Impact of panniculectomy on transplant candidacy of obese patients with chronic kidney disease declined for kidney transplantation because of a high-risk abdominal panniculus: A pilot study

Abstract

Background. Obese patients can develop a large lower abdominal panniculus (worsened by significant weight loss). Patients with advanced chronic kidney disease (CKD) affected by this obesity-related sequela are not infrequently declined for kidney transplantation because of the high risk for serious woundhealing complications. We hypothesized that pretransplant panniculectomy in these patients would (1) render them transplant candidates, and (2) result in low posttransplant wound-complication rates. Methods. In a pilot study, adult patients with CKD who had a high-risk panniculus as the only absolute contraindication to kidney transplantation subsequently were referred to a plastic surgeon to undergo a panniculectomy in order to become transplant candidates. We analyzed the effect of panniculectomy on (1) transplant candidacy and (2) wait list and transplant outcomes (04/2008-06/2014). Results. Overall, 36 patients had panniculectomy (median prior weight loss, 38 kg); all were wait-listed with these outcomes: (1) 22 (62%) patients were transplanted; (2) 7 (19%) remain listed; and (3) 7 (19%) were removed from the wait list. Survival after panniculectomy was greater for those transplanted versus not transplanted (at 5 years, 95% vs 35%, respectively; P = .002). For the 22 kidney recipients, posttransplant wound-complication rate was 5% (1 minor subcutaneous hematoma). Conclusion. For obese CKD patients with a high-risk abdominal panniculus, panniculectomy was highly effective in obtaining access to the transplant wait list and successful kidney transplantation. This approach is particularly pertinent for CKD patients because they are disproportionally affected by the obesity epidemic and because obese CKD patients already face multiple other barriers to transplantation. (Surgery 2015;

Panniculectomy at the time of living donor renal transplantation: An 8-year experience

“…9 Although the combined operation has a consequence of a single larger incision versus a re-incision through scarred subcutaneous tissues, we report wound infection rates that were not higher than those published for panniculectomy, without simultaneous transplantation. Our study demonstrates that combining these procedures did not increase The staged approach for panniculectomy and renal transplantation has been suggested in order to prevent theoretical wound-related risks of a larger operation combined with induction immunosuppression at the time of transplantation.…”

“…17,18 This is important because at the time of transplantation, kidney transplant recipients receive very high dose induction immunosuppression, which places them at high risk The staged approach for panniculectomy and renal transplantation has been suggested in order to prevent theoretical wound-related risks of a larger operation combined with induction immunosuppression at the time of transplantation. 9 Although the combined operation has a consequence of a single larger incision versus a re-incision through scarred subcutaneous tissues, we report wound infection rates that were not higher than those published for panniculectomy, without simultaneous transplantation. It is widely accepted that panniculectomies are often accompanied by a high complication rate; however, patients still achieve high satisfaction.…”

“…[8][9][10][20][21][22][23][24][25][26] In a study of patients with a history of solid organ transplant, Zellner et al 27 reported a 14% wound complication rate following plastic surgery procedures. [8][9][10][20][21][22][23][24][25][26] In a study of patients with a history of solid organ transplant, Zellner et al 27 reported a 14% wound complication rate following plastic surgery procedures.…”

“…[8][9][10] This is the first description in the literature of concurrent living donor renal transplantation and panniculectomy (LRT-PAN), and we sought to describe our experience with this unique approach to transplantation in the obese and postobese populations. [8][9][10] This is the first description in the literature of concurrent living donor renal transplantation and panniculectomy (LRT-PAN), and we sought to describe our experience with this unique approach to transplantation in the obese and postobese populations.…”

“…Additionally, obese patients, or patients with a focal pannus, on the deceased donor list may undergo prophylactic panniculectomy. [8][9][10] This is the first description in the literature of concurrent living donor renal transplantation and panniculectomy (LRT-PAN), and we sought to describe our experience with this unique approach to transplantation in the obese and postobese populations. We found that all patients had successful kidney transplants as well as acceptable wound complication and aesthetic outcomes.…”