Abstracts
1998 Digestive Disease Week

#996

RENAL TRANSPLANT PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE ARE AT INCREASED RISK FOR COMPLICATED DIVERTICULAR DISEASE OF THE COLON. NN Armstrong, AM D'Alessandro, JS Odorico, M Kalayoglu, HW Sollinger, SJ Knechtle. University of Wisconsin Hospital and Clinics, Madison, WI.

Introduction: Renal transplantation (RT) is commonly employed as treatment for patients with end-stage renal disease (ESRD) secondary to autosomal dominant polycystic kidney disease (ADPKD). Patients with ADPKD are known to be at increased risk for many extrarenal manifestations of their disease, such as coronary artery and valvular disease, intracranial aneurysms, polycystic liver disease, inguinal hernias, and diverticulosis. Pretransplant colectomy has been advocated by some in effort to avoid complications of diverticular disease of the colon (DDC) following renal transplant.

Methods: A retrospective chart review was performed on 185 patients that had undergone RT for ADPKD at our institution over the last 15 years, in relation to the incidence and outcome of complicated DDC. The control group consisted of a review of 2259 patients that had undergone RT for other etiologies of ESRD during the same time period. Both cohorts consisted of cadaveric, living-related, and living-unrelated RTs.

Results: In this series, we identified 17 patients (9%) that had undergone RT for ADPKD and had complicated DDC, including diverticulitis (n=12), diverticular perforation (n=2), or diverticular bleed (n=3). This number was significantly greater than the incidence of complicated DDC seen in the control population (0.7%, p<0.05). Surgical resection was required in 7 patients (41%), while non-operative management was successful in 10 patients (59%). There were no deaths related to diverticular disease in this study group.

Conclusions: In this study, we have demonstrated that there is a significantly increased incidence of complicated diverticular disease of the colon in ADPKD renal transplant patients as compared to patients undergoing transplant for other reasons. The management of renal transplant patients with ADPKD who have complicated diverticular disease is not different from that of the general population. Therefore, we do not recommend pretransplant colectomy in this group of patients.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.