| Autor: |
McCune, Thomas R., Nylander, William A., Van Buren, David H., Richie, Robert E., MacDonell, Robert C., Johnson, H. Keith, Shull, Harrison, Cate, Clifford K., Helderman, J. Harold |
| Zdroj: |
Clinical Transplantation; April 1992, Vol. 6 Issue: 2 p91-96, 6p |
| Abstrakt: |
Colonic complications after renal transplantation are uncommon but have a high mortality rate. Some have recommended colonic screening in patients over 50 years of age prior to transplantation to lessen the impact of colonic diverticular disease. We report our 9‐year experience of colonic screening for diverticular disease in potential recipients over the age of 50 and compare these results to the overall colonic complication rate in the same time period. From 1981‐1990, 1186 renal transplants in 1019 patients were perormed, during which time all potential recipients over the age of 50 yr were required to undergo colon evaluation prior to transplantation. Twenty cases of diverticular disease were found with more than a quarter of the cases in patients with adult polycystic disease. All underwent renal transplantation without a pre‐transplant colectomy, and none had post transplant symptomatic colon disease. During that same time period a total of 14 colonic complications requiring surgical intervention were encountered with a mortality rate of 40%. Acute diverticulitis occurred in 5 patients, all of whom were over 50 yr of age, on low‐dose immunosuppression, and in most cases it occurred remotely after transplantation. Colonic dysplasia/neoplasia also occurred remotely after transplantation in 2 patients over the age of 50. Cytomegalovirus (CMV) colitis was the next most common complication, accounting for 3 cases. This complication, which occurred in younger patients, was associated with high‐dose steroid immunosuppression and had a high mortality rate, in spite of surgical intervention. Although half of all colonic complications occurred in patients over the age of 50, advanced age was not associated with increase mortality. Mortality rate was lowered by aggressive surgical intervention but remained high when colonic complications were a manifestation of systemic disease. Because of the inability to predict which patients are at risk for colonic complications and, in those patients who had such a complication, the remoteness between occurrence and transplant, we recommend abandoning pre‐transplant colon screening. |
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