[Immunosuppression and surgical complications after renal transplantation].
OBJECTIVE
The new immunosuppressive regimens in kidney transplantation have diminished the rate of acute rejection and improved graft survival. However, the use of new agents results in the development of surgical complications. The authors analyze the incidence of such complications accordingly to the type of drug.


METHODS
This study included 350 kidney transplantations performed between January 1997 and December 2004. The average age was 54 years. The incidence of diabetes mellitus was 8.5% and the rate of obese recipients (BMI >30 kg/m2) was 15.4%. The average follow-up rate was 44 +/- 5.6 months (5-96). A surgical complication was defined as any complication directly related to the surgical transplant that occurs along the first year after transplantation.


RESULTS
The incidence of surgical complications was 34.8% (122/350). The rates of perigraft collections and bleeding posttransplant were significantly higher in the CsA group than in the Tacro one: 12% vs. 3.8% (p = 0.005) and 11.5% vs. 3% (p = 0.002). The Sirolimus and Everolimus-based immunosuppresive regimens led to a higher incidence of lymphocele (16% vs. 3.7%) (p = 0.012). There were no significant difference in the incidence of surgical complications in recipients immunosuppressed with and without MMF, and in diabetic vs. no diabetic patients. Surgical complications were higher in obese patients (66.5% vs. 33.5%) (p = 0.002).


CONCLUSIONS
Recipients receiving Sirolimus/Everolimus demonstrated a significantly higher lymphocele rate. The CsA regimens were associated with bleeding and post transplant pararenal fluid collections. The introduction of MMF did not result in a significant increase in posttransplant surgical complications. The obesity was a risk factor associated with those complications.
Quicios Dorado
Cristina
C
Servicio de Urología y Servicio Nefrología, Hospital Ramón y Cajal, Madrid, España. cquicios@yahoo.es
Burgos Revilla
Francisco Javier
FJ
Pascual Santos
Julio
J
Marcén Letosa
Roberto
R
Gómez García
Ignacio
I
García Navas
Ricardo
R
de Castro Guerín
Cristina
C
D000328:Adult; D000368:Aged; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology
D007166:Immunosuppressive Agents