XXXX following renal transplantation.

@entity1 @entity8 @entity500 @entity229 @entity532 @entity177 @entity205 @entity292 @entity4436 @entity516 @entity694 @entity298
PURPOSE: @entity694 in renal transplant recipients have historically been associated with mortality rates as high as 50 to 100 percent. However, these previous series generally predate the use of @entity205 -based immunosuppressive protocols. METHODS: We retrospectively reviewed all @entity1 who had undergone renal transplant from our institution and who developed complicated @entity4436 . @entity532 was defined as @entity4436 involving free perforation, abscess, phlegmon, or @entity292 . Factors analyzed included the time interval since transplantation, use of @entity205 , living-related vs. cadaveric donor, cause of @entity177 , and presenting signs and symptoms. RESULTS: Between August 1969 and September 1996, 1,211 kidney transplants were performed in 1,137 @entity1 . The first 388 @entity1 (1969-1984) received @entity229 and @entity500 , with @entity205 added to the immunosuppressive regimen for the subsequent 823 recipients (1984-1996). Thirteen (1.1 percent) @entity1 had episodes of complicated @entity4436 , occurring from 25 days to 14 years after transplant; all required surgical therapy. Clinical presentation was highly variable, ranging from asymptomatic @entity516 (2 @entity1 ) to generalized @entity298 . There was one perioperative mortality (7.7 percent). @entity1 with @entity8 as the cause of @entity177 had a significantly higher rate of complicated @entity4436 . Specifically, @entity1 with @entity8 (9 percent of the total transplant population) accounted for 46 percent of the cases of @entity4436 (P < 0.001, Fisher's exact probability test). Neither treatment with @entity205 nor donor source had a significant effect on the rate of diverticular complications (P = 0.36 and P = 0.99, respectively, Fisher's exact probability test). CONCLUSION: @entity532 following renal transplantation is rare, and the clinical presentation may be atypical in the immunosuppressed transplant recipient. @entity1 with @entity8 experience a significantly higher rate of complicated @entity4436 than do other transplant @entity1 and, therefore, warrant aggressive diagnostic evaluation of even vague abdominal symptoms. In addition, pretransplant screening and prophylactic sigmoid resection in this high-risk population deserve consideration and further study.
