Evidence to support a drain-free strategy in kidney transplantation using a retrospective comparison of 500 consecutively transplanted cases at a single center

Ahmed Farag,Giuseppe Serena,Gaetano Ciancio,Jeffrey J. Gaynor

doi:10.1186/s12893-021-01081-x

Abstract

IntroductionRoutine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value.ObjectivesTo determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors.MethodsRetrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. did (Drain, D) receive a drain at the time of transplant was performed. The primary outcome was the development of any wound complication (superficial or deep) during the first 12 months post-transplant. Secondary outcomes included the development of superficial wound complications, deep wound complications, DGF, and graft loss during the first 12 months post-transplant.Results388 and 112 recipients had DF/D, respectively. DF-recipients were significantly more likely to be younger, not have pre-transplant diabetes, receive a living donor kidney, receive a kidney-alone transplant, have a shorter duration of dialysis, shorter mean cold-ischemia-time, and greater pre-transplant use of anticoagulants/antiplatelets. Wound complications were 4.6% (18/388) vs. 5.4% (6/112) in DF vs. D groups, respectively (P = 0.75). Superficial wound complications were observed in 0.8% (3/388) vs. 0.0% (0/112) in DF vs. D groups, respectively (P = 0.35). Deep wound complications were observed in 4.1% (16/388) vs. 5.4% ((6/112) in DF vs. D groups, respectively (P = 0.57). Higher recipient body mass index and ≥ 1 year of pre-transplant dialysis were associated in multivariable analysis with an increased incidence of wound complications. Once the prognostic influence of these 2 factors were controlled, there was still no notable effect of drain use (yes/no). The lack of prognostic effect of drain use was similarly observed for the other clinical outcomes.ConclusionsIn a relatively large cohort of renal transplant recipients, routine surgical drain use appears to offer no distinct prognostic advantage.

Highlights

Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value
Renal transplant recipients are at an increased risk for wound complications owing to a number of risk factors associated with slower wound healing [3]
There were significant differences (Table 1) between the groups in mean age (DF < D, P = 0.00005), having pre-transplant diabetes mellitus (DF < D, P = 0.0005), pre-transplant use of anticoagulants or antiplatelets (DF > D, P = 0.001), pre-transplant duration on dialysis (DF < D, P = 0.00006), deceased donor recipient (DF < D, P < 0.000001), mean cold ischemia time (DF < D, P = 0.00001), and kidney transplant combined with other organs (DF < D, P < 0.000001)

Summary

Introduction

Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value. Advances in immunosuppressive protocols and refinements in surgical techniques have been accompanied by decreased morbidity and improved patient and graft survival in renal transplant recipients. Wound complications as a subcategory are the most common type of transplant-associated surgical complications, but their occurrence has not been associated with any decreases in graft or patient survival [2]. Obesity, older age, pre-transplant malnutrition, pre-transplant diabetes mellitus, prolonged pre-transplant dialysis, pre-transplant uremia, the occurrence of delayed graft function (DGF), and post-transplant use of specific immunosuppressive agents such as mTOR inhibitors are transplant-related risk factors that may affect wound healing following renal transplantation, in addition to surgical technique-related risk factors (e.g., extensive dissection, excessive use of electrocautery, and poor hemostasis) [4,5,6,7]. While different immunosuppression protocols may affect the rates of developing wound complications and lymphoceles in renal transplant recipients [8,9,10,11], the surgeon’s experience has been reported to affect the rate of developing wound complications [5]

Objectives

Methods

Results

Conclusion