Colorectal surgery after kidney transplantation: characteristics of early vs. late posttransplant interventions.
BACKGROUND
The majority of colorectal complications after kidney transplantation reportedly occur <1 year of transplant. We aimed to identify differences in complications in the early and late posttransplant period.


METHODS
We retrospectively reviewed kidney transplant recipients undergoing colorectal resection from 1 June 2000 to 1 June 2012 at a single institution, comparing patients by posttransplant year (<1 vs. >1 year). Measured outcomes included major complications, postoperative length of stay, perioperative mortality, reoperations, and readmissions.


RESULTS
We identified 45 patients aged 31-77 (median 55). Gastrointestinal malignancy (31 %), diverticular disease (24 %), and ischemic colitis (16 %) were the most common indications for surgery. The early group (n = 9) had more cases of ischemic colitis (44 vs. 6 %, p = 0.01), emergent operations (100 vs. 33 %, p = 0.0003), blood transfusion (78 vs. 31 %, p = 0.02), longer length of stay (23.2 ± 12 vs. 11.7 ± 10 days, p = 0.02), and higher mortality rate (33 vs. 6 %, p = 0.05 compared to the late group (n = 36)). There were no significant differences in major complications, reoperations, or readmissions.


CONCLUSIONS
Kidney transplant recipients undergoing colorectal resection <1 year of transplant have a higher incidence of emergency surgery and ischemic colitis compared with those with >1 year posttransplant. Despite these findings, patients with grafts <1 year had a similar postoperative complication rate to patients with grafts >1 year.
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC#195, Minneapolis, MN, 55455, USA, leex1203@umn.edu.
Janet T
JT
Lee
Ty B
TB
Dunn
Anne-Marie
AM
Sirany
Genevieve B
GB
Melton
Robert D
RD
Madoff
Mary R
MR
Kwaan
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D004241:Diverticulum, Colon / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome