Surgical site complications in kidney transplant recipients: incidence, risk factors and outcomes in the modern era

Abstract

Background: Surgical site complications (SSCs) are an important source of morbidity after kidney transplantation. We assessed the incidence, risk factors, outcomes and economic impact of SSCs in a large, diverse population of kidney transplant recipients. Methods: We conducted a single-centre, observational cohort study of adult (age ≥ 18 yr) patients who underwent kidney transplantation between Jan. 1, 2005, and Dec. 31, 2015, with a minimum of 1 year of follow-up. Cases of SSC, including infections and wound dehiscence, were determined from patient records. Inpatient and outpatient hospital costs were determined 6 and 12 months after transplantation. We used the Kaplan–Meier product-limit method to determine the cumulative probability of SSCs and other outcomes. We evaluated risk factors and clinical outcomes using Cox proportional hazard ratios. Linear regression models were used to study the effect of SSCs on graft function. Results: The incidence rate of SSCs within 30 days after transplantation was 4.19 per 100 person-months. The cumulative probability of developing an SSC within 30 days after transplantation was 4.13% (95% confidence interval [CI] 3.23%–5.28%). Increased recipient body mass index (BMI) (hazard ratio [HR] 1.07, 95% CI 1.02–1.11), longer cold ischemic time (HR 1.05, 95% CI 1.01–1.09) and transplantation in 2010–2012 versus 2005–2009 (HR 2.20, 95% CI 1.19–4.04) were risk factors for SSC development. In multivariable stepwise Cox proportional hazard models, SSC was a significant risk factor for death-censored graft failure (HR 3.08, 95% CI 1.60–5.90) and total graft failure (HR 2.09, 95% CI 1.32–3.32). Cumulative median hospital costs were $2238.46 greater for patients with an SSC than for those without. Conclusion: Increased BMI, longer cold ischemic time and the 2010–2012 transplantation period predisposed to SSCs. The development of SSCs was associated with a higher risk of graft failure. Strategies to minimize SSCs may improve outcomes after kidney transplantation and reduce costs.

Factores de riesgo para el desarrollo de complicaciones de la herida quirúrgica en el trasplante renal

“…Las complicaciones de la HQ son un problema frecuente en nuestro centro según detallan nuestros datos. La dehiscencia y la infección de la herida quirúrgica aparecen en un 15,9% y un 13,5% respectivamente, de los pacientes sometidos a un TR en nuestro centro, datos semejantes a otras series publicadas [1][2][3][4]12 Pese a las prácticas impulsadas para el control de la infección en el TR, como la profilaxis antibiótica, la infección de la HQ sigue siendo un problema frecuente en el postoperatorio del TR 11 . Ante la falta de recomendaciones estrictas sobre un patrón adecuado para dicha profilaxis antibiótica, cada centro debería personalizar el protocolo a su entorno microbiológico con el fin de evitar patrones de resistencia y colonizaciones asociadas.…”

“…El trasplante renal (TR) sigue siendo en la actualidad, el tratamiento de preferencia para los pacientes con Enfermedad Renal Crónica Terminal (ERCT), ya que ofrece mayor supervivencia y calidad de vida que las técnicas dialíticas 1,2 .…”

Potential utility of urinary chemokine CCL2 to creatinine ratio in prognosis of 5‐year graft failure and mortality post 1‐year protocol biopsy in kidney transplant recipients

“…Many risk factors of kidney graft failure are determined: those linked to the donor, to surgical procedures and to recipients 27,28 . Antibody‐mediated rejection is recognized as the major cause of renal allograft failure 29 .…”

“…26 Many risk factors of kidney graft failure are determined: those linked to the donor, to surgical procedures and to recipients. 27,28 Antibody-mediated rejection is recognized as the major cause of renal allograft failure. 29 Early identification of the risk factors of graft failure or mortality could influence clinical decisions and be crucial in maintaining stable graft function and in prolonging patient survival.…”

Wound related complications and the anterior rectus sheath versus Gibson approach to kidney transplantation: A single center randomized controlled trial

“…Kidney transplant recipients are at increased risk of wound-related complications (WRC) due to underlying conditions such as obesity and diabetes. [1][2][3][4][5] Given the increasing age of and co-morbidity status of kidney transplant recipients, rising annual rates of kidney transplantation, and the association between WRC and poorer graft survival, it is paramount to minimize the incidence of WRC. 2,4,6,7 One method to decrease WRC is via modifications in surgical technique.…”