Colonic perforation after renal transplantation: risk factor analysis.
BACKGROUND
The incidence of gastrointestinal (GI) complication in renal transplantation is relatively high. These complications may be severe, leading to graft loss and patient death.


METHODS
We reviewed 1651 patients who underwent renal transplantation between 1976 and 2007, analyzing the incidence of colonic perforations and the clinical prognostic factors.


RESULTS
Twenty-one patients (1.3%) developed colonic perforations with 7 subsequent deaths. Diverticulitis and ischemia were the most common causes of perforation. Eleven patients (52.3%) were diagnosed and treated within the first 24 hours; their mortality was 18.1%. The 10 patients (47.7%) who were diagnosed and treated 24 hours after the clinical event displayed an high mortality rate (50%). Diverting stoma procedures were performed in all cases.


CONCLUSIONS
The follow-up of the kidney transplant patients should include a careful evaluation for possible GI complications and colonic perforations. Early diagnosis and timely treatment were associated with improved outcomes, regardless of the surgical procedures, the cause of perforation or the clinical and laboratory parameters.
Coccolini
F
F
Department of General Surgery, S. Orsola University Hospital, Bologna, Italy. fedecocco@iol.it
Catena
F
F
Di Saverio
S
S
Ansaloni
L
L
Faenza
A
A
Pinna
A D
AD
D000328:Adult; D003108:Colonic Diseases / Q000453:epidemiology*; D004241:Diverticulum, Colon / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology*; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000150:complications*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors