TY - JOUR
T1 - Colon perforation after renal transplantation
T2 - A single-institution review
AU - Pirenne, J.
AU - Lledo-Garcia, E.
AU - Benedetti, E.
AU - West, M.
AU - Hakim, N. S.
AU - Sutherland, D. E R
AU - Gruessner, R. W G
AU - Najarian, J. S.
AU - Matas, A. J.
PY - 1997/4
Y1 - 1997/4
N2 - Colon perforation (CP) is an uncommon but dramatic complication after renal transplantation. Of 1530 consecutive kidney transplants performed at our center, 8 recipients had an CP (incidence of 0.5%), either early (n = 5, 2-14 days) or late (n = 3, 8-48 months) post transplant. Clinical symptoms were generally vague. Biological findings were inconstant. Risk factors for CP included a cadaver graft (versus a living donor), high body weight, history of diverticulitis, and Kayexalate use. Crucial to outcome were: 1) immediate diagnosis and 2) aggressive surgical care consisting of resectional therapy, broad-spectrum antibiotics, and reduced immunosuppression. Applying these principles, mortality in our patients (25%) was lower than in previously reported series (33-64%). All grafts were functioning at the time of diagnosis; graft function was preserved in recipients who recovered from CP. Patients with a documented history of diverticulitis should undergo prophylactic colonic resection. Constipation and colonic dilatation should be treated aggressively in the early post-operative period.
AB - Colon perforation (CP) is an uncommon but dramatic complication after renal transplantation. Of 1530 consecutive kidney transplants performed at our center, 8 recipients had an CP (incidence of 0.5%), either early (n = 5, 2-14 days) or late (n = 3, 8-48 months) post transplant. Clinical symptoms were generally vague. Biological findings were inconstant. Risk factors for CP included a cadaver graft (versus a living donor), high body weight, history of diverticulitis, and Kayexalate use. Crucial to outcome were: 1) immediate diagnosis and 2) aggressive surgical care consisting of resectional therapy, broad-spectrum antibiotics, and reduced immunosuppression. Applying these principles, mortality in our patients (25%) was lower than in previously reported series (33-64%). All grafts were functioning at the time of diagnosis; graft function was preserved in recipients who recovered from CP. Patients with a documented history of diverticulitis should undergo prophylactic colonic resection. Constipation and colonic dilatation should be treated aggressively in the early post-operative period.
KW - Colon perforation
KW - Renal transplantation
UR - http://www.scopus.com/inward/record.url?scp=0030936494&partnerID=8YFLogxK
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U2 - 10.1111/j.1399-0012.1997.tb00786.x
DO - 10.1111/j.1399-0012.1997.tb00786.x
M3 - Article
C2 - 9113442
AN - SCOPUS:0030936494
SN - 0902-0063
VL - 11
SP - 88
EP - 93
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 2
ER -