COMPLICATED DIVERTICULITIS FOLLOWING RENAL-TRANSPLANTATION

PURPOSE: Colonic perforations in renal transplant recipients have hist orically been associated with mortality rates as high as 50 to 100 per cent. However, these previous series generally predate the use of cycl osporine-based immunosuppressive protocols. METHODS: We retrospectivel y reviewed all patients who had undergone renal transplant from our in stitution and who developed complicated diverticulitis. Complicated di verticulitis was defined as diverticulitis involving free perforation, abscess, phlegmon, or fistula. Factors analyzed included the time int erval since transplantation, use of cyclosporine, living-related vs, c adaveric donor, cause of renal failure, and presenting signs and sympt oms. RESULTS: Between August 1969 and September 1996, 1,211 kidney tra nsplants were performed in 1,137 patients. The first 388 patients (196 9-1984) received prednisone and azathioprine, with cyclosporine added to the immunosuppressive regimen for the subsequent 823 recipients (19 84-1996). Thirteen (1.1 percent) patients had episodes of complicated diverticulitis, occurring from 25 days to 14 years after transplant; a ll required surgical therapy. Clinical presentation was highly variabl e, ranging from asymptomatic pneumoperitoneum (2 patients) to generali zed peritonitis. There was one perioperative mortality (7.7 percent). Patients with polycystic kidney disease as the cause of renal failure had a significantly higher rate of complicated diverticulitis. Specifi cally, patients with polycystic kidney disease (9 percent of the total transplant population) accounted for 46 percent of the cases of diver ticulitis (P < 0.001, Fisher's exact probability test). Neither treatm ent with cyclosporine nor donor source had a significant effect on the rate of diverticular complications (P = 0.36 and P = 0.99, respective ly, Fisher's exact probability test). CONCLUSION: Complicated divertic ulitis following renal transplantation is rare, and the clinical prese ntation may be atypical in the immunosuppressed transplant recipient. Patients with polycystic kidney disease experience a significantly hig her rate of complicated diverticulitis than do other transplant patien ts and, therefore, warrant aggressive diagnostic evaluation of even va gue abdominal symptoms. In addition, pretransplant screening and proph ylactic sigmoid resection in this high-risk population deserve conside ration and further study.