Management and Outcomes of Diverticulitis After Lung Transplantation

Abstract

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.

Concomitant diverticulosis among patients undergoing liver transplantation. Does it influence the length of hospitalization after the procedure?

“…Olson et al . [ 13 ] conducted a retrospective study to review patients undergoing lung transplant between 2007 and 2016 with posttransplant acute colonic diverticulitis. The study group consisted of 512 transplant recipients.…”

“…There is another crucial issue that needs to be mentioned in reference to diverticulosis and its complications among patients after solid organ transplantation. The classic presentation of diverticulitis may be complicated by immunosuppressive medications or the patient’s critical condition, which may delay diagnosis and intervention [ 13 ]. Glucocorticoids reduce infection defense capabilities by the inhibition of granulocytes and macrophages.…”

“…Analyzing previous publications, there are a few similar studies investigating the presence of diverticular disease and its complications after lung, heart, or kidney transplantation [10][11][12]. Olson et al [13] conducted a retrospective study to review patients undergoing lung transplant between 2007 and 2016 with posttransplant acute colonic diverticulitis. The study group consisted of 512 transplant recipients.…”