Top

Journal of Gastrointestinal Surgery

Published in:

01-11-2014 | Review Article

A Systematic Review of Complicated Diverticulitis in Post-Transplant Patients

Authors: J. E. Oor, J. J. Atema, M. A. Boermeester, B. C. Vrouenraets, Ç. Ünlü

Published in: Journal of Gastrointestinal Surgery | Issue 11/2014

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.

Objectives

The aim of this systematic review is to assess the incidence of complicated diverticulitis in post-transplant patients.

Data Source

We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases for papers published between January 1966 and January 2014.

Study Selection and Intervention

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.

Main Outcome Measures

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.

Conclusion

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.

Etzioni DA, Mack TM, Beart RW Jr, Kaiser AM. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg. 2009; 249:210–7CrossRefPubMed

Etzioni DA, Cannom RR, Ault GT, Beart RW Jr, Kaiser AM. Diverticulitis in California from 1995 to 2006: increased rates of treatment for younger patients. Am Surg. 2009; 75:981–5PubMed

Shaikh S, Krukowski ZH. Outcome of a conservative policy for managing acute sigmoid diverticulitis. Br J Surg. 2007; 94(7):876–9CrossRefPubMed

Morris CR, Harvey IM, Stebbings WS, Hart AR. Incidence of perforated diverticulitis and risk factors for death in a UK population. Br J Surg. 2008; 95(7):876–81CrossRefPubMed

Humes DJ, Solaymani-Dodaran M, Fleming KM, Simpson J, Spiller RC, West J. A population-based study of perforated diverticular disease incidence and associated mortality. Gastroenterology. 2009; 136(4):1198–205CrossRefPubMed

Campbell K, Steele RJ. Non-steroidal anti-inflammatory drugs and complicated diverticular disease: a case–control study. Br J Surg. 1991; 78(2):190–1CrossRefPubMed

Hwang SS, Cannom RR, Abbas MA, Etzioni D. Diverticulitis in transplant patients and patients on chronic corticosteroid therapy: a systematic review. Dis Colon Rectum. 2010; 53(12):1699–707CrossRefPubMed

http://www.cdc.gov/hiv/topics/surveillance/incidence.htm. Accessed Jan 2013

Huetsch JC, Uman JE, Udris EM, Au DH. Predictors of adherence to inhaled medications among Veterans with COPD. J Gen Intern Med. 2012; 27(11):1506–12PubMedCentralCrossRefPubMed

10.

http://optn.transplant.hrsa.gov/latestData/rptData.asp. Accessed Jan. 2013

11.

Biondo S, Borao JL, Kreisler E, Golda T, Millan M, Frago R, Fraccalvieri D, Guardiola J, Jaurrieta E. Recurrence and virulence of colonic diverticulitis in immunocompromised patients. Am J Surg. 2012; 204(2):172–9CrossRefPubMed

12.

Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA. Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg. 2009; 249(1):39–44CrossRefPubMed

13.

Rafferty J, Shellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 2006; 49(7):939–44CrossRefPubMed

14.

Collins D, Winter DC. Elective resection for diverticular disease: an evidence based review. World J Surg 2008; 32:2429–33CrossRefPubMed

15.

Biondo S, Lopez Borao J, Millan M, Kreisler E, Jaurrieta E. Current status of the treatment of acute colonic diverticulitis: a systematic review. Colorectal Dis. 2012; 14(1):e1–11CrossRefPubMed

16.

17.

Detry O, Defraigne JO, Meurisse M, Bertrand O, Demoulin JC, Honoré P, Jacquet N, Limet R. Acute diverticulitis in heart transplant patients. Transpl Int. 1996; 9:376–9CrossRefPubMed

18.

Mueller XM, Tevaearai HT, Stumpe F, Hurni M, Ruchat P, Fischer AP, Seydoux C, Goy JJ, von Segesser LK. Gastrointestinal disease following heart transplantation. World J Surg. 1999; 23:650–5CrossRefPubMed

19.

Goldberg HJ, Hertz MI, Ricciardi R, Madoff RD, Baster NN, Bullard KM. Colon and rectal complications after heart and lung transplantation. J Am Coll Surg. 2006; 202:55–61CrossRefPubMed

20.

Qasabian RA, Meagher AP, Lee R, Dore GJ, Keogh A. Severe diverticulitis after heart, lung, and heart-lung transplantation. J Heart Lung Transplant. 2004; 23:845–9CrossRefPubMed

21.

Khan S, Eppstein AC, Anderson GK, Dengal MK, Eggenberger JC, Lee CS, Szilagy EJ, Margolin DA. Acute diverticulitis in heart- and lung transplant patients. Transpl Int. 2001; 14:12–5CrossRefPubMed

22.

Hoekstra HJ, Hawkins K, de Boer WJ, Rottier K, van de Bij W. Gastrointestinal complications in lung transplant survivors that require surgical intervention. Br J Surg. 2001; 88:433–8CrossRefPubMed

23.

Paul S, Escareno CE, Clancy K, Jaklitsch MT, Bueno R, Lautz DB. Gastrointestinal complications after lung transplantation. J Heart Lung Transplant. 2009; 28:475–9CrossRefPubMed

24.

Maurer JR. The spectrum of colonic complications in a lung transplant population. Ann Transplant. 2000; 5(3):54–7PubMed

25.

Stelzner M, Vlahakos DV, Milford EL, Tilney NL. Colonic perforations after renal transplantation. J Am Coll Surg. 1997; 184:63–9PubMed

26.

McCune TR, Nylander WA, Van Buren DH, et al. Colonic screening prior to renal transplantation and its impact on posttransplant colonic complications. Clin Transplant. 1992; 6:91–6PubMed

27.

Lao A, Bach D. Colonic complications in renal transplant recipients. Dis Colon Rectum. 1988; 31:130–3CrossRefPubMed

28.

Starnes HF, Lazarus JM, Vineyard G. Surgery for diverticulitis in renal failure. Dis Colon Rectum. 1985; 28:827–31CrossRefPubMed

29.

Sawyer OI, Garvin PJ, Codd JE, Graff RJ, Newton WT, Willman VL. Colorectal complications of renal allograft transplantation. Arch Surg. 1978; 113:84–6CrossRef

30.

Coccolini F, Catena F, Di Saverio S, Ansaloni L, Faenza A, Pinna AD. Colonic perforation after renal transplantation: risk factor analysis. Transplant Proc. 2009; 41:1189–90CrossRefPubMed

31.

Dalla Valle R, Capocasale E, Mazzoni MP, Busi N, Benozzi L, Sivelli R, Sianesi M. Acute diverticulitis with colon perforation in renal transplantation. Transplant Proc. 2005; 37:2507–10CrossRefPubMed

32.

Lederman ED, Conti DJ, Lempert N, Singh TP, Lee EC. Complicated diverticulitis following renal transplantation. Dis Colon Rectum. 1998; 41:613–8CrossRefPubMed

33.

Soravia C, Baldi A, Kartheuser A, Mourad M, Kestens PJ, Detry R, Squifflet JP. Acute colonic complications after kidney transplantation. Acta Chir Belg. 1995; 95(3):157–61PubMed

34.

Meyers WC, Harris N, Stein S, Brooks M, Jones RS, Thompson WM, Stickel DL, Seigler HF. Alimentary tract complications after renal transplantation. Ann Surg. 1979; 190:535–42PubMedCentralCrossRefPubMed

35.

Leonardi MJ, Jamil KG, Hiscox B, Ross D, Hiatt JR. Abdominal surgery after lung transplantation. Am Surg. 2010; 76:1130–4PubMed

36.

Benjamin ER, Jim J, Kim TJ, Meals C, Gritsch HA, Tillou A, Cryer HG, Hiatt JR. Acute care surgery after renal transplantation. Am Surg. 2009; 75:882–6PubMed

37.

Domínguez Fernandez E, Albrecht KH, Heemann U, Kohnle M, Erhard J, Stöblen F, Eigler FW. Prevalence of diverticulosis and incidence of bowel perforation after kidney transplantation in patients with polycystic kidney disease. Transpl Int. 1998; 11:28–31CrossRefPubMed

38.

Fenton JJ, Cicale MJ. Sigmoid diverticular perforation complicating lung transplantation. J Heart Lung Transplant. 1997; 16:681–5PubMed

39.

Beaver TM, Fullerton DA, Zamora MR, Badesch DB, Weill D, Brown JM, Campbell DN, Grover FL. Colon perforation after lung transplantation. Ann Thorac Surg. 1996; 62:839–43CrossRefPubMed

40.

Abramson SJ, Berdon WE, Laffey K, Ruzal-Shapiro C, Nash M, Baer J. Colonic diverticulitis in young patients with chronic renal failure and transplantation. Pediatr Radiol. 1991; 21:325–4CrossRef

41.

Carson SD, Krom RA, Uchida K, Yokota K, West JC, Weil R III. Colon perforation after kidney transplantation. Ann Surg. 1978; 188:109–13PubMedCentralCrossRefPubMed

42.

Misra MK, Pinkus GS, Birtch AG, Wilson RE. Major colonic diseases complicating renal transplantation. Surgery 1973; 73(6):942–8PubMed

43.

Perkins JD, Shield CF III, Chang FC, Farha GJ. Acute diverticulitis: comparison of treatment in immunocompromised and nonimmunocompromised patients. Am J Surg. 1984; 148:745–8CrossRefPubMed

44.

Golda T, Trenti L, Frago R, Kreisler E, Milan M, Fraccalvieri D, Rafecas A, Biondo S. Perforated colonic diverticulitis in immunosuppressed patients. Colorect Dis Conference. 2010

45.

Pirenne J, Lledo-Garcia E, Benedetti E, West M, Hakim NS, Sutherland DER, Gruessner RWG, Najarian JS, Matas AJ. Colon perforation after renal transplantation: a single-institution review. Clin Trans. 1997; 11:88–93

46.

Flanigan RC, Reckard CR, Lucas BA. Colonic complications of renal transplantation. J Urol. 1988; 139:503–6PubMed

47.

Catena F, Ansaloni L, Gazzotti F, Bertelli R, Severi S, Coccolini F, Fuga G, Nardo B, D’Alessandro L, Faenza A, Pinna AD. Gastrointestinal perforations following kidney transplantation. Transplant Proc. 2008; 40:1895–6CrossRefPubMed

48.

Ricciardi R, Baxter NN, Read TE, Marcello PW, Hall J, Roberts PL. Is the decline in the surgical treatment for diverticulitis associated with an increase in complicated diverticulitis? Dis Colon Rectum 2009; 52:1558–63CrossRefPubMed

49.

Hjern F, Johansson C, Mellgren A, Baxter NN, Hjern A. Diverticular disease and migration—the influence of acculturation to a Western lifestyle on diverticular disease. Aliment Pharmacol Ther. 2006 Mar 15; 23(6):797–805

50.

Warshaw AL, Welch JP, Ottinger LW. Acute perforation of the colon associated with chronic corticosteroid therapy. Am J Surg. 1976; 131:442–6CrossRefPubMed

51.

von Rahden BH, Kircher S, Landmann D, Schlegel N, Lazariotou M, Jurowich CF, Germer CT, Grimm M. Glucocorticoid-induced tumour necrosis factor receptor expression: a potential molecular link between steroid intake and complicated diverticulitis? Colorectal Dis. 2012; 14:1276–86CrossRef

Title: A Systematic Review of Complicated Diverticulitis in Post-Transplant Patients
Authors: J. E. Oor
J. J. Atema
M. A. Boermeester
B. C. Vrouenraets
Ç. Ünlü
Publication date: 01-11-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 11/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2593-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A Systematic Review of Complicated Diverticulitis in Post-Transplant Patients

Abstract

Background

Objectives

Data Source

Study Selection and Intervention

Main Outcome Measures

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objectives

Data Source

Study Selection and Intervention

Main Outcome Measures

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2014

Response to Preoperative Chemotherapy Predicts Survival in Patients Undergoing Hepatectomy for Liver Metastases from Gastric and Esophageal Cancer

Endoscopy in the Early Postoperative Setting after Primary Gastrointestinal Anastomosis

Early Vein Reconstruction and Right-to-Left Dissection for Left-Sided Pancreatic Tumors with Portal Vein Occlusion

Mitochondrial Neuro-Gastrointestinal Encephalomyopathy Presenting with Recurrent Bowel Perforations and Intra-abdominal Abscesses

Determinants of Repeat Curative Intent Surgery in Colorectal Liver Metastasis

RETRACTED ARTICLE: Does the Hepatic Branch of Vagus Mediate the Secretion of Glucagon-Like Peptide-1 During the Roux-en-Y Gastric Bypass Surgery?