title: A systematic review of complicated diverticulitis in post-transplant patients.
abstract: BACKGROUND
  Immunosuppression could increase the complication rate in patients with acute diverticulitis. This would justify a low threshold for elective sigmoid resection in these patients after an episode of diverticulitis. Well-documented groups of immunocompromised patients are transplant patients, in which many prospective studies have been conducted.
  
  
  OBJECTIVE
  The aim of this systematic review is to assess the incidence of complicated diverticulitis in post-transplant patients.
  
  
  METHODS
  We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases for papers published between January 1966 and January 2014.
  Publications dealing with post-transplant patients and left-sided diverticulitis were eligible for inclusion. The following exclusion criteria were used for study selection: abstracts, case-series and non-English articles.
  
  
  METHODS
  Primary outcome measure was the incidence of complicated diverticulitis. Secondary outcome was the incidence of acute diverticulitis and the proportion of complicated diverticulitis. Pooling of data was only performed when more than five reported on the outcome of interest with comparable cohorts. Only studies describing proportion of complicated diverticulitis and renal transplant studies were eligible for pooling data.
  
  
  RESULTS
  Seventeen articles met the inclusion criteria. Nine renal transplant cohorts, four mixed lung-heart-heart lung transplant cohorts, two heart transplant cohorts, and two lung cohorts. A total of 11,966 post-transplant patients were included in the present review. Overall incidence of complicated diverticulitis in all transplantation studies ranged from 0.1 to 3.5%. Nine studies only included renal transplant patients. Pooled incidence of complicated diverticulitis in these patients was 1.0% (95% CI 0.6 to 1.5%). Ten studies provided proportion of complicated diverticulitis. Pooled incidence of acute diverticulitis in these studies was 1.7% (95% CI 1.0 to 2.7%). Pooled proportion of complicated diverticulitis among these patients was 40.1% (95% CI 32.2 to 49.7%). All studies were of moderate quality using the MINORS scoring scale.
  
  
  CONCLUSIONS
  The incidence of complicated diverticulitis is about one in 100 transplant patients. Additionally when a transplant patient develops an episode of acute diverticulitis, a high proportion of patients have a complicated disease course.
authors.affiliation: Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
authors.forename: J E
authors.initials: JE
authors.lastname: Oor
authors.forename: J J
authors.initials: JJ
authors.lastname: Atema
authors.forename: M A
authors.initials: MA
authors.lastname: Boermeester
authors.forename: B C
authors.initials: BC
authors.lastname: Vrouenraets
authors.forename: Ç
authors.initials: Ç
authors.lastname: Ünlü
mesh_terms: D004238:Diverticulitis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome