Alimentary Tract Complications After Renal Transplantation

Abstract

A computer analysis of post renal transplantation gastrointestinal problems was performed to identify important associated clinical factors. Thirty-seven per cent of all transplant recipients developed one or more significant problems. Hemorrhage, nondiverticular intestinal perforation, and esophagitis occurred most frequently in hospitalized patients. Pancreatitis, diverticulitis, and gastroduodenal perforation occurred characteristically in long-term survivors with well functioning allografts. Eleven of 32 HLA identical recipients treated with maintenance corticosteroids during stable kidney function developed gastrointestinal disease while only one of 13 HLA identical recipients not given maintenance steroids developed a problem, which strongly suggests a causal role for steroids in the development of late complications. The association of preexisting peptic ulcer and diverticular disease with hemorrhage and perforation supports previous recommendations that documented peptic ulcer disease or diverticulitis should be corrected surgically prior to transplantation.

Diverticulitis in immunosuppressed patients: A fatal outcome requiring a new approach?

“…The incidence of free peritoneal perforation or complicated disease is increasing in IS patients compared with IC patients. 2,3 Since a number of studies have shown high mortality associated with diverticulitis in IS patients, particularly in transplant recipients, [4][5][6] clinicians have been inclined to offer elective surgery after a single episode of uncomplicated disease. 7 A recently published study showed similar morbidity and mortality in elective surgery of the colon in kidney transplant recipients, 8 which supports the idea of preventive elective surgery for this high-risk group.…”

Unexpected Colonic Perforation in a Renal Recipient. A Case Report

“…[10] Spontaneous perforation of the colon, especially of the sigmoid colon, which was revealed as being related to immunosuppression, has been reported previously. [1,4,5,9] Spontaneous perforation of the GI tract usually occurs in the early period after transplantation. The mean duration time is 3 to 6 months after transplantation.…”

“…The mean duration time is 3 to 6 months after transplantation. [5] The differences in patient characteristics, such as medical problems, general condition, peritonitis grade, or cause of perforation, influence both the surgical decision and outcome. A cumulative effect of sepsis and medical conditions may be responsible for the high postoperative mortality, which ranges between 30-55%.…”

“…Nevertheless, many others have concluded that immunosuppression, septic shock, fecal peritonitis, or high cardiac risk patients at admission were correlated with higher morbidity and mortality rates, and that usage of a two-stage procedure with or without primary anastomosis would be safer than one-stage surgery. [1,5,16,18] There is no comment about the timing of the second stage of the operation, but most of the authors favor delaying the second stage, usually preferring to perform it 6 months after the first stage. [14,18] In conclusion, colon perforation due to immunoUnexpected colonic perforation in a renal recipient Ulus Travma Acil Cerrahi Derg suppressant use in renal allograft recipients is a rare but serious complication, with high mortality and morbidity rates.…”

“…[1] Gastrointestinal (GI) complications such as bleeding or perforations are the most common lifethreatening surgical complications, ranging from 10-20%. [2][3][4][5] CASE REPORT A 52-year-old male was admitted to our transplantation clinic on the 7th day of living donor-related renal allograft transplantation (right-sided, retroperitoneal approach surgery), after being discharged from a hospital in Egypt. He had end-stage renal failure because of diabetes and was on maintenance therapy by hemodialysis.…”