Teamwork Makes the Dream Work: Maximizing Surgical Intervention at the Time of Living Donor Renal Transplantation

Baglien, Brigit; Ngaage, Ledibabari M.; Elegbede, Adekunle; Gebran, Selim; Nam, Arthur J.; Niederhaus, Silke V.; Scalea, Joseph R.; Bromberg, Jonathan S.; Bartlett, Stephen T.; Rasko, Yvonne M.

doi:10.1016/j.transproceed.2020.01.027

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…Nine articles were ultimately included (Figure 1). Three articles pertained to panniculectomy performed simultaneously to renal transplantation 13–15 . The remaining six studies focused on panniculectomy in ESRD patients prior to transplantation 8,9,16–19 .…”

Section: Resultsmentioning

confidence: 99%

“…However, when performed concomitant to renal transplantation, worse outcomes were reported. [13][14][15] Analysis of the ACS-NSQIP cohort of panniculectomy patients revealed several factors predictive of increased complications. Specifically, we focused on patients with diabetes, hypertension requiring medication, and patients on dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Though ESRD and RT patients are at higher surgical risk, panniculectomy surgery did not demonstrate an increase in complications when compared to panniculectomy performed in obese patients without advanced chronic kidney disease. However, when performed concomitant to renal transplantation, worse outcomes were reported 13–15 …”

Section: Discussionmentioning

confidence: 99%

“…In eight articles, authors described performing the transverse technique, a single surgical incision is performed allowing for horizontal pannus dissection. 9,13,[15][16][17][18][19] One study also employed the Fleur-de-Lis technique in which both horizontal and vertical incisions are carried, increasing the possible amount of skin ressected. 14 Surgical drains were routinely placed in all but one study.…”

Section: Systematic Reviewmentioning

confidence: 99%

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Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

Laspro,

Stead,

Barrow

et al. 2024

Clinical Transplantation

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BackgroundAs the obesity crisis in the United States continues, some renal transplantation centers have liberalized their BMI criteria necessary for transplant eligibility. More individuals with larger body‐habitus related comorbidities with End‐Stage Renal Disease (ESRD) now qualify for renal transplantation (RT). Surgical modalities from other fields also interact with this patient population.MethodsIn order to assess surgical outcomes of panniculectomy in the context of renal transplantation and ESRD, the authors performed a systematic review following the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) 2020 guidelines. Due to a paucity of existing primary studies, we retrospectively collected data on patients with ESRD undergoing panniculectomy from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) to evaluate outcomes of body contouring in this patient population.ResultsFrom the systematic review, a total of 783 ESRD patients underwent panniculectomy among the studies identified. Of these, 91 patients underwent panniculectomy simultaneously to RT while 692 had their pannus resected prior to kidney transplant. The most common complication was hematoma followed by wound dehiscence. From the NSQIP database, 24 868 patients met the inclusion criteria for analysis. In the setting of renal transplant status, patients with diabetes, hypertension requiring medication, and requiring dialysis were more likely to suffer postoperative complications (OR 1.31, 1.15, and 2.2, respectively). However, upon sub‐analysis of specific types of complications, the only retained association was between diabetes and wound complication.ConclusionPreliminary data show that panniculectomy in ESRD patients appears to be safe, though with a nominal increased risk for complications. Pannus resection does not appear to impact post‐transplantation outcomes, including long‐term allograft survival. Larger, higher powered, randomized studies are needed to confirm the safety, utility, and medical benefit of panniculectomy in the context of renal transplantation.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

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Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

Laspro,

Stead,

Barrow

et al. 2024

Clinical Transplantation

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“…There are studies available considering a simultaneous approach. However, Baglien et al [33] describe a wound complication rate of 46.2% and a reoperation rate of 30.8% and Ngaage et al [34] even depict a graft-related complication in almost 25%.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

et al. 2021

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Background: Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. Methods: A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. Results: The median body mass index was 35.2 kg/m2 (range 28.5–53.0 kg/m2) at first transplant-assessment versus 31.0 kg/m2 (range 28.0–34.4 kg/m2) at panniculectomy, and 31.6 kg/m2 (range 30.3–32.4 kg/m2) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. Conclusion: Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.

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Teamwork Makes the Dream Work: Maximizing Surgical Intervention at the Time of Living Donor Renal Transplantation

Cited by 4 publications

References 14 publications

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

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