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Introduction
Major abdominal procedures in transplant recipients are considered high-risk. The aim of this study is to evaluate the safety of colorectal resection in solid organ transplant recipients.
Methods
Solid organ transplant recipients who underwent elective and urgent colorectal procedures from 1994-2010 were identified from prospectively maintained databases. Demographics, indications, surgical procedures, graft survival and perioperative outcomes were assessed.
Results
Out of 7937 consecutive patients undergoing transplant since 1975, 90 patients who underwent colorectal resection after heart (23), lung (17), kidney (29) and liver (21) transplant (63 men, 27 women, mean age: 57±10 years) were identified. The most frequent indication for surgery was diverticulitis (58%) followed by cancer (25%) and IBD (15%). The mean interval time from transplantation to surgery was 6.3 years (ranges between 1 week and 33 years). Elective procedures were performed in 46 patients (sigmoidectomy in 17, right colectomy in 11, subtotal colectomy in 9, proctectomy in 8) and urgent procedures were performed in 44 (Hartmann’s procedure in 29, sigmoidectomy in 9 and right colectomy in 2). Only 22 patients (24%) underwent primary anastomosis without diverting ileostomy. Six patients (7%) were left with a permanent stoma. When compared to elective surgeries, urgent procedures had significantly increased post-operative mortality (18% vs. 0%, p=0.002), longer length of stay (16.5±13 vs. 8.5±5 days, p<0.001) and non-significantly higher overall morbidity (40% vs. 28%, p=0.27). Kidney transplant recipients were the only group without any postoperative deaths (p=0.05). All patients except one (kidney) retained their graft function.
Conclusions:
Elective colorectal procedures in transplant recipients are safe and often associated with proximal diversion. Urgent surgery is associated with substantial mortality except in kidney transplant recipients.
Short term (30 days) outcomes

	Elective	Urgent	P
Number	46	44
Age	59.5±10	54.3 ± 10	0.01
Mortality	0	8 (18%)	0.002
Length of stay	8.5±5	16.5±13	<0.001
overall morbidity	13 (28%)	17 (40%)	0.3
Leakage	2 (4%)	1 (2%)	0.6
Wound infection	4 (8%)	3 (6%)	0.7
Abscess	2 (4%)	2 (4%)	1
DVT	2 (4%)	3 (6%)	1