Background: Diarrhea is a common condition after solid organ transplantation (SOT). Cryptosporidiosis is a rare disease after SOT.

Patient and methods: A retrospective chart review of all cases of Cryptosporidiosis in SOT recipients from two centers was performed. Cryptosporidiosis was defined by presence of diarrhea and detection of the pathogen using either microscopy or enzyme immuno assay.

Results: Five renal-, one lung- and one pancreas recipient median aged 51 (range 36-57) years were diagnosed with cryptosporidiosis median 22.1 (range 3.4-53.1) months post-SOT. Symptoms had existed for median 14 (range 10-42) days before diagnosis (microscopy: 3, EIA: 4) was made. Therapy consisted of azithromycin and/or nitazoxanide. Median TAC levels increased from 6ng/ml to 22ng/ml; median serum creatinine increased temporarily from 1.2mg/dl to 2.4mg/dl. All patients recovered from enteritis. Thirty-one articles on cryptosporidiosis after SOT were found. Publications from India, South America and the Middle East –all reporting on renal recipients - suggest a high prevalence of the disease in renal recipients in these endemic regions. The majority of the 22 reports from Europe and the US including 39 patients are sporadic cases commonly involving patients with intensified immunosuppression. Renal, pancreas, liver, small bowel and cardiac recipients were affected and 56% of patients were children.

Conclusion: Cryptosporidiosis should be recognized an important cause of diarrhea after SOT. A rise in TAC levels is commonly observed.