The spectrum of peritonitis in renal transplant recipients

Peritonitis in immunosuppressed renal transplant recipients continues to be associated with a high mortality. Twenty-four patients with intraperitoneal infections were identified in 542 consecutive renal transplant recipients over a period of 15 years (4.4%). Sixteen of the 24 (66.6%) died as a result of these infections. Transplant wound sepsis and the complications and surgery of gastrointestinal diseases accounted for the majority of instances. During the period 1980-1983 only four cases occurred with no episodes being due to wound complications. Symptoms and signs were vague and nonspecific, and in three patients the diagnosis was made only at autopsy. Surgery aimed to eliminate the septic focus with the drainage of abscesses and the avoidance of large bowel anastomoses. In 22 patients, a polymicrobial flora was obtained from the contaminated peritoneal cavity, with an average of 2.25 organisms per patient. These data suggest that the prohibitive mortality of peritonitis in renal transplant recipients may be lowered by prophylactic gastrointestinal surgery prior to transplantation, as well as by measures designed to lower the incidence of transplant wound sepsis. Peritoneal lavage, computed tomography, and laparotomy in the face of an undiagnosed source for sepsis may be warranted in these high-risk patients.