Acute diverticulitis in renal transplant patients: should we treat them differently?

Jeremy Sugrue, Joanna S Lee, Christina Warner, Sany Thomas, Ivo Tzvetanov, Winnie Mar, Anders Mellgren, Johan Nordenstam

Research output: Contribution to journalArticle

Abstract

Background: Current guidelines suggest that transplant patients with acute diverticulitis should be managed aggressively with early operative intervention to reduce morbidity and mortality. This study compared the treatment choices and clinical outcomes between renal transplant patients and immunocompetent patients with acute diverticulitis. Methods: A retrospective review was performed of all patients who were admitted with acute diverticulitis between 2002 and 2015 at a single academic institution. Patient demographics, comorbidities, physiologic and radiologic disease severity, management, and disease-specific outcomes were recorded and compared between renal transplant patients and immunocompetent patients. Predictors of complications also were analyzed. Results: In the study, 20 renal transplant patients and 134 immunocompetent patients were admitted for acute diverticulitis and were followed for a median time of 36 and 40 months, respectively. Patient demographics were similar between the groups. Transplant patients had significantly more comorbidities. Overall, there were no differences in physiologic disease severity or rates of elective or urgent operation, ostomy, permanent ostomy, duration of stay, 30-day readmission, disease recurrence or disease-specific complications, organ failure, or death. Among patients with complicated disease, renal transplant patients were significantly more likely to undergo an urgent operation and had more complications. On multivariate analysis, undergoing operative therapy remained the sole predictor of complications. Conclusion: Nonoperative management of renal transplant patients who present with uncomplicated diverticulitis is safe as outcomes are similar to immunocompetent patients. However, the optimal management of renal transplant patients with complicated diverticulitis remains unclear as both treatment choices and complication rates differed from immunocompetent patients.

Original languageEnglish (US)
Pages (from-to)857-865
Number of pages9
JournalSurgery (United States)
Volume163
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Diverticulitis
Transplants
Kidney
Ostomy
Comorbidity
Demography

ASJC Scopus subject areas

  • Surgery

Cite this

Acute diverticulitis in renal transplant patients : should we treat them differently? / Sugrue, Jeremy; Lee, Joanna S; Warner, Christina; Thomas, Sany; Tzvetanov, Ivo; Mar, Winnie; Mellgren, Anders; Nordenstam, Johan.

In: Surgery (United States), Vol. 163, No. 4, 01.04.2018, p. 857-865.

Research output: Contribution to journalArticle

Sugrue, J, Lee, JS, Warner, C, Thomas, S, Tzvetanov, I, Mar, W, Mellgren, A & Nordenstam, J 2018, 'Acute diverticulitis in renal transplant patients: should we treat them differently?', Surgery (United States), vol. 163, no. 4, pp. 857-865. https://doi.org/10.1016/j.surg.2017.11.013
Sugrue, Jeremy ; Lee, Joanna S ; Warner, Christina ; Thomas, Sany ; Tzvetanov, Ivo ; Mar, Winnie ; Mellgren, Anders ; Nordenstam, Johan. / Acute diverticulitis in renal transplant patients : should we treat them differently?. In: Surgery (United States). 2018 ; Vol. 163, No. 4. pp. 857-865.
@article{5eba74ef616e4b4581e78eb2d428b1c0,
title = "Acute diverticulitis in renal transplant patients: should we treat them differently?",
abstract = "Background: Current guidelines suggest that transplant patients with acute diverticulitis should be managed aggressively with early operative intervention to reduce morbidity and mortality. This study compared the treatment choices and clinical outcomes between renal transplant patients and immunocompetent patients with acute diverticulitis. Methods: A retrospective review was performed of all patients who were admitted with acute diverticulitis between 2002 and 2015 at a single academic institution. Patient demographics, comorbidities, physiologic and radiologic disease severity, management, and disease-specific outcomes were recorded and compared between renal transplant patients and immunocompetent patients. Predictors of complications also were analyzed. Results: In the study, 20 renal transplant patients and 134 immunocompetent patients were admitted for acute diverticulitis and were followed for a median time of 36 and 40 months, respectively. Patient demographics were similar between the groups. Transplant patients had significantly more comorbidities. Overall, there were no differences in physiologic disease severity or rates of elective or urgent operation, ostomy, permanent ostomy, duration of stay, 30-day readmission, disease recurrence or disease-specific complications, organ failure, or death. Among patients with complicated disease, renal transplant patients were significantly more likely to undergo an urgent operation and had more complications. On multivariate analysis, undergoing operative therapy remained the sole predictor of complications. Conclusion: Nonoperative management of renal transplant patients who present with uncomplicated diverticulitis is safe as outcomes are similar to immunocompetent patients. However, the optimal management of renal transplant patients with complicated diverticulitis remains unclear as both treatment choices and complication rates differed from immunocompetent patients.",
author = "Jeremy Sugrue and Lee, {Joanna S} and Christina Warner and Sany Thomas and Ivo Tzvetanov and Winnie Mar and Anders Mellgren and Johan Nordenstam",
year = "2018",
month = "4",
day = "1",
doi = "10.1016/j.surg.2017.11.013",
language = "English (US)",
volume = "163",
pages = "857--865",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Acute diverticulitis in renal transplant patients

T2 - should we treat them differently?

AU - Sugrue, Jeremy

AU - Lee, Joanna S

AU - Warner, Christina

AU - Thomas, Sany

AU - Tzvetanov, Ivo

AU - Mar, Winnie

AU - Mellgren, Anders

AU - Nordenstam, Johan

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: Current guidelines suggest that transplant patients with acute diverticulitis should be managed aggressively with early operative intervention to reduce morbidity and mortality. This study compared the treatment choices and clinical outcomes between renal transplant patients and immunocompetent patients with acute diverticulitis. Methods: A retrospective review was performed of all patients who were admitted with acute diverticulitis between 2002 and 2015 at a single academic institution. Patient demographics, comorbidities, physiologic and radiologic disease severity, management, and disease-specific outcomes were recorded and compared between renal transplant patients and immunocompetent patients. Predictors of complications also were analyzed. Results: In the study, 20 renal transplant patients and 134 immunocompetent patients were admitted for acute diverticulitis and were followed for a median time of 36 and 40 months, respectively. Patient demographics were similar between the groups. Transplant patients had significantly more comorbidities. Overall, there were no differences in physiologic disease severity or rates of elective or urgent operation, ostomy, permanent ostomy, duration of stay, 30-day readmission, disease recurrence or disease-specific complications, organ failure, or death. Among patients with complicated disease, renal transplant patients were significantly more likely to undergo an urgent operation and had more complications. On multivariate analysis, undergoing operative therapy remained the sole predictor of complications. Conclusion: Nonoperative management of renal transplant patients who present with uncomplicated diverticulitis is safe as outcomes are similar to immunocompetent patients. However, the optimal management of renal transplant patients with complicated diverticulitis remains unclear as both treatment choices and complication rates differed from immunocompetent patients.

AB - Background: Current guidelines suggest that transplant patients with acute diverticulitis should be managed aggressively with early operative intervention to reduce morbidity and mortality. This study compared the treatment choices and clinical outcomes between renal transplant patients and immunocompetent patients with acute diverticulitis. Methods: A retrospective review was performed of all patients who were admitted with acute diverticulitis between 2002 and 2015 at a single academic institution. Patient demographics, comorbidities, physiologic and radiologic disease severity, management, and disease-specific outcomes were recorded and compared between renal transplant patients and immunocompetent patients. Predictors of complications also were analyzed. Results: In the study, 20 renal transplant patients and 134 immunocompetent patients were admitted for acute diverticulitis and were followed for a median time of 36 and 40 months, respectively. Patient demographics were similar between the groups. Transplant patients had significantly more comorbidities. Overall, there were no differences in physiologic disease severity or rates of elective or urgent operation, ostomy, permanent ostomy, duration of stay, 30-day readmission, disease recurrence or disease-specific complications, organ failure, or death. Among patients with complicated disease, renal transplant patients were significantly more likely to undergo an urgent operation and had more complications. On multivariate analysis, undergoing operative therapy remained the sole predictor of complications. Conclusion: Nonoperative management of renal transplant patients who present with uncomplicated diverticulitis is safe as outcomes are similar to immunocompetent patients. However, the optimal management of renal transplant patients with complicated diverticulitis remains unclear as both treatment choices and complication rates differed from immunocompetent patients.

UR - http://www.scopus.com/inward/record.url?scp=85039161383&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85039161383&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2017.11.013

DO - 10.1016/j.surg.2017.11.013

M3 - Article

C2 - 29289391

AN - SCOPUS:85039161383

VL - 163

SP - 857

EP - 865

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 4

ER -