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.
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References
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; 249:210–7
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; 75:981–5
Shaikh S, Krukowski ZH. Outcome of a conservative policy for managing acute sigmoid diverticulitis. Br J Surg. 2007; 94(7):876–9
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):876–81
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):1198–205
Campbell K, Steele RJ. Non-steroidal anti-inflammatory drugs and complicated diverticular disease: a case–control study. Br J Surg. 1991; 78(2):190–1
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):1699–707
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):1506–12
http://optn.transplant.hrsa.gov/latestData/rptData.asp. Accessed Jan. 2013
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):172–9
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):39–44
Rafferty J, Shellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 2006; 49(7):939–44
Collins D, Winter DC. Elective resection for diverticular disease: an evidence based review. World J Surg 2008; 32:2429–33
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):e1–11
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):172–9
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; 9:376–9
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; 23:650–5
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; 202:55–61
Qasabian RA, Meagher AP, Lee R, Dore GJ, Keogh A. Severe diverticulitis after heart, lung, and heart-lung transplantation. J Heart Lung Transplant. 2004; 23:845–9
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; 14:12–5
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; 88:433–8
Paul S, Escareno CE, Clancy K, Jaklitsch MT, Bueno R, Lautz DB. Gastrointestinal complications after lung transplantation. J Heart Lung Transplant. 2009; 28:475–9
Maurer JR. The spectrum of colonic complications in a lung transplant population. Ann Transplant. 2000; 5(3):54–7
Stelzner M, Vlahakos DV, Milford EL, Tilney NL. Colonic perforations after renal transplantation. J Am Coll Surg. 1997; 184:63–9
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; 6:91–6
Lao A, Bach D. Colonic complications in renal transplant recipients. Dis Colon Rectum. 1988; 31:130–3
Starnes HF, Lazarus JM, Vineyard G. Surgery for diverticulitis in renal failure. Dis Colon Rectum. 1985; 28:827–31
Sawyer OI, Garvin PJ, Codd JE, Graff RJ, Newton WT, Willman VL. Colorectal complications of renal allograft transplantation. Arch Surg. 1978; 113:84–6
Coccolini F, Catena F, Di Saverio S, Ansaloni L, Faenza A, Pinna AD. Colonic perforation after renal transplantation: risk factor analysis. Transplant Proc. 2009; 41:1189–90
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; 37:2507–10
Lederman ED, Conti DJ, Lempert N, Singh TP, Lee EC. Complicated diverticulitis following renal transplantation. Dis Colon Rectum. 1998; 41:613–8
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):157–61
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; 190:535–42
Leonardi MJ, Jamil KG, Hiscox B, Ross D, Hiatt JR. Abdominal surgery after lung transplantation. Am Surg. 2010; 76:1130–4
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; 75:882–6
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; 11:28–31
Fenton JJ, Cicale MJ. Sigmoid diverticular perforation complicating lung transplantation. J Heart Lung Transplant. 1997; 16:681–5
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; 62:839–43
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; 21:325–4
Carson SD, Krom RA, Uchida K, Yokota K, West JC, Weil R III. Colon perforation after kidney transplantation. Ann Surg. 1978; 188:109–13
Misra MK, Pinkus GS, Birtch AG, Wilson RE. Major colonic diseases complicating renal transplantation. Surgery 1973; 73(6):942–8
Perkins JD, Shield CF III, Chang FC, Farha GJ. Acute diverticulitis: comparison of treatment in immunocompromised and nonimmunocompromised patients. Am J Surg. 1984; 148:745–8
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
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
Flanigan RC, Reckard CR, Lucas BA. Colonic complications of renal transplantation. J Urol. 1988; 139:503–6
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; 40:1895–6
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; 52:1558–63
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
Warshaw AL, Welch JP, Ottinger LW. Acute perforation of the colon associated with chronic corticosteroid therapy. Am J Surg. 1976; 131:442–6
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; 14:1276–86
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Oor, J.E., Atema, J.J., Boermeester, M.A. et al. A Systematic Review of Complicated Diverticulitis in Post-Transplant Patients. J Gastrointest Surg 18, 2038–2046 (2014). https://doi.org/10.1007/s11605-014-2593-2
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DOI: https://doi.org/10.1007/s11605-014-2593-2