Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

Abstract

BackgroundAbdominal wall surgical site complications following renal transplantation can be challenging to manage. A sub-group of these recipients will require operative management or advanced wound care such as negative pressure wound therapy (NPWT). The aim of this study was to determine if there were any preoperative, intraoperative and postoperative characteristics in our recipients’ cohort which were associated with the requirement for such interventions.MethodsA retrospective review of medical records was performed for all recipients who sustained abdominal wall complications following renal transplantation at our centre from 2006 to 2016.ResultsA total of 64/828 recipients (7.7%) had abdominal wall complications. The mean weight for these patients was 84.9 kg (±16.6 kg) and the mean body mass index was 30.2 (±5.1). Forty-five recipients (70%) had a superficial wound dehiscence while nine (14%) had a complete fascial dehiscence. Operative intervention was required in 13/64 patients (20%) and was more likely to be required in the presence of a fascial dehiscence (9/9, 100%) or a wound collection (10/31, 32%) (p < 0.001, p = 0.021). NPWT was used in 17/64 patients (27%) and was more commonly required in patients with diabetes mellitus (10/24, 42%), a complete fascial dehiscence (5/9, 56%) or evidence of infection (16/44, 36%) (p = 0.039, p = 0.034, p = 0.008).ConclusionsThe requirement for either operative management or the use of NPWT in the management of abdominal wall complications following renal transplantation in our experience was more common in recipients with diabetes mellitus, and in the setting of either complete fascial dehiscence, abdominal wall wound collections and/ or infection.

Surgical Site Infections Complicating the Use of Negative Pressure Wound Therapy in Renal Transplant Recipients

“…We report three cases of renal transplant recipients who despite being managed in a standard manner with a NPWT dressing regimen for abdominal wall complications, have then all gone on to either develop recurrent infection and or further episodes of sepsis in the abdominal wall, with at times different organisms being involved. This particular complication has not been previously described in the literature, in the context of NPWT being used to manage a spectrum of abdominal wall surgical site complications in renal transplant recipients [17, 20–22] and including previously in our own unit [23].…”

Abdominal wall complications after kidney transplantation: A clinical review

“…In 70% of patients, superficial wound dehiscence occurred, while nine patients (14%) had complete wound dehiscence involving the fascia, requiring surgical intervention. While there was a trend toward an increased incidence of complete fascial dehiscence in older patients with higher BMI, the only significant factors for complete fascial dehiscence were the presence of documented peripheral vascular disease and the presence of a superficial wound collection 11 . The majority of recipients (40/64, 63%) with abdominal wall complications did not require an operative intervention, while 17 patients were managed with surgical debridement and/or NPWT.…”

No Benefit of Prophylactic Surgical Drainage in Combined Liver and Kidney Transplantation: Our Experience and Review of the Literature

“…Wound infections or dehiscence, incisional hernia, evisceration and fluid collections are the most common types of post-transplant surgical complications and are responsible for significant morbidity, prolonged hospitalization, high rates of hospital readmission, and increased costs (5)(6)(7). Though most of them are managed conservatively, others require interventions such as percutaneous drain insertion, vacuum-assisted closure, and surgery.…”

“…It is common practice to place a surgical drain in the setting of abdominal organ transplantation with the aim to decompress the surgical site, prevent collections and monitor post-operative bleeding, bile or urine leakage ( 4 , 5 , 8 ). However, in most cases, these drains are removed days before the peak incidence of fluid accumulation.…”