Are Wound Complications After a Kidney Transplant More Common With Modern Immunosuppression?

Humar, Abhinav; Thiagarajan, Ramcharan; Denny, Roger; Gillingham, Kristen J.; Payne, William D.; Matas, Arthur J.

doi:10.1097/00007890-200112270-00009

Cited by 229 publications

(162 citation statements)

References 13 publications

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“…6,18,44 Çalışmamıza alınan dokuz İH'li hastanın sekizi nakil sonrası dönemde MMF kullanırken, sadece bir hasta İH oluştuktan sonra sirolimus kullandı. İnsizyonel herni oluşma-yan hastalarımızın %85'inde MMF KN sonrası kullanılan standart immünsupresyon tedavisinde yer aldığı için, bu ilacın kullanımının etkili bir risk faktörü olduğunu söylemek literatür bilgileri ile uyuş-mamaktadır.…”

Section: Discussionunclassified

Outcomes of Incisional Hernia Repair Following Liver Transplantation

Ünek¹,

Özbilgin²,

Arslan³

et al. 2012

Turkiye Klinikleri J Med Sci

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346Karaciğer Nakli Sonrası İnsizyonel Herni Onarım Sonuçları Ö ÖZ ZE ET T A Am ma aç ç: : Bu olgu serisinde karaciğer nakli sonrası oluşan insizyonel hernilerde risk faktörleri, onarım şekilleri ve sonuçları sunulmaktadır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Ortotopik karaciğer nakli yapılan 362 hastanın kayıtları retrospektif olarak incelendi. Bu çalışma tanımlayıcı bir çalışma olarak tasarlandı ve herhangi bir istatistiksel yöntem kullanılmadı. Sonuçlar ortalama±standart sapma ve sayı (%) olarak verildi. Çalışmaya karaciğer nakli sonrası en az bir yıl izlenen hastalar alındı. İlk altı ay içinde ölen 57 (%15,7) hasta çalışma dışı bırakıldı. İnsizyonel herni ortaya çıkan dokuz hastanın risk faktörleri, defekt büyüklükleri, kullanılan yamalar ve onarım şekilleri incelendi. B Bu ul lg gu ul la ar r: : Çalışmaya alınan 305 hastanın dokuzunda (%2,9) insizyonel herni saptandı. Bu hastalarda en sık karaciğer nakil endikasyonu kronik hepatit C'ye bağlı sirozdu. Karaciğer nakli sonrası bu dokuz hastanın dördünde (%44,4) komplikasyon (duodenal ülser perforasyonu, hepatik arter anastomozundan kanama, duodenal ülserden kanama ve mekanik bağırsak tıkanıklığı) gelişti. Dokuz hastanın üçüne relaparotomi uygulandı. Defektin en büyük çapının ortalaması 27,9±10,1 (6-40) cm idi. İnsizyonel herni onarımlarında en sık expanded-politetrafluoroetilen yama kullanıldı. Bir hastada oluşan nüks insizyonel herni dışında erken ve geç dönemde komplikasyon ortaya çıkmadı. S So on nu uç ç: : İnsizyonel herni oluşumu için ek risk faktörlerine sahip sirozlu hastalarda, karaciğer nakli sonrasında uygun kapatılma tekniği ve materyalleri kullanılarak insizyonel herni gelişimi azaltılabilir, insizyonel herni gelişen hastalarda ise uygun yamalar ve teknik kullanılarak güvenle onarım yapılabilir.A An na ah ht ta ar r K Ke el li im me el le er r: : Fıtık, abdominal; karaciğer transplantasyonu; immünosupresyon A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : In this case series, the risk factors, types of repair and outcomes for the development of incisional hernias following liver transplantation are presented. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The medical records of 362 patients who underwent orthotopic liver transplantation were analyzed retrospectively. This study was designed as a descriptive study and statistical methods were not used. Results were given as mean ± standard deviation and number (%). Patients who were followed up for at least one year after liver transplantation were included in the study. Fiftyseven (15.7%) patients who died within the first six months were excluded. The risk factors, defect size, meshes used and types of repair were analyzed in nine patients who developed incisional hernia. R Re es su ul lt ts s: : Incisional hernia was detected in nine (2.9%) out of 305 patients included in the study. The most common indication for liver transplantation was cirrhosis due to chronic viral hepatitis C. Complications (duodenal ulcer perforation, bleeding from hepatic artery anastom...

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Section: Discussionunclassified

Outcomes of Incisional Hernia Repair Following Liver Transplantation

Ünek¹,

Özbilgin²,

Arslan³

et al. 2012

Turkiye Klinikleri J Med Sci

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“…Almost all trials have layered "specialised" induction agents on an installation base of bolus methylprednisolone. As with all forms of aggressive immunosuppression, induction therapy using rATGis associated with increased incidences of infectious and malignant complications [23]. The risks of post-transplant lymphoproliferative disease (PTLD) and death ae higher from malignancy when combined with conventional maintenance immunosuppression [24,25].…”

Section: Other Induction Agentsmentioning

confidence: 99%

Low Dose Rabbit Anti-Thymocyte Globulin as an Induction immunosuppression in High-Risk Renal Transplant Recipients

Halawa¹

2017

UNOAJ

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High immunologic risk recipients pose a major challenge in transplantation. It is associated with early acute rejection post-transplantation and leads to decrease patient and graft survival. The need for effective immunosuppression early post-transplantation has resulted in emerging of induction protocols. Biologic agents used for induction are classified to monoclonal and polyclonal which are either depletive or non-depletive antibody therapies. Choosing the best agent and optimal dose remains a controversial issue and depends on many factors including the proper assessment of the immunologic risk, efficacy and safety of the used agent. There is no consensus for the optimal agent used as induction immunosuppression in kidney transplantation. rATG use is associated with decreased incidence of delayed graft function and acute rejection episodes.

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“…Although data specific to the paediatric population are scarce, in adult recipients the incidence of surgical site infection appears to dramatically increase with rising BMI and has been reported to reach 40 % in the very morbidly obese transplant patients [14]. In both paediatric and adult settings, comparatively avascular adipose tissue combined with chronic, pretransplantation uraemia and inflammation impairs wound healing and increases the incidence of wound complications, including a fourfold increased risk of wound infection [15]. Wound complications following renal transplantation are further compounded by the use of certain immunosuppressive drugs, including mammalian target of rapamycin (mTOR) inhibitors, in particular sirolimus, and corticosteroids [16].…”

Section: Surgical Complicationsmentioning

confidence: 99%

Paediatric obesity and renal transplantation: current challenges and solutions

Terrace

Oniscu

2015

Pediatr Nephrol

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The increased incidence of obesity in the paediatric population poses significant challenges to renal transplantation. Whilst the body mass index appears to be widely used as a measure of obesity in adults, there are no standardised definitions in the paediatric population, making comparative analyses difficult. In the paediatric transplant population, obesity is associated with an increased incidence of surgical complications, diabetes, hyperlipidaemia and cardiovascular morbidity, leading to diminished graft function and impacting patient and graft survival. Management of obesity in renal transplantation requires multiple interventions starting with lifestyle and behavioural modification combined with medical and possibly surgical therapies, representing a unique challenge in the childhood setting. In this review we discuss the current challenges of obesity and potential solutions in the setting of paediatric transplantation.

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Are Wound Complications After a Kidney Transplant More Common With Modern Immunosuppression?

Cited by 229 publications

References 13 publications

Outcomes of Incisional Hernia Repair Following Liver Transplantation

Outcomes of Incisional Hernia Repair Following Liver Transplantation

Low Dose Rabbit Anti-Thymocyte Globulin as an Induction immunosuppression in High-Risk Renal Transplant Recipients

Paediatric obesity and renal transplantation: current challenges and solutions

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