Acute diverticulitis in renal transplant patients: should we treat them differently?

Sugrue, Jeremy; Lee, Joanna; Warner, Christina; Thomas, Sany; Tzvetanov, Ivo; Mar, Woongchon; Mellgren, Anders; Nordenstam, Johan

doi:10.1016/j.surg.2017.11.013

Cited by 23 publications

(49 citation statements)

References 19 publications

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“…16,26 Recurrence rates may even be as high as 40%. 40 In the included studies, there was a paucity of data pertaining to the severity of recurrence, however previous evidence suggests immunosuppressed patients have up to a five-fold increased risk of recurrence with perforation. 41 Altogether, nonoperative outcomes might further support consideration for elective operation following a single attack of colonic diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis

McKechnie

Lee

Kruse

et al. 2021

The American Journal of Surgery

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Section: Discussionmentioning

confidence: 99%

Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis

McKechnie

Lee

Kruse

et al. 2021

The American Journal of Surgery

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“…Nonoperative management of renal transplant patients with uncomplicated diverticulitis is safe, with outcomes similar to immunocompetent patients. However, the optimal management of renal transplant patients with complicated diverticulitis remains unclear as both treatment choices and complication rates differed from immunocompetent patients [195]. elective colectomy in transplant patients after one episode vs multiple attacks of diverticulitis showed no differences in complication rates and mortality.…”

Section: Should Immunocompromised and Young Patients Be Treated Diffementioning

confidence: 99%

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Schultz

Azhar

Binda³

et al. 2020

Colorectal Disease

168

177

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Aim The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to surgeons. Methods The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements. Results This guideline contains 38 evidence based consensus statements on the management of diverticular disease. Conclusion This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.

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“…This approach is recently challenged by data demonstrating comparable recurrence rates in IS and IC patients after successful medical therapy without the necessity of subsequent emergent surgery in the IS cohort, outbalancing significant major morbidity in IS patients when undergoing elective sigmoidectomy [19][20][21]. Furthermore, conservative management of uncomplicated diverticulitis in transplanted patients was not associated with inferior clinical outcomes in comparison to immunocompetent patients [22]. In light of the above, the latest American Society of Colon and Rectal Surgeons (ASCRS) guidelines propose an individualized treatment strategy and only surgery in those IS patients with inevitable resection indications [23].…”

Section: Introductionmentioning

confidence: 99%

Surgical management in immunosuppressed patients with sigmoid diverticulitis, still a challenge: a single-center observational study

Vaghiri

Prassas

Knoefel

et al. 2022

Int J Colorectal Dis

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Purpose The question of whether immunosuppressed (IS) patients should be offered elective sigmoidectomy following a single episode of diverticulitis is controversial. We intended to examine the perioperative outcome of IS and immunocompetent (IC) patients after sigmoid resection. Methods A single institutional cohort study was conducted, including all surgically treated patients with sigmoid diverticulitis between 2004 and 2021. IS and IC patients were further subdivided into emergency and elective cases. Morbidity and mortality in both groups and factors influencing surgical outcome were examined using uni- and multivariate regression analyses. Results A total of 281 patients were included in the final analysis. Emergency surgery was performed on 98 patients while 183 patients underwent elective sigmoid resection. Emergency sigmoidectomy demonstrates significantly higher morbidity and mortality rates in IS patients as compared to IC patients (81.81% vs. 42.1%; p = 0.001, respectively 27.27% vs. 3.94%; p = 0.004), while major morbidity and mortality was similar in both groups in the elective setting (IS: 23.52% vs. IC: 13.85%; p = 0.488, respectively IS: 5.88% vs. IC: 0%; p = 1). On multivariate regression analysis for major postoperative morbidity, ASA score [OR 1.837; (95% CI 1.166–2.894); p = 0.009] and emergency surgery under immunosuppression [OR 3.065; (95% CI 1.128–8.326); p = 0.028] were significant. In-hospital mortality was significantly related to age [OR 1.139; (95% CI 1.012–1.282); p = 0.031], preoperative CRP count [OR 1.137; (95% CI 1.028–1.259); p = 0.013], and immunosuppression [OR 35.246; (95% CI 1.923–646.176), p = 0.016] on multivariate analysis. Conclusions Elective surgery for sigmoid diverticulitis in immunocompromised patients demonstrates higher efficacy and safety when compared to sigmoid resection in the emergency setting.

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Acute diverticulitis in renal transplant patients: should we treat them differently?

Cited by 23 publications

References 19 publications

Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis

Operative management of colonic diverticular disease in the setting of immunosuppression: A systematic review and meta-analysis

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

Surgical management in immunosuppressed patients with sigmoid diverticulitis, still a challenge: a single-center observational study

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