Targeting risk factors for impaired wound healing and wound complications after kidney transplantation.
BACKGROUND
Because of potent immunosuppression, impaired wound healing and complications are frequent features after kidney transplantation (KTx).


OBJECTIVE
To investigate the incidence and nature of impaired wound healing and complications at a single transplantation center in Norway.


METHODS
Of 226 patients who underwent KTx, 199 (87%) were followed up prospectively for 1 year (2005) via close and meticulous wound inspection.


RESULTS
The study revealed a high rate of wound complications (200-250/y) in a high-volume center. Fifty-four patients (27%) experienced prolonged wound healing, defined as gaps, secretions, or wound complications, at 3 to 5 weeks posttransplantation, and 41 patients (21%) had impaired wound healing, defined as gaps, secretions, or wound complications after 5 weeks posttransplantation. In total, 50 patients (25%) required surgical or radiologic reintervention. Complications included lymphocele in 29 patients (14.6%), wound dehiscence in 16 (8.0%), bleeding or hematoma in 10 (5.0%), and infection in 9 (4.5%). Risk factors associated with wound complications included recipient older than 60 years, body mass index greater than 30, hemoglobin concentration less than 10 g/dL, albumin concentration less than 36 g/dL, duration of surgery more than 200 minutes, no subcutaneous sutures, and sirolimus or everolimus therapy. At nominal and logistic regression analysis, recipient older than 60 years, body mass index greater than 30, and no subcutaneous sutures were independent risk factors.


CONCLUSIONS
Risk factor analysis and previous documentation suggest that wound complications might be counteracted using the following measures: subcutaneous sutures, predialysis transplantation, sealing or ligation of lymphatic trunks, prophylactic fenestration, reduction of corticosteroid load, and avoiding sirolimus/everolimus therapy.
Røine
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Department of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway.
Bjørk
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Oyen
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D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000379:methods; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000276:immunology; D006435:Renal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D014945:Wound Healing / Q000502:physiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000276:immunology
D007166:Immunosuppressive Agents