AimThe safety of nonoperative treatment for patients with transplanted kidneys who develop acute diverticulitis is unclear. Our primary aim was to examine the long‐term sequelae of nonoperative management in this group.MethodWe performed a population‐based retrospective cohort study using linked administrative databases housed at ICES in Ontario, Canada. We included adult (≥18 years) patients admitted with acute diverticulitis between April 2002 and December 2019. Patients with a functioning kidney transplant were compared with those without a transplant. The primary outcome was failure of conservative management (operation, drainage procedure or death due to acute diverticulitis) beyond 30 days. The cumulative incidence function and a Fine–Grey subdistribution hazard model were used to evaluate this outcome accounting for competing risks.ResultsWe examined 165 patients with transplanted kidneys and 74 095 without. Patients with transplanted kidneys were managed conservatively 81% of the time at the index event versus 86% in nontransplant patients. Short‐term outcomes were comparable, but cumulative failure of conservative management at 5 years occurred in 5.6% (95% CI 2.3%–11.1%) of patients with transplanted kidneys versus 2.1% (95% CI 2.0%–2.3%) in those without. Readmission for acute diverticulitis was also higher in transplanted patients at 5 years at 16.7% (95% CI 10.1%–24.7%) versus 11.6% (95% CI 11.3%–11.9%). Adjusted analyses showed increased failure of conservative management [subdistribution hazard ratio (sHR) 3.24, 95% CI 1.69–6.22] and readmissions (sHR 1.55, 95% CI 1.02–2.36) for patients with transplanted kidneys.ConclusionMost patients with transplanted kidneys are managed conservatively for acute diverticulitis. Although long‐term readmission and failure of conservative management is higher for this group than the nontransplant population, serious outcomes are infrequent, substantiating the safety of this approach.

中文翻译：

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移植肾患者急性憩室炎的短期和长期结局

目的 对于发生急性憩室炎的移植肾患者，非手术治疗的安全性尚不清楚。我们的主要目的是检查该组非手术治疗的长期后遗症。方法我们使用位于加拿大安大略省 ICES 的链接管理数据库进行了一项基于人群的回顾性队列研究。我们纳入了 2002 年 4 月至 2019 年 12 月期间因急性憩室炎入院的成年（≥18 岁）患者。将进行功能性肾移植的患者与未进行移植的患者进行比较。主要结局是保守治疗（手术、引流手术或因急性憩室炎死亡）超过 30 天失败。累积发生率函数和 Fine-Grey 次分布风险模型用于评估这一结果，考虑到竞争风险。结果我们检查了 165 名接受移植肾的患者和 74 095 名未移植肾的患者。肾移植患者在指数事件中接受保守治疗的比例为 81%，而非移植患者的这一比例为 86%。短期结果具有可比性，但肾移植患者中 5.6%（95% CI 2.3%–11.1%）发生保守治疗累积失败的比例为 2.1%（95% CI 2.0%–2.3%）没有。移植患者 5 年时因急性憩室炎再入院的比例也较高，分别为 16.7% (95% CI 10.1%–24.7%) 和 11.6% (95% CI 11.3%–11.9%)。调整后的分析显示，肾移植患者的保守治疗失败率 [亚分布风险比 (sHR) 3.24，95% CI 1.69–6.22] 和再入院率 (sHR 1.55，95% CI 1.02–2.36) 有所增加。结论 大多数肾移植患者得到了管理对于急性憩室炎，保守治疗。尽管该人群的长期再入院和保守治疗失败的情况高于非移植人群，但严重后果并不常见，这证实了这种方法的安全性。