Abstract
Background: Contrasting results have emerged from limited studies investigating the role of prophylactic surgical drainage in preventing wound morbidity after liver and kidney transplantation. This retrospective study analyzes the use of surgical drain and the incidence of wound complications in combined liver and kidney transplantation (CLKTx).Methods: A total of 55 patients aged ≥18 years were divided into two groups: the drain group (D) (n = 35) and the drain-free group (DF) (n = 20). Discretion to place a drain was based exclusively on surgeon preference. All deceased donor kidneys were connected to the LifePort Renal Preservation Machine® prior to transplantation, in both simultaneous and delayed technique of implantation of the renal allograft. The primary outcome was the development of superficial/deep wound complications during the study follow-up. Secondary outcomes included the development of delayed graft function (DGF) of the transplanted kidney, primary non-function (PNF) and early allograft dysfunction (EAD) of the transplanted liver, graft failure, graft and patient survival, overall post-operative morbidity rate and length of hospital stay.Results: With a median follow-up of 14.4 months after transplant, no difference in the incidence of superficial/deep wound complications, except for hematomas, in collections size, intervention rate, PNF, EAD, graft failure and patient survival, was observed between the 2 groups. Significantly lower level of platelets, higher INR values, DGF, morbidity rates and length of hospital stay were reported post-operatively in the D group. Pre-operative hypoalbuminemia and longer CIT were included in the propensity score for receiving a drain and were associated with a significantly higher rate of developing a hematoma post-transplant.Conclusions: Absence of the surgical drain did not appear to adversely affect wound morbidity compared to the prophylactic use of drains in renal transplant patients during CLKTx.
Highlights
Advances in surgical techniques and improvements in immunosuppression protocols have led to an appreciable reduction in post-operative morbidity and graft loss in solid organ transplantation [1, 2]
As far as we are aware, this is the first study to investigate the role of prophylactic drainage after KTx during CLKTx
Fong et al were the first to report that intraoperative drain insertion during elective liver resection did not lead to significant differences in hospital stay, morbidity, and mortality [16], while in a prospective randomized study in patients with chronic liver disease undergoing elective hepatic resection for hepatocarcinoma, prophylactic drainage was associated with increased rates of complications and infections [17]
Summary
Advances in surgical techniques and improvements in immunosuppression protocols have led to an appreciable reduction in post-operative morbidity and graft loss in solid organ transplantation [1, 2]. Diabetes, obesity, smoking history, poor nutritional status, specific immunosuppression protocols and peculiar surgical techniques are widely accepted risk factors for the development of these complications [6, 8, 9]. The peak incidence occurs at 2–6 weeks post-transplant, these complications have been known to develop at 6 months following surgery [8, 11,12,13]. Contrasting results have emerged from limited studies investigating the role of prophylactic surgical drainage in preventing wound morbidity after liver and kidney transplantation. This retrospective study analyzes the use of surgical drain and the incidence of wound complications in combined liver and kidney transplantation (CLKTx)
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