Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease

Abstract

Sigmoid perforation due to diverticulitis is a life-threatening complication in the postoperative course of allogenic kidney transplantation. The incidence of diverticulosis is especially high among patients with autosomal dominant polycystic kidney disease (ADPKD). Thus, those who undergo allogenic kidney transplantation represent a high-risk group. The aim of this study was to evaluate the prevalence of diverticulosis in ADPKD patients awaiting renal transplantation and the incidence of bowel perforation following allogenic kidney transplantation due to ADPKD. Within the group of 1128 patients who underwent transplantation between January 1974 and January 1990, there were 46 patients (4.07%) whose indication for transplantation was ADPKD. There was one patient who developed a sigmoid perforation under postoperative immunosuppression. Surgical treatment was a discontinuity resection of the sigmoid (Hartmann's procedure). The postoperative course was favorable, the bowel continuity has already been restored, and the graft is still functioning well. Fifteen of the 28 (53.5%) ADPKD patients awaiting transplantation had colon diverticulosis (12 male and 3 female patients). No case of bowel perforation has thus far been observed in 15 of these patients who have undergone transplantation. A sigmoid resection was necessary in one patient due to diverticulitis without perforation. We did not find a higher prevalence of diverticulosis in patients with ADPKD, nor did we see a higher incidence of sigmoid perforation during post-transplant immunosuppression in this study.

Incidence and outcome of abdominal surgical interventions following lung transplantation—a single center experience

“…Nevertheless, the incidence rate of acute abdomen in the presented population (6%) was lower than in previous reports [3,5,6,15,18,[23][24][25], but the mortality rate in cases of abdominal emergency interventions performed (28%) is comparable. Comparable data are also reported for other organ transplant settings especially in kidney transplantation, with diverging results to mortality and morbidity [26][27][28].…”

Risk Factors for Diverticulosis, Diverticulitis, Diverticular Perforation, and Bleeding: A Plea for More Subtle History Taking

“…Of six case series involving a total of 186 patients with PKD [ 80 , 81 , 82 , 83 , 84 , 85 ], three made statements about the prevalence of diverticulosis. Scheff et al [ 80 ] documented a prevalence of 10/12 (83%), Dominguez Fernandez et al [ 82 ] of 15/28 (53.5%), and Sharp et al [ 83 ] of 28/59 (47%). In a group of patients with kidney failure but no PKD, Scheff et al [ 80 ] documented a diverticular prevalence of 10/31 (32%).…”

“…One risk factor for death was pre-existing kidney disease with an OR of 18.7 [ 86 ]. Of six case series including a total of 186 patients [ 80 , 81 , 82 , 83 , 84 , 85 ], four made statements about the incidence of diverticular disease. Scheff et al [ 80 ], Lederman et al [ 84 ], and Pourfarziani et al [ 85 ] reported high incidence of severe cases in particular, at 4/12 (33%), 12/59 (20%), and 3/18 (17%), respectively.…”

“…Only Lederman et al [ 84 ] quantified incidence of diverticular disease in a comparative group with kidney failure but no PKD at 4/125 (3%). Dominguez Fernandez et al [ 82 ] found no increased risk of diverticular disease (1/28 or 4%) even in patients with PKD. No special management of the disease is recommended for patients with PKD compared to the normal patient population [ 87 ].…”

Gastrointestinal complications in renal transplant recipients

“…There is an increased risk of colonic complications in renal transplant recipients, particularly in aged subjects and in patients with polycystic kidney disease [43]. Cecum or ascending colon hemorrhage can occur in association with severe CMV infection.…”