Chronic Inguinal Pain After Kidney Transplantation, a Common and Underexposed Problem

Abstract

BackgroundThe incidence and impact of chronic inguinal pain after kidney transplantation is not clearly established. A high incidence of pain after inguinal hernia repair, a comparable surgical procedure, suggests an underexposed problem.MethodsBetween 2011 and 2013, 403 consecutive patients who underwent kidney transplantation were invited to complete the Caroline Comfort Scale (CCS) and Visual Analog Scale (VAS) in order to assess the incidence of chronic inguinal pain and movement disabilities, complemented by questions regarding comorbidity during follow-up.ResultsThe response rate was 58 % (n = 199) with a median follow-up of 22 months (IQR 12–30). In total, 90 patients (45 %) reported a CCS > 0 and 64 patients (32 %) experienced at least mild but bothersome complaints. Most inguinal complaints were reported during bending over and walking with a mean CCS score of 1.1 (SD ± 2.2) and 1.2 (SD ± 2.4), respectively. A high body mass index (BMI), delayed graft function, and the need for a second operation were associated with a higher CCS score on univariate analysis. Using multivariate analysis, only BMI (p = 0.02) was considered an independent risk factor for chronic inguinal pain.ConclusionsThe incidence of chronic inguinal pain is a common though underexposed complication after kidney transplantation. More awareness to prevent neuropathic pain seems indicated.

Perioperative antithrombotic therapy does not increase the incidence of early postoperative thromboembolic complications and bleeding in kidney transplantation – a retrospective study

“…No subcutaneous heparin was given to recipients intraoperatively. KTx was performed according to local protocol and published before . Multiple artery reconstruction was performed in either an end‐to‐end or end‐to‐side fashion in both centers.…”

“…Kidney transplantation was performed with either a living or deceased donor kidney (donation after brain death (DBD) or circulatory death (DCD)). According to the protocol within EuroTransplant, DBD donors received 20 000 IU of heparin prior to systemic [19,20]. Multiple artery reconstruction was performed in either an end-to-end or end-to-side fashion in both centers.…”

Chronic pain after hand-assisted laparoscopic donor nephrectomy

“…The questionnaire consisted of the modified Carolinas Comfort Scale (CCS) ( Appendix S1 , supporting information), a visual analogue scale (VAS) with scores ranging from 0 to 100 on a 100‐mm scale, and questions regarding the medical history and use of analgesics. The CCS was originally validated for pain assessment after inguinal hernia repair with use of a mesh, and was modified in a previous study on chronic pain in kidney recipients.…”

Aggravation of fibrin deposition and microthrombus formation within the graft during kidney transplantation

“…DCD donors or living kidney donors were not given any form of antithrombotic prophylaxis. The transplant procedure was performed according to local protocol which was published in detail before [6]. Per protocol preemptively transplanted recipients, in contrast to dialysis-dependent recipients, were given 5000 IU of unfractionated heparin prior to reperfusion.…”