title: A systematic approach to minimizing wound problems for de novo sirolimus-treated kidney transplant recipients.
abstract: 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.
authors.affiliation: The Transplant Center/Glickman Kidney and Urological Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Ho Yee
authors.initials: HY
authors.lastname: Tiong
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Flechner
authors.forename: Lingme
authors.initials: L
authors.lastname: Zhou
authors.forename: Alvin
authors.initials: A
authors.lastname: Wee
authors.forename: Barbara
authors.initials: B
authors.lastname: Mastroianni
authors.forename: Kathy
authors.initials: K
authors.lastname: Savas
authors.forename: David
authors.initials: D
authors.lastname: Goldfarb
authors.forename: Ithaar
authors.initials: I
authors.lastname: Derweesh
authors.forename: Charles
authors.initials: C
authors.lastname: Modlin
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid; D020123:Sirolimus