Outcomes of Colorectal Resections in Renal Transplant Patients: A Systematic Review and Meta-Analysis

BackgroundRenal transplant recipients are an increasingly encountered patient cohort due to improving long-term survival. They are also a vulnerable and often comorbid population with unique challenges presented by immunosuppression regimens. Colorectal resections are a critical intervention for a wide range of pathologies, and outcomes of the same in this cohort are poorly consolidated. The primary objective of this systematic review and meta-analysis is to comprehensively evaluate outcomes of colorectal resections in renal transplant recipients, with a specific focus on survival following surgery, alongside other morbidity and stoma related complications.MethodsOur search was conducted in line with the most recent Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. An electronic search was conducted of the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases up to August 2024.ResultsIn total, 11388 renal transplant recipients were included in this review, across 13 studies. Of these, 4,121 patients underwent a colorectal resection, the most common indications for resection were malignancy and diverticulitis, with an overall pooled mortality rate of 8% (95% CI: 3 to 15%). The pooled stoma formation rate was 62% (95% CI: 38 to 83%) and the pooled stoma reversal rate was 31% (95% CI: 22 to 40%). Sepsis/intra-abdominal infection and ST elevation myocardial infarction (STEMI) were the most common causes of morbidity/mortality within 90 days.ConclusionsThe morbidity and mortality considerations regarding renal transplant patients undergoing colorectal resections are significant. The management of these patients requires early involvement of multidisciplinary teams to consider optimization of underlying comorbidities, alteration of immunosuppressive regimens and addressing any postoperative complications that are unique to this cohort of patients.