Treating acute diverticulitis in pre- and post-solid-organ transplant patients: a single-institution cohort study

Surgical outcomes of colorectal cancer surgery in transplant recipients: A matched case-control study

AIM

The incidence of colorectal carcinoma (CRC) in transplant (TX) recipients is higher than in the general population. Registry data indicate inferior oncological outcomes for this population. While the general surgical risk is increased in TX recipients, the risk associated with elective CRC surgery in this population is not well investigated.

METHODS

TX recipients, who underwent elective surgical treatment for CRC at our specialized centre from 2008 to 2024 were included in this case-control study. The controls were randomly selected from our CRC database and matched according to tumour location and Charlson Comorbidity Index. Outcomes assessed included intensive care unit stay, in-hospital mortality, length of hospital stay and major morbidity (defined as Clavien-Dindo Grade ≥3).

RESULTS

The study included 24 TX recipients. Ten patients had had either liver or kidney TX, three patients had undergone lung TX and one patient heart TX. The mean time interval between transplantation surgery and CRC was 8.82 years. Morbidity was significantly higher in the TX group (54.2% vs. 8.3%, P = 0.001; OR 13.0, 95% CI 2.5-68,1, P = 0.002) and length of hospital stay was significantly longer (25 vs. 9 days, P = 0.001; OR 9.09, 95% CI 1.4-16.7, P = 0.022) for TX patients. No significant differences in mortality and intensive care unit stay were observed.

CONCLUSIONS

The risk of surgery for CRC in TX patients is significantly increased. Treatment decisions should involve TX experts to develop a tailored and considered treatment plan.

Diverticulitis Management in Complex Medical Contexts

Diverticulitis is a prevalent medical issue, particularly among elderly individuals in the Western world. Management is nuanced and is influenced by both disease presentation and patient factors, especially those that affect risk of septic and surgical complications. This paper reviews existing literature to explore the incidence, presentation, and management of diverticulitis in complex medical contexts—immunocompromised populations, specifically highlighting those undergoing chemotherapy, HIV/AIDS patients, transplant recipients, and individuals with autoimmune and connective tissue diseases. Not surprisingly, management of diverticulitis in these complex patient populations is associated with increased morbidity. However, even taking into consideration the risk of septic and surgical complications, more recent data and treatment recommendations suggest that both nonoperative and operative management strategies may be appropriate based on individual patient presentations, mirroring the treatment paradigm of immunocompetent patients. In addition, in discussing operative management of complex medical patients, immunosuppression alone should not be considered a contraindication to primary anastomosis. Overall, there are limited existing data on diverticulitis in immunocompromised populations and, especially, patients with autoimmune and connective tissue disorders. Further research is warranted to better understand the impact of these chronic diseases on diverticulitis severity and to best inform evidence-based practices in this complex clinical scenario.