A systematic approach to minimizing wound problems for de novo sirolimus-treated kidney transplant recipients.
BACKGROUND
Wound healing problems and lymphoceles have been reported with greater frequency in kidney recipients given de novo sirolimus. This problem has led to increased patient morbidity and cost; and has been an impediment to the completion of randomized controlled trials in which wound problems have necessitated premature discontinuation of mammalian target of rapamycin inhibitors.


METHODS
We developed a systematic program to reduce these problems based on patient selection (body mass index [BMI] <32 kg/m2), the use of closed suction drains, modifications of surgical technique, and avoidance of a loading dose of sirolimus. Consecutive series of adult kidney-only recipients given antibody induction followed by de novo sirolimus, mycophenolate mofetil, and steroids were compared; group 1: 204 patients transplanted with few restrictions and group 2: 103 patients transplanted using the above program.


RESULTS
This approach resulted in a significant reduction (group 2 vs. group 1) in cumulative wound complications (7.8% vs. 19.6%, P=0.007), and nonoperative wound complications (2.9% vs. 14.2%, P=0.001). In addition, the incidence of lymphoceles detected (22.3% vs. 47.1%, P<0.0001), treated (4.8% vs. 24.5%, P<0.0001), or needing surgical intervention (1.9% vs. 14.2%, P=0.001) was significantly reduced. Multivariate analysis demonstrated that a BMI more than 30 to 32 kg/m2 was the most significant variable related to delayed wound healing (odds ratio [OR] 3.01, 0.02) or surgical repair (OR 8.05, P=0.0001), whereas BMI (OR 1.54, P=0.038) and acute rejections (OR 1.34, P=0.03) were most associated with lymphocele treatment.


CONCLUSIONS
A systematic program of wound care using de novo sirolimus can produce wound healing complications comparable with that reported with other agents.
Tiong
Ho Yee
HY
The Transplant Center/Glickman Kidney and Urological Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Flechner
Stuart M
SM
Zhou
Lingme
L
Wee
Alvin
A
Mastroianni
Barbara
B
Savas
Kathy
K
Goldfarb
David
D
Derweesh
Ithaar
I
Modlin
Charles
C
D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008210:Lymphocele / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016017:Odds Ratio; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000009:adverse effects*; D013256:Steroids / Q000627:therapeutic use; D013396:Suction; D014945:Wound Healing / Q000187:drug effects*; D055815:Young Adult
D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid; D020123:Sirolimus