title: Risk factors of severe incisional hernia after renal transplantation: a retrospective multicentric case-control study on 225 patients.
abstract: OBJECTIVE
  The aim of this study was to analyze the incidence of severe incisional hernias and find their specific risk factors in renal transplant patients.
  
  
  METHODS
  This retrospective multicentric case-control study focused on 225 kidney transplant patients among 4348 patients transplanted during this period within two French university hospitals (Saint-Louis/Lariboisière in Paris and Tours, Loire Valley) from 2000 to 2014 and from 1995 to 2014, respectively. Forty-five patients developed a severe incisional hernia after renal transplantation. The primary outcome measure was the development of a severe incisional hernia after surgery. Statistical analysis included an univariate analysis and a multivariate analysis using a logistic regression according to the Cox model.
  
  
  RESULTS
  Forty-five patients (1.03%) had a severe incisional hernia surgery after renal transplantation. The median follow-up was 55.5 months. In univariate analysis, smoking, the occurrence of a lymphocele and parietal closure in a single musculo-fascial layer was significantly associated with the occurrence of incisional hernia after renal transplantation. Former or active smoking (OR 2.32, p = 0.0370), lymphocele (OR 4.3903, p = 0.0018) and parietal musculo-fascial closure in one single layer (OR 3.37, p = 0.0088) significantly increased the risk of incisional hernia after kidney transplant in multivariate analysis.
  
  
  CONCLUSIONS
  We report in this study one of the largest series of patients who had incisional hernia after renal transplantation. Former or active smoking, lymphocele and parietal closure in one single musculo-fascial layer were independent risk factors for incisional hernia following kidney transplant.
authors.affiliation: Department of Urology and Renal Transplantation, Saint-Louis/Lariboisière University Hospital, Paris, France. etienne.broggi@aphp.fr.
authors.forename: E
authors.initials: E
authors.lastname: Broggi
authors.affiliation: Department of Urology and Renal Transplantation, Tours University Hospital, Loire Valley, France.
authors.forename: F
authors.initials: F
authors.lastname: Bruyère
authors.affiliation: Department of Urology and Renal Transplantation, Saint-Louis/Lariboisière University Hospital, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Gaudez
authors.affiliation: Department of Urology and Renal Transplantation, Saint-Louis/Lariboisière University Hospital, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Desgrandchamps
mesh_terms: D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D000069290:Incisional Hernia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008210:Lymphocele / Q000453:epidemiology; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D013997:Time Factors; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000706:statistics & numerical data
keywords: Incisional hernia; Kidney transplant; Renal transplantation; Risk factors