Analysis of risk factors for impaired wound healing after kidney transplantation

Increased Risk of Postoperative Complications in Organ Transplant Recipients Undergoing Mohs Micrographic Surgery

BACKGROUND

Solid organ transplant recipients (SOTRs) are at increased risk of developing nonmelanoma skin cancers (NMSC), which may require treatment by Mohs micrographic surgery (MMS). Previous small-scale studies yielded conflicting findings on post-MMS complications in immunosuppressed individuals, and large-scale population-based analyses for SOTRs undergoing MMS are lacking.

OBJECTIVE

The authors investigate postoperative complications after MMS in SOTRs using the TriNetX database of over 106 million patients in the US Collaborative Network.

MATERIALS AND METHODS

Among MMS recipients in this database, a cohort of organ transplant recipients and a cohort of immunocompetent patients were generated. Immunosuppressive medications other than antirejection medications for the SOTR cohort were excluded from both groups. The outcomes for common postoperative complications including infection, wound disruption, graft failure, bleeding, rash, disturbance of skin sensation, and hypertrophic scarring were assessed during a 60-day postoperative window.

RESULTS

SOTRs exhibit a twofold increased risk of postoperative infection, 2.5-fold increased risk of surgical wound disruption, and over threefold increased likelihood of swelling within 60 days post-MMS compared with immunocompetent patients. There was no significant difference in bleeding between the cohorts.

CONCLUSION

Given these findings, it may be worth assessing the role of antibiotics and close monitoring for the SOTR population in larger prospective studies to inform future surgical guidelines.

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

Renal transplantation is common worldwide, with >25,000 procedures performed in 2022. Usage of prophylactic perinephric drains is variable in renal transplantation; drains are associated with risks, and there is a lack of consensus regarding benefit of routine drain placement in these patients. This meta-analysis assessed whether prophylactic drainage reduced need for reintervention postoperatively. This systematic review and meta-analysis was carried out using the Preferred Reporting Items in Systematic Reviews and Meta-Analysis, and prospectively registered on PROSPERO. 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). A systematic literature search in June 2023 revealed 1,540 unique articles across four databases. Of these, four retrospective cohort studies were selected. Meta-analysis of three studies showed no significant reduction in reintervention rate with pre-emptive 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 prophylactic drain insertion 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. Further work is needed, including well-designed, prospective studies to assess the risks and benefits of drain placement in these patients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023422685, Identifier PROSPERO CRD42021255795.

Exploration of wound-related complications post-kidney transplantation

An essential intervention for patients with end-stage renal disease is kidney transplantation. Nonetheless, patient outcomes are substantially affected by complications associated with postoperative wounds. The purpose of this research was to determine the prevalence, risk factors and repercussions of wound-related complications among kidney transplant recipients. A cross-sectional observational study was undertaken at Qilu Hospital of Shandong University Department of Organ Transplantation, China. Included in the study were 118 patients who had undergone kidney transplantation during the specified time period. Medical record evaluations, questionnaires and patient interviews were utilized to collect data, with an emphasis on demographics, transplant information, postoperative care and wound complications. Infection, dehiscence, lymphocoele, delayed wound healing, seroma formation and haematoma were classified as complications. The presence of comorbidities, age over 50 and living donor transplants were identified as significant risk factors for postoperative complications. The most prevalent complications observed were delayed wound healing (21.2%) and infections (16.9%) (p < 0.05). Antibiotics were found to be effective in managing infections, while prolonged conservative management was necessary for delayed wound healing. Prominent complications that recurred were infections and wound healing delays. No statistically significant correlation was observed between gender, BMI and prior transplants with the occurrence of complications (p > 0.05). The research highlighted the significance of taking into account patient-specific variables, including age and concurrent medical conditions, when conducting post-kidney transplantation treatment. The results supported the use of individualized strategies in postoperative care, particularly for populations at high risk, in order to reduce the incidence and severity of complications associated with wounds in pursuit to enhancing clinical practices and formulating focused intervention strategies to improve patient outcomes following transplantation.