Background Hernia formation is common following abdominal operations and transplant patients are at increased risk due to their need for postoperative immunosuppression. The purpose of this study is to estimate the incidence of incisional hernia formation following primary abdominal solid organ transplantation and identify clinical risk factors for hernia formation. Methods We performed a single-institution retrospective review of a prospectively collected database to evaluate all patients who underwent primary liver, kidney, or pancreas transplantation between 2000 and 2011. The primary outcome measure was hernia formation at the transplant incision. Univariate and multivariate Cox proportional hazards models were used to identify risk factors for incisional hernia formation. Results 3460 transplants were performed during the study period: 2247 kidney only, 718 liver only, and 495 pancreas or simultaneous pancreas and kidney (pancreas group). The overall incisional hernia rate was 7.5%. The Kaplan-Meier rates of hernia formation at 1, 5, and 10 years were 2.5%, 4.9%, and 7.0% for kidney; 4.5%, 13.6%, and 19.0% for liver; and 2.5%, 12.7%, and 21.8% for the pancreas groups. On univariate analysis, surgical site infection (SSI), body mass index (BMI) >25, delayed graft function (DGF), and absence of a calcineurin inhibitor or mycophenolic acid (MMF) were associated with hernia formation in the kidney group. SSI and BMI>25 were associated with hernia formation in the liver group. In the pancreas group, SSI, the use of cyclosporine, and lack of MMF were all associated with hernia formation. On multivariate analysis, SSI was strongly associated with hernia formation in all groups (Hazard Ratio (HR): Kidney = 24.71, p<0.001; Liver = 12.0, p<0.001, Pancreas = 12.95, p=0.001). Conclusion Incisional hernias are common following abdominal organ transplant with nearly one in five patients developing an incisional hernia five years after liver of pancreas transplantation. Strategies focusing on prevention and early treatment of SSI may help to decrease the risk of incisional hernia formation following abdominal organ transplantation.

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Structured Abstract Background The utilization of thyroidectomy for Graves’ disease remains controversial; we aim to evaluate the indications for and complications of thyroidectomy for Graves’ in children. Methods A retrospective analysis was performed on all Graves’ patients who underwent thyroidectomy from 2009–2013 at a high volume academic center. Pediatric patients were < 18 years old, and a comparative analysis of indications for surgery and complications was performed. Results 167 patients underwent thyroidectomy: 31 pediatric patients and 136 adults. Failure of antithyroid medications was the indication for surgery in 55% of the children vs 36% of adults (p=0.05). Mean duration of medications prior to surgery was similar. No children had failed RAI therapy prior to surgery, but 12.5% of the adult population had (p=0.04). Surgical outcomes were similar. Conclusion Clinicians may be more likely to refer children who fail medical treatment to surgery over RAI. Thyroidectomy at a high volume hospital should be discussed as a treatment option for children with Graves’.

Objective: To describe the implementation and results of a proactive patient outreach project to offer selfadministered, depot medroxyprogesterone (DMPA) subcutaneous (SC) to interested patients at a California safety-net clinic following expanded state Medicaid coverage. Study design: We contacted non-pregnant patients at an urban, safety-net hospital-based primary care clinic who had been prescribed DMPA intramuscular (IM) in the past year to gauge interest in selfadministered DMPA-SC. Interested patients received a prescription for DMPA-SC and a telehealth appointment with a clinic provider to learn self-injection. We recorded patient interest in DMPA-SC, completed appointments, and completed first injections. We conducted initial outreach in May, 2020 and recorded appointment attendance and completed injections through August, 2020. Results: Of 90 eligible patients (age 17-54), we successfully contacted and discussed DMPA-SC with 70 (78%). Twenty-six (37%) patients expressed interest in DMPA-SC and scheduled telehealth appointments to learn to self-administer the medication. Fifteen (58%) of those interested (21% of the total) successfully self-injected DMPA-SC. Of the 44 (63%) patients not interested in DMPA-SC, the three most common reasons were fear of self-injection (n = 23 [52%]), wanting to stop DMPA (n = 11 [25%]), and satisfaction with DMPA-IM (n = 6 [14%]). Conclusion: There is interest in and successful initiation of self-administered DMPA-SC among patients at an urban safety net hospital-based primary care clinic who have used DMPA-IM in the last year. Implications: Our data provide evidence for the interest and successful first injection rate after offering self-administered DMPA-SC to patients on DMPA-IM. Expanding coverage of self-administered DMPA-SC could increase patient-centeredness and accessibility of contraception as well as reduce patient anxiety around COVID-19 transmission without losing contraceptive access.

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