M. Parker1, S. Kelley1, K. Mathis1 1Mayo Clinic,Surgery,Rochester, MN, USA
Introduction: Patients with polycystic kidney disease (PKD) who have had a kidney transplant have an increased risk of complicated diverticulitis compared to those who have had a transplant for other reasons. There is limited published literature regarding the risk of diverticulitis in patients with PKD who have not had a transplant.
Methods: We carried out a retrospective review of patients with PKD who were evaluated for diverticulitis in our system between January 2000 and June 2016. Patients were identified using ICD-9 and ICD-10 diagnosis codes. The electronic medical record was reviewed to obtain patient demographics, imaging, laboratory investigations, treatment course and outcomes. Patients without both documented polycystic kidney disease and diverticulitis in the electronic medical record were excluded. We compared patients who were status-post renal transplant at the time of diagnosis of diverticulitis, to patients with PKD and diverticulitis who did not have a renal transplant. Fisher’s exact test was used to compare categorical variables.
Results: Forty-one patients with PKD treated for diverticulitis were identified. Mean age was 60 (± 12), and 56% were female. Thirteen patients had undergone renal transplant. All transplanted patients had functioning allografts at the time of evaluation for diverticulitis (mean GFR 62). Mean GFR for non-transplant patients who were not on hemodialysis was 40. Three patients were on hemodialysis. Twenty-one percent of non-transplant patients had complicated diverticulitis, compared to 38% of transplanted patients (p=0.28). Fifty-four percent of patients in each group had recurrent diverticulitis either with a history of prior episodes reported by the patient, in health records from referring institutions, or with multiple episodes treated at our institution (p=1.0). There was one in-hospital death in each group. Thirty-two percent of non-transplant patients underwent operation, compared to 46% of transplanted patients (p=0.49). One patient in the non-transplant group underwent Hartmann procedure, and 8 underwent sigmoid resection with primary anastomosis without diversion. In the transplanted group, 2 patients underwent Hartmann procedure, one underwent sigmoid resection with diversion, and 3 underwent sigmoid resection with undiverted primary anastomosis.
Conclusion: In our group of patients, there is no statistically significant difference in rate of recurrent diverticulitis, complications from diverticulitis, or operative intervention in patients with PKD status-post renal transplant compared to those with PKD and no transplant.
