Colorectal complications of end-stage renal failure and renal transplantation: a review

Abstract

Aim: End-stage renal failure (ESRF) and renal transplant recipients are thought to be associated with an increased risk of colorectal complications. Method: A review of the literature was performed to assess the prevalence and outcome in both benign and malignant colorectal disease. Results: No prospective randomized studies assessing colorectal complications in ESRF or renal transplant were identified. Case series and case reports have described the incidence and management of benign colorectal complications. Complications included diverticulitis, infective colitis, colonic bleeding and colonic perforation. There was insufficient evidence to associate diverticular disease with adult polycystic kidney disease. Three population-based studies have shown up to a twofold increased incidence of colonic cancer but not rectal cancer for renal transplant recipients. Bowel cancer screening (as per the general population) by faecal occult blood testing appears justified for renal transplant patients; however, evidence suggests that consideration of starting screening at a younger age may be worthwhile because of an increased risk of developing colonic cancer. Two population-based studies have shown a threefold and 10-fold increased incidence of anal cancer for renal transplant recipients. A single case-control study demonstrated significant increased prevalence of anal human papillomavirus (HPV) and intraepithelial neoplasia (AIN) in patients with established renal transplants. Conclusions: Despite the lack of high-level evidence, ESRF and renal transplantation were associated with colorectal complications that could result in major morbidity and mortality. Bowel cancer screening in this patient group appears justified. The effectiveness of screening for HPV, AIN and anal cancer in renal transplant recipients remains unclear.