic diarrhea underwent oesophago-gastroduodenoscopy (OGD) and duodenal biopsy.
  • Exclusion of other common causes of diarrhea was performed prior to OGD.

Main Results:

  • DVA was diagnosed in 15.9% of patients.
  • Mycophenolic acid (MPA) therapy was identified as the cause in 85.7% of DVA cases (MMF or enteric-coated mycophenolate sodium).
  • Diarrhea resolved in MPA-associated DVA cases after MPA withdrawal or dose reduction.

Conclusions:

  • Duodenal villous atrophy (DVA) is a frequent cause of chronic diarrhea in SOT recipients.
  • Mycophenolic acid (MPA) therapy is the most common iatrogenic cause of DVA.
  • OGD with duodenal biopsy is recommended for SOT patients with persistent diarrhea.

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