OGILVIE'S SYNDROME POST RENAL TRANSPLANT AND ITS ASSOCIATION WITH DELAYED GRAFT FUNCTION OR PRIMARY NON-FUNCTIONING GRAFT

Abstract

316 Ogilvie's syndrome (acute colonic pseudo-obstruction), a known complication of retroperitoneal surgery, is a potentially serious condition that may lead to severe life threatening complications (e.g. colonic perforation or necrosis) if unrecognized. Here we report the first retrospective study showing an association between delayed graft function (DGF) or primary graft non-function (PGNF) post renal transplant and Ogilvie's syndrome (OS). Methods: All renal transplant patients with intra-abdominal complications were reviewed. Cases of acute colonic pseudo-obstruction were identified. Presence or absence of immediate renal function, cause of renal dysfunction, age, amount of narcotic analgesics and presence of retroperitoneal collections were noted. DGF was defined as lack of >15% spontaneous drop in serum creatinine by day 3 ± need for dialysis in the first week post transplant. PGNF was due to hyperacute rejection or vascular complications. Results: Between July 1993- December 1998, 511(350 cadaveric, 161 live donor) renal transplants were performed in adult patients at our institution. 15 patients had OS diagnosed by clinical picture+abdominal series±colonoscopy±contrast colon studies. Only 2 patients with OS had peri-renal fluid collection. Sixty-nine patients had DGF (67 cadaveric, 2 live donor transplant) and 11 patients had PGNF. Of 80 patients with DGF or PGNF, 11 developed OS (13.7%), compared to 4 patients with OS and immediate graft function (4/432, 0.9%) (p=0.0000, χ2 test, odds ratio=17). There was no statistically significant difference in age between patients with or without OS (mean±SD 43±14 vs 41±13 year). Patients with and without OS received equivalent narcotic analgesic in first week post transplant (424±141 mg meperidine HCl and 348±128 mg codeine phosphate vs 484±110 mg meperidine HCl and 467±122 mg codeine phosphate, respectively; differences were not statistically significant). OS was treated conservatively ± rectal tube decompression in 10 cases. Four patients had one or more colonoscopic decompression. Two patients with OS developed colonic perforation and subsequently underwent open surgery; one of them developed septic shock post-operatively and died despite aggressive treatment. Conclusion: OS is associated with DGF and PGNF post-renal transplant. To our knowledge this is the first retrospective study showing this association. Knowledge of this association can lead to early recognition of this potentially serious condition, which in turn might prevent occurrence of further complications.