BACKGROUND: Transplant patients with acute diverticulitis require more frequently an operation because immunosuppresion can mask initial symptoms, delaying treatment and leading to perforation. Our goal is to report the incidence, management, and outcomes of acute diverticulitis in solid organ recipients in our institution. METHODS: We retrospectively reviewed records of all patients undergoing solid organ transplants (kidney, pancreas, heart, liver, and lung) and who developed acute diverticulitis. RESULTS: Between 1965 and September 2012, 4,155 solid organ transplants were performed at the Massachusetts General Hospital. We found that 121 patients developed at least one episode of acute diverticulitis. The median follow-up post transplant was 15.5 years. Severity of diverticulitis was grouped by Hinchey’s classification (grade I: 55%, grade 2: 12.6%, grade 3/4: 7%, not available: 21%). 73.6% of patients was treated surgically (after first episode 78.6%, second 8.9%, third 5.6%, and fourth 1.1%). The median time between transplant and first episode of diverticulitis post transplant was 46.07 months. The incidence was significantly higher in lung and heart transplant patients (fig.1). Overall patient survival post-transplant was 86% in 30 years, and median survival time was 8.7 years. Mortality was not directly associated with complications of diverticulitis and happened between 333 and 9574 days post-transplant. 26.4% of patients with diverticulitis had conservative treatment, 73.6% surgical treatment. Recurrence rate of those initially treated conservatively was 15.7%. From patients that received surgical treatment sigmoidectomy with colostomy was the most common operation (88.7%). The incidence of reoperation for complications was 16.9%. CONCLUSIONS: The incidence of acute diverticulitis is higher in lung and heart transplant recipients probably because of higher immunosuppression. Compared to the literature, the immunocompromised patient with acute diverticulitis requires more frequently an operation. The operation of choice in our center is resection and colostomy after the first episode.

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