Targeting Risk Factors for Impaired Wound Healing and Wound Complications After Kidney Transplantation

doi:10.1016/j.transproceed.2010.05.162

Transplantation Proceedings

Volume 42, Issue 7, September 2010, Pages 2542-2546

https://doi.org/10.1016/j.transproceed.2010.05.162 Get rights and content

Abstract

Background

Because of potent immunosuppression, impaired wound healing and complications are frequent features after kidney transplantation (KTx).

Objective

To investigate the incidence and nature of impaired wound healing and complications at a single transplantation center in Norway.

Patients

Of 226 patients who underwent KTx, 199 (87%) were followed up prospectively for 1 year (2005) via close and meticulous wound inspection.

Results

The study revealed a high rate of wound complications (200–250/y) in a high-volume center. Fifty-four patients (27%) experienced prolonged wound healing, defined as gaps, secretions, or wound complications, at 3 to 5 weeks posttransplantation, and 41 patients (21%) had impaired wound healing, defined as gaps, secretions, or wound complications after 5 weeks posttransplantation. In total, 50 patients (25%) required surgical or radiologic reintervention. Complications included lymphocele in 29 patients (14.6%), wound dehiscence in 16 (8.0%), bleeding or hematoma in 10 (5.0%), and infection in 9 (4.5%). Risk factors associated with wound complications included recipient older than 60 years, body mass index greater than 30, hemoglobin concentration less than 10 g/dL, albumin concentration less than 36 g/dL, duration of surgery more than 200 minutes, no subcutaneous sutures, and sirolimus or everolimus therapy. At nominal and logistic regression analysis, recipient older than 60 years, body mass index greater than 30, and no subcutaneous sutures were independent risk factors.

Conclusion

Risk factor analysis and previous documentation suggest that wound complications might be counteracted using the following measures: subcutaneous sutures, predialysis transplantation, sealing or ligation of lymphatic trunks, prophylactic fenestration, reduction of corticosteroid load, and avoiding sirolimus/everolimus therapy.

Section snippets

Patients

From a cohort of 226 adult (>18 years) Norwegian patients who underwent kidney transplantation during 2005, 199 (87%) were included in the study. Those who underwent simultaneous kidney-pancreas or kidney-liver transplantation were excluded. After discharge from the transplantation-surgical department, recipients were followed up prospectively. Wound inspection and patient interviews were conducted 1 to 3 times per week until the wound was fully healed, which was defined as presence of no gaps

Results

Baseline characteristics of the 199 study patients including pretransplantation risk factors are given in Table 1. Only 51.8 % of wounds were fully healed at 3 weeks posttransplantation, and at 5 weeks, 20.6 % still were considered unhealed (Table 2). The Pearson χ² test revealed statistically significant associations between secretions and lymphocele (P < .00) and between secretions and wound dehiscence (P < .00) (data not shown).

Bacteriologic analysis of secretions revealed primarily skin

Discussion

The primary findings in the present study was the high rate of impaired wound healing (21% at 5 weeks posttransplantation) and the high rate of reinterventions (25%). The threshold for considering a wound unhealed was low: no secretion or diastases. The immunosuppression therapy must be considered a major offender, accounting for the distinctly elevated level of complications and reinterventions, compared with similar procedures in the nonimmunosuppressed population. Most complications were due

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There are more references available in the full text version of this article.

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Incisional hernias (IH) constitute a complication after kidney transplant (KT). Patients may be particularly at risk because of comorbidities and immunosuppression. The study aim was to assess the incidence, risk factors, and treatment of IH in patients undergoing KT.
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Citation Excerpt :
More recently, introduction of more potent antiproliferative drugs in particular mycophenolate mofetil and sirolimus or everolimus have accentuated the incidence of wound complications. Several studies highlight deleterious effect of sirolimus [30–32]. Given the large number of different immunospressive combinations used in our population, this parameter could not be studied.
Obesity prevalence has increased over the past 20 years in the general population and among kidney transplant recipients. General surgical belief is that obesity increases surgical difficulty. The aim of this study was to assess the impact of Body Mass Index (BMI) on perioperative complications.
All kidney transplantations performed in adults in our centre from 2006 to 2011 were analysed. Data on patients’ characteristics, surgical protocol, intra and postoperative complications and renal function were collected. Patients were divided into 4 groups as follows: underweight (BMI < 18.5 kg/m²), normal weight (18.5 kg/m² ≤ BMI < 25 kg/m²), overweight (25 kg/m² ≤ BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²). We also studied the impact of BMI on complications using it as a continuous variable to identify potential threshold values.
Among 694 patients included, 52% had normal BMI, 7%, 31% and 9% were underweight, overweight and obese, respectively. In multivariate analysis, overweight was significantly associated with longer operative time compared to normal-weight patients (estimated mean difference of 10,4 min, 95% confidence interval (CI) [4.0; 16.9]) and obesity was associated with an increased risk of wound dehiscence (odds ratio 3.1, 95% CI [1.3; 7.3] compared with normal-weight patients). Considering BMI as a continuous variable, the risk of parietal dehiscence significantly increased beyond a BMI of 26 kg/m², intraoperative blood loss and the risk of ureteral stenosis beyond 32 kg/m² and the risk of abdominal wall hematoma beyond a BMI of 34 kg/m².
We found BMI thresholds above which intraoperative blood loss and the risk of parietal dehiscence, ureteral stenosis, and parietal hematoma significantly increased.
3.
La prévalence de l’obésité n’a cessé d’augmenter ces 20 dernières années dans la population générale et parmi les patients receveurs de transplants rénaux. Dans l’esprit chirurgical, l’obésité est associée à une augmentation des difficultés chirurgicales. L’objectif de cette étude était d’évaluer l’impact de l’IMC sur les complications périopératoires.
Toutes les transplantations rénales réalisées chez l’adulte dans notre centre de 2006 à 2011 ont été analysées. Les données concernant les caractéristiques des patients, la procédure chirurgicale, les complications per- et postopératoires ainsi que la fonction rénale ont été collectées. Les patients on été repartis en 4 groupes : sous-poids (BMI < 18,5 kg/m²), poids normal (18,5 kg/m² ≤ BMI < 25 kg/m²), surpoids (25 kg/m² ≤ BMI < 30 kg/m²) et obésité (BMI ≥ 30 kg/m²). Nous avons également étudié l’impact de l’IMC sur les complications en tant que variable continue afin d’identifier de potentielles valeurs seuils.
Parmi 694 patients inclus, 52 % avait un IMC normal, 7 %, 31 % et 9 % étaient respectivement en sous-poids, surpoids et obèses. En analyse multivariée, le surpoids était associé à une augmentation de la durée opératoire comparé au patients de poids normal (différence moyenne estimée à 10,4 min, 95 % intervalle de confiance (IC) [4,0 ; 16,9]) et l’obésité était associée à une augmentation du risque d’éventration (odds ratio 3,1, 95 %CI [1,3 ; 7,3] comparé aux patients de poids normal). En considérant l’IMC en tant que variable continue le risque d’éventration augmentait significativement au-delà d’un IMC à 26 kg/m², de pertes sanguines et de sténose urétérale au-delà d’un IMC à 32 kg/m² et d’hématome de paroi au-delà d’un IMC à 34 kg/m².
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3.
Relation Between Wound Complication and Lymphocele After Kidney Transplantation: A Monocentric Study
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Wound complication frequently arises after kidney transplantation and its risk factors are well known. In a previous paper we analyzed these factors, and in this new retrospective study we evaluate the influence of lymphocele in the development of wound complications.
From January 2000 to December 2018, 731 consecutive kidney transplants have been performed in our center. We have analyzed the incidence of wound complication and lymphocele and their risk factors.
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Abstract

Background

Objective

Patients

Results

Conclusion

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Discussion

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