Colorectal perforation in renal transplant recipients

Of 525 patients who received 585 renal transplants, seven developed colonic perforations from 6 to 27 days post-transplantation. Six were undergoing antirejection therapy at the time of perforation. Prompt diagnosis was made and colonic resection carried out immediately under broad spectrum antibiotic coverage. Primary gastrointestinal reconstruction was performed in one instance and colonic exclusion in the others. One patient died from the insult; three are alive eight to 42 months after perforation; and three succumbed to late unrelated problems at two, three, and 24 months. Early diagnosis, immediate thorough debridement of the peritoneal cavity, and colonic exclusion carry the best prognosis.