Elective Colectomy for Diverticulitis in Transplant Patients: Is It Worth the Risk?

Lee, Janet T.; Skube, Steve; Melton, Genevieve B.; Kwaan, Mary R.; Jensen, Christine C.; Madoff, Robert D.; Gaertner, Wolfgang B.

doi:10.1007/s11605-017-3432-z

Cited by 9 publications

(6 citation statements)

References 6 publications

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“…elective colectomy in transplant patients after one episode vs multiple attacks of diverticulitis showed no differences in complication rates and mortality. Colectomy after a single attack of diverticulitis in transplant patients is not justified as the operative risk is higher in these patients [196].…”

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

144

161

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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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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

144

161

View full text Add to dashboard Cite

show abstract

“…On multivariate analysis, disease management with urgent and/or elective colectomy (versus nonoperative) remained the only significant risk factor for increased complications. To identify whether there is an advantage to performing an elective colectomy after a primary incidence of diverticulitis in transplant recipients, Lee et al [10] performed a retrospective cohort study including 30 transplant recipients who underwent elective colectomy for acute diverticulitis. They compared those who underwent colectomy after the primary presentation with those undergoing colectomy after a recurrent episode.…”

Section: Discussionmentioning

confidence: 99%

Treating acute diverticulitis in pre‐ and post‐solid‐organ transplant patients: a single‐institution cohort study

et al. 2023

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Aim: Immunosuppressed patients are more likely to fail nonoperative management of acute diverticulitis and have more postoperative complications than the immunocompetent. Transplant recipients form a subcategory among the immunosuppressed with unique challenges. The aim of this work is to report 30-day postoperative complications after colectomy for acute diverticulitis and success rates of nonoperative management in pre-and post-transplant patients.Method: This is a retrospective cohort study at a single-institution tertiary referral centre. Patients with a history of acute diverticulitis were extracted from a database of 6152 recipients of solid-organ abdominal transplant between 2000 and 2015 and stratified by the index episode of diverticulitis: before or after solid-organ transplant surgery.Outcomes included 30-day postoperative complications and failure of nonoperative management.Results: Acute diverticulitis occurred in 93 patients, 69 (74%) posttransplant.Postcolectomy complications were higher posttransplant than pretransplant (43% vs. 13%, p = 0.04). Posttransplant status was not an independent risk factor for complications (odds ratio 3.59, 95% CI 0.79-16.31) when adjusting for sex and surgical acuity.Immediate urgent colectomy (29% vs. 31%, p = 0.84) and failure of nonoperative management (7% vs. 9%, p = 0.82) were similar. Complications occurred equally in those requiring urgent colectomy after nonoperative management and those undergoing immediate urgent colectomy. Conclusion:Urgent colectomy rates are similar in solid-organ abdominal transplant recipients pre-and posttransplant. Posttransplant complication rates appear to be increased but transplant status as an independent factor is not significantly associated with an increased risk in this study cohort. These findings should be considered when counselling patients on the relative risks and benefits of surgical intervention for diverticulitis before versus after solid-organ transplantation.

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“…They observed a similar overall complication rate in patients undergoing primary anastomosis (n = 26) versus proximal diversion (n = 10), with no colorectal anastomotic leaks. 22…”

Section: Discussionmentioning

confidence: 99%

Management and Outcomes of Diverticulitis After Lung Transplantation

et al. 2020

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Introduction: Most lung transplant patients are older than 50 years. Complications from colonic diverticula are not uncommon, especially with chronic immunosuppression. However, limited data exist regarding the optimal management of these patients. We sought to investigate the incidence, risk factors, and outcomes of diverticulitis after lung transplant. Methods: We conducted a retrospective study to review patients undergoing lung transplant between 2007 and 2016 with posttransplant acute colonic diverticulitis. Patients were grouped based on medical or surgical management. Results: Of 512 transplant recipients, 17 (3.32%) developed 26 episodes of diverticulitis over a median follow-up of 39 months. Nine patients had documented diverticulosis on pretransplant colonoscopy. These patients had a higher incidence of surgical intervention for diverticulitis, were more likely to have recurrent diverticulitis, and had longer lengths of stay than patients without pretransplant diverticulosis. Six (35.3%) of 17 patients required surgery (ie, Hartmann procedure; 4 during the initial episode and 2 during their third and fourth episodes); 11 patients (64.7%) were managed with antibiotics alone. Patients in the surgical group presented earlier posttransplant ( P = .004) and were on higher doses of tacrolimus ( P = .03). Six (46.1%) of 13 patients with medically managed first episodes of diverticulitis experienced recurrence. No recurrence occurred after surgical management. No deaths were attributable to diverticulitis in either group. Conclusions: Patients with pretransplant diverticulosis experienced earlier, more complicated episodes of diverticulitis posttransplant than patients without. Surgical patients received higher doses of tacrolimus and presented earlier than medical patients. Uncomplicated diverticulitis in posttransplant patients can be managed medically, even in the case of recurrent, uncomplicated disease.

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Elective Colectomy for Diverticulitis in Transplant Patients: Is It Worth the Risk?

Cited by 9 publications

References 6 publications

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

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

Treating acute diverticulitis in pre‐ and post‐solid‐organ transplant patients: a single‐institution cohort study

Management and Outcomes of Diverticulitis After Lung Transplantation

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