442 Prophylactic Peri-Nephric Drain Placement in Renal Transplant Surgery: A Systematic Review and Meta-Analysis

Abstract

Abstract Aim Usage of prophylactic perinephric drains is variable in renal transplantation, drains are associated with risks, and there is a lack of consensus as to the relative benefit of placing a drain intraoperatively in this patient cohort. This meta-analysis assessed whether prophylactic perinephric drainage reduced the need for postoperative intervention to manage collections. Method This systematic review and meta-analysis was performed using the Preferred Reporting Items in Systematic Reviews and Meta-Analysis and was prospectively registered on PROSPERO (CRD42021255795). A literature search was carried out in June 2023, and titles and s was screened against our pre-defined criteria. Quality assessment was performed using the Newcastle Ottawa Scale. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval (CI) of 95% and are presented as Forest Plots for Odds Ratio (OR). Results Literature search revealed 1540 unique titles and s across all four databases. Of these, 4 retrospective cohort studies were selected. Meta-analysis of 3 studies showed no evidence of a significant reduction in reintervention rate with drain placement, OR=0.59 (95%CI: 0.16-2.23, p=0.44). Meta-analysis did not show a significant reduction in perinephric collections with drainage OR=0.55 (95%CI: 0.13-2.37, p=0.42). Finally, there is not good evidence that drain placement reduces superficial wound complications or improves 12-month graft survival. Conclusions Given the lack of current evidence basis supporting the practice of prophylactic perinephric drain placement in renal transplantation, we advocate for a drain-free strategy in this patient cohort. Well-designed, prospective studies to assess the risks and benefits of intraoperative drain placement in these patients is needed.