Increased incidence of gastrointestinal surgical complications in renal transplant recipients with polycystic kidney disease

Background. We had the impression that, although our renal transplant recip ients with polycystic kidney disease (PKD) had excellent long-term renal gr aft function, they had an increased incidence of postoperative gastrointest inal (GI) complications. Methods. Over a 10-year period (1987 through 1996), 1467 renal transplants were performed in 1417 patients; 145 of these transplants involved PKD reci pients. In the PKD group, 18 patients (12.4%) developed a posttransplant co mplication necessitating GI surgery (PKD-GI), an incidence twice that in th e non-PKD recipients (73 patients or 6.2%, non-PKD-GI). Results. PKD and non-PKD recipients displayed no significant difference in mortality. The PKD patients had better long-term renal graft survival than the non-PKD patients (P=0.08). There was no difference in mortality (P>0.6) or renal graft survival (P>0.6) between the PKD-GI and PKD-non-GI groups. The PKD-GI group had no increased mortality over the non-PKD-GI patients (P >0.6), despite a higher incidence of GI surgical complications in the PKD g roup versus the non-PKD group (overall: 12.4 vs. 6.2%, P<0.01; within 90 da ys of transplant: 7.6 vs. 3.3%, P<0.02) and a greater propensity for small and large bowel complications (overall: 9.0 vs. 2.6%; P<0.001; less than 90 days: 6.9 vs. 2.0%, P<0.002). The PKD-GI recipients tended toward less lon g-term graft loss than their non-PKD-GI counterparts (11.1 vs, 27.4%; P=.22 ). The PKD-GI recipients suffered no acute rejection episodes within 90 day s after their GI operation versus 11 of 73 non-PKD-GI recipients (0 vs. 15. 1%; P=0.075). Conclusions. PKD recipients of renal grafts should be watched closely early after transplant because of their increased risk of GI complications. Thes e complications resulted in no increase in mortality or graft loss compared to non-PKD recipients with GI complications despite the PKD group's higher incidence of bowel perforation and increased age at time of transplant.