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. 2019 Mar 26:24:168-173.
doi: 10.12659/AOT.914134.

Clinical Characteristics of Acute Appendicitis in Kidney Transplant Recipients

So Hyun Kwon  1   2 , Sung Hyun Park  1   2 , Hwa Young Lee  1   2 , Eun Jeong Ko  1   2 , Tae Hyun Ban  1   2 , Byung Ha Chung  1   2 , Chul Woo Yang  1   2   3
Affiliations

Clinical Characteristics of Acute Appendicitis in Kidney Transplant Recipients

So Hyun Kwon et al. Ann Transplant. .

Abstract

BACKGROUND Clinical characteristics of acute appendicitis in kidney transplant recipients may be different from those in the general population due to kidney transplant recipient's immunosuppressive state and position change of appendix caused by graft. MATERIAL AND METHODS Clinical characteristics of 10 cases of acute appendicitis among 2880 cases of kidney transplantation were evaluated, including diagnostic rate, location of appendix and complication in kidney transplant recipients. RESULTS Acute appendicitis was suspected in 9 of 10 patients (90%) with acute appendicitis based on clinical and laboratory findings. Five patients (50%) presented with typical migrating pain and 1 patient (10%) had only periumbilical pain. Leukocytosis (WBC >10 000) was present in 8 patients (80%). Radiologic study revealed various locations of appendix relative to grafted kidney. Computed tomography scan was superior to ultrasonography in diagnosis of acute appendicitis. The complication rate was 50%. Complicated patients showed longer duration from symptoms onset to operation (69±48 hours versus. 25±6 hours, P<0.05) and hospital stay (15.4±15 days versus 5.4±1.8 days, P<0.05) than uncomplicated patients. CONCLUSIONS Clinical suspicion and differential diagnosis are needed for kidney transplantation patients with acute appendicitis. Early diagnosis with radiologic study is essential to reduce complications of acute appendicitis.

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Figures

Figure 1
Figure 1
Location of the appendix relative to graft kidney. The appendix located in upper-side of graft kidney (A, B: yellow arrow), medial-side of graft kidney (C: yellow arrow), or posterior-lateral side of graft kidney (D: black arrow).
Figure 2
Figure 2
Distribution of anatomical location of appendix. Distribution of anatomical location of appendix relative to cecum (A) and relative to graft kidney (B).
Figure 3
Figure 3
Comparison between complicated group and uncomplicated group. Comparison of mean duration between complicated and uncomplicated groups. Pre-hospital time (A) and in-hospital time (B) had higher tendency in the complicated group. There were significant differences in overall time (C), and hospital stay (D), between the 2 groups. P-values were calculated using Mann-Whitney U test and * P<0.05 was considered statistically significant.
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References

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