J Korean Soc Transplant.  2009 Dec;23(3):233-236. 10.4285/jkstn.2009.23.3.233.

Clinical Characteristics of Acute Appendicitis in Kidney Transplant Recipients

• Lee HH
• Lee JJ
• Ju MK
• Kim MS
• Huh KH
• Yoon ES
• Joo DJ
• Kim SJ
• Kim SI
• Kim YS

• KMID: 1819845
• DOI: http://doi.org/10.4285/jkstn.2009.23.3.233

Abstract

BACKGROUND
Appendicitis is a common surgical disease. There are many problems for the early diagnosis of acute appendicitis in kidney transplant patients; differential diagnosis for acute rejection, limitation in imaging study, problems of immunosuppressant and non-characteristic symptoms.
METHODS
We reviewed medical records and transplant database of 2,947 renal transplant patients between April, 1979 and September, 2009 retrospectively. Patient's characteristics, diagnostic methods for appendicitis and operative/postoperative progresses were analyzed.
RESULTS
Of the 2,947 renal transplant patients, there were 15 (0.51%, 13 males and 2 females) acute appendicitis patients. Mean age at the diagnosis of appendicitis was 37.2+/-10.1 years. Fourteen (93.3%) patients suffered from prodromal symptom, such as abdominal pain, direct or rebound tenderness, nausea and vomiting. There were 12 (80%) patients with leukocytosis (WBC count >10,000/microliter). Computed tomography scans were performed in 5 (33.4%) patients for diagnosis. Laparoscopic appendectomies were applied for 8 (53.4%) patients. In pathologic diagnosis, 2 cases were reported as 'non pathologic diagnosis' complications occurred in 2 patients as remnant appendicitis and pancreatitis. However, there was no patient with mortality and renal failure during the hospitalization.
CONCLUSIONS
There were no significant differences between the transplant patients and the general population in the incidence, clinical features, diagnosis and postoperative progresses of acute appendicitis.

Keyword

Acute appendicitis; Kidney transplantation; Acute abdomen

MeSH Terms

Abdomen, Acute
Abdominal Pain
Appendectomy
Appendicitis
Diagnosis, Differential
Early Diagnosis
Hospitalization
Humans
Incidence
Kidney
Kidney Transplantation
Leukocytosis
Male
Medical Records
Nausea
Pancreatitis
Prodromal Symptoms
Rejection (Psychology)
Renal Insufficiency
Retrospective Studies
Transplants
Vomiting

Reference

1). Wright FH Jr, Abu-Yousef MM, Smith JL, Georgi B, Corry RJ. Appendicitis in a transplant patient. Transplantation. 1988; 45:1159.

2). Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006; 333:530–4.

3). Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epi-demiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132:910–25.

4). Hegde S, Moghal NE, Coulthard MG. Acute appendicitis occurring immediately post-renal transplant. Pediatr Transplant. 2006; 10:119–20.

5). Talwalkar NC, Javali D, Venkatesh K, Iyer S, Venkatesh M, Joshi UB. Acute appendicitis mistaken as acute rejection in renal transplant recipients. J Postgrad Med. 1994; 40:39–40.

6). Lao A, Bach D. Colonic complications in renal transplant recipients. Dis Colon Rectum. 1988; 31:130–3.

7). Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008; 77:971–8.

8). Archibald SD, Jirsch DW, Bear RA. Gastrointestinal complications of renal transplantation. 2. The colon. Can Med Assoc J. 1978; 119:1301–5. 1309.

9). Bardaxoglou E, Maddern G, Ruso L, Siriser F, Campion JP, Poqamp P, et al. Gastrointestinal surgical emergencies following kidney transplantation. Transpl Int. 1993; 6:148–52.

10). Flanigan RC, Reckard CR, Lucas BA. Colonic complications of renal transplantation. J Urol. 1988; 139:503–6.

11). Larner AJ. The aetiology of appendicitis. Br J Hosp Med. 1988; 39:540–2.

12). Chan MK, Wilcox DT, Trompeter RS. Acute appendicitis in children after renal transplantation. Arch Dis Child. 1999; 81:372.

13). Rao PM, Boland GW. Imaging of acute right lower abdominal quadrant pain. Clin Radiol. 1998; 53:639–49.

14). Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006; 202:401–6.

15). Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2004; 18:CD001546.

16). Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR. Mortality after appendectomy in Sweden, 1987-1996. Ann Surg. 2001; 233:455–60.