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Abstract
Introduction: Surgical complications are a risk for the patient after kidney transplantation, with several possible risk factors involved. Objective: To determine which risk factors contribute to the development of surgical wound complications in renal transplant patients.
Material and Method: Retrospective cohort study in renal transplant patients from January 2018 to December 2021. Sociodemographic and clinical data were collected from the donor and recipient. The incidence of surgical wound infection and dehiscence, and risk factors were analysed.
Results: 13.5% of the patients presented infection and 15.9% dehiscence, being older patients (61.71±9.81 years versus 56.56±11.88 years; p=0.030), with a higher rate of overweight according to BMI (42.9% versus 19.6%; p=0.046) and a higher associated comorbidity (3.07±1.54 versus 2.23±1.38; p=0.003). Of the patients with infection, 53.6% also had superficial wound dehiscence. Exudate appeared in 90.9% of the cases who developed dehiscence compared to 12.1% of the patients who did not suffer such a complication (p<0.001).
Conclusions: Infection and dehiscence are frequent complications after renal transplantation. Age, overweight, high comorbidity and exudate are risk factors for developing surgical wound complications after renal transplantation.
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References
- Wong RBK, Minkovich M, Famure O, Li Y, Lee JY, Selzner M, et al. Surgical site complications in kidney transplant recipients: incidence, risk factors and outcomes in the modern era. Can J Surg 2021;64(6):E669-76. DOI: https://doi.org/10.1503/cjs.015820
- Ostaszewska A, Wszola M, Olszewska N, Karpeta E, Serwanska-Swietek M, Kuthan R, et al. Reoperation in Early Kidney Post-transplant Period as a Strong Risk Factor of Surgical Site Infection Occurrence. Transplant Proc 2019;51(8):2724-30. DOI: https://doi.org/10.1016/j.transproceed.2019.05.018
- Ferraresso M, Berardinelli L. Nosocomial infection in kidney transplant recipients: a retrospective analysis of a single-center experience. Transplant Proc 2005;37(6):2495-6. DOI: https://doi.org/10.1016/j.transproceed.2005.06.029
- Fockens MM, Alberts VP, Bemelman FJ, Van Der Pant KAMI, Idu MM. Wound morbidity after kidney transplant. Prog Transplant 2015;25(1):45-8. DOI: https://doi.org/10.7182/pit2015812
- Harris AD, Fleming B, Bromberg JS, Rock P, Nkonge G, Emerick M, et al. Surgical site infection after renal transplantation. Infect Control Hosp Epidemiol 2015;36(4):417-23. DOI: https://doi.org/10.1017/ice.2014.77
- Abdo-Cuza AA, Gómez-Bravo MA, Pérez-Bernal JB, Suárez-López J, Gómez-Peire F, Leiva-Torres JL, et al. Health Care-Associated Infection in Solid Organ Transplant Recipients. Transplant Proc 2020;52(2):509-11. DOI: https://doi.org/10.1016/j.transproceed.2019.12.010
- Alonso-García M, de-la-Morena JM, de-la-Peña E, Martínez-Hurtado J, Lucas WC, del-Moral-Luque JA, et al. Incidence of surgical wound infection in renal surgery. The effect of antibiotic prophylaxis appropriateness. A prospective cohort study. Actas Urol Esp 2018;42(10):639-44. DOI: https://doi.org/10.1016/j.acuroe.2018.10.004
- Sociedad Española de Medicina Preventiva Salud Pública e Higiene. ESTUDIO EPINE-EPPS no 31: 2021. Prevalencia de infecciones (relacionadas con la asistencia sanitaria y comunitarias) y uso de antimicrobianos en hospitales de agudos. Informe de España. [Internet]. 2021 [consultado 10 Feb 2022]. p. 1-89. Disponible en: https://epine.es/api/documento-publico/2021EPINE Informe España 27122021.pdf/reports-esp
- Organización Nacional de Trasplantes. Balance de actividad donación y trasplante 2021 ONT [Internet]. 2021 [consultado Feb de 2022]. p. 1-42. Disponible en: http://www.ont.es/Documents/Balance de actividad Donación y Trasplante 2021_ONT.pdf.
- Gioco R, Sanfilippo C, Veroux P, Corona D, Privitera F, Brolese A, et al. Abdominal wall complications after kidney transplantation: A clinical review. Clin Transplant 2021;35(12). DOI: https://doi.org/10.1111/ctr.14506
- Warzyszyńska K, Zawistowski M, Karpeta E, Ostaszewska A, Jonas M, Kosieradzki M. Early Postoperative Complications and Outcomes of Kidney Transplantation in Moderately Obese Patients. Transplant Proc 1 octubre 2020;52(8):2318-23. DOI: https://doi.org/10.1016/j.transproceed.2020.02.110
- Alonso Nates R, Menezo Viadero R, Zudaire Arana MT, Cabeza Guerra MV, Arias Ramos N, Las complicaciones de la herida quirúrgica en el trasplante renal. Enferm Nefrol [Internet]. 2005 [consultado 10 Ago 2022];8(1):23-6. Disponible en: https://www.redalyc.org/articulo.oa?id=359833116005. DOI: https://doi.org/10.4321/S1139-13752005000100005
- Peluso G, Incollingo P, Campanile S, Menkulazi M, Scotti A, Tammaro V, et al. Relation Between Wound Complication and Lymphocele After Kidney Transplantation: A Monocentric Study. Transplant Proc 2020;52(5):1562-5. DOI: https://doi.org/10.1016/j.transproceed.2020.02.053
- Martins LS, Malheiro J, Pedroso S, Almeida M, Dias L, Henriques AC, et al. Pancreas-Kidney transplantation: Impact of dialysis modality on the outcome. Transpl Int 2015;28(8):972-9. DOI: https://doi.org/10.1111/tri.12565
- Padillo-Ruiz J, Arjona-Sánchez A, Muñoz-Casares C, Ruiz-Rabelo J, Navarro MD, Regueiro JC. Impact of peritoneal dialysis versus hemodialysis on incidence of intra-abdominal infection after simultaneous pancreas-kidney transplant. World J Surg 2010;34(7):1684-8. DOI: https://doi.org/10.1007/s00268-010-0527-z
- Alonso M, Villanego F, Vigara LA, Aguilera A, Ruíz E, García A, et al. Surgical Wound Dehiscence in Kidney Transplantation: Risk Factors and Impact on Graft Survival. Transplant Proc 2022;54(1):27-31. DOI: https://doi.org/10.1016/j.transproceed.2021.09.066
- Vedove Rosales L, Marrero Fernández M del P, Dorta Hernández A, Álvarez Rodríguez Ó, Martín Fleitas AE. Revisión de los factores de riesgo relacionados con la dehiscencia y/o infección de la herida quirúrgica en el trasplantado renal. En: Libro Comunicaciones Presentadas al XXXIV Congreso Nacional SEDEN. Madrid: Sociedad Española de Enfermería Nefrológica; 2009. p. 191-5.
- Røine E, Bjørk IT, Øyen O. Targeting risk factors for impaired wound healing and wound complications after kidney transplantation. Transplant Proc 2010;42(7):2542-6. DOI: https://doi.org/10.1016/j.transproceed.2010.05.162
- Toon CD, Lusuku C, Ramamoorthy R, Davidson BR, Gurusamy KS. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane database Syst Rev. 2015;2015(9). DOI: https://doi.org/10.1002/14651858.CD010259.pub3
- Lumbers M. Selecting appropriate postoperative dressings to support wound healing and reduce surgical site infection. Br J Nurs. 2018;27(6):S32-5. DOI: https://doi.org/10.12968/bjon.2018.27.6.S32
References
Wong RBK, Minkovich M, Famure O, Li Y, Lee JY, Selzner M, et al. Surgical site complications in kidney transplant recipients: incidence, risk factors and outcomes in the modern era. Can J Surg 2021;64(6):E669-76. DOI: https://doi.org/10.1503/cjs.015820
Ostaszewska A, Wszola M, Olszewska N, Karpeta E, Serwanska-Swietek M, Kuthan R, et al. Reoperation in Early Kidney Post-transplant Period as a Strong Risk Factor of Surgical Site Infection Occurrence. Transplant Proc 2019;51(8):2724-30. DOI: https://doi.org/10.1016/j.transproceed.2019.05.018
Ferraresso M, Berardinelli L. Nosocomial infection in kidney transplant recipients: a retrospective analysis of a single-center experience. Transplant Proc 2005;37(6):2495-6. DOI: https://doi.org/10.1016/j.transproceed.2005.06.029
Fockens MM, Alberts VP, Bemelman FJ, Van Der Pant KAMI, Idu MM. Wound morbidity after kidney transplant. Prog Transplant 2015;25(1):45-8. DOI: https://doi.org/10.7182/pit2015812
Harris AD, Fleming B, Bromberg JS, Rock P, Nkonge G, Emerick M, et al. Surgical site infection after renal transplantation. Infect Control Hosp Epidemiol 2015;36(4):417-23. DOI: https://doi.org/10.1017/ice.2014.77
Abdo-Cuza AA, Gómez-Bravo MA, Pérez-Bernal JB, Suárez-López J, Gómez-Peire F, Leiva-Torres JL, et al. Health Care-Associated Infection in Solid Organ Transplant Recipients. Transplant Proc 2020;52(2):509-11. DOI: https://doi.org/10.1016/j.transproceed.2019.12.010
Alonso-García M, de-la-Morena JM, de-la-Peña E, Martínez-Hurtado J, Lucas WC, del-Moral-Luque JA, et al. Incidence of surgical wound infection in renal surgery. The effect of antibiotic prophylaxis appropriateness. A prospective cohort study. Actas Urol Esp 2018;42(10):639-44. DOI: https://doi.org/10.1016/j.acuroe.2018.10.004
Sociedad Española de Medicina Preventiva Salud Pública e Higiene. ESTUDIO EPINE-EPPS no 31: 2021. Prevalencia de infecciones (relacionadas con la asistencia sanitaria y comunitarias) y uso de antimicrobianos en hospitales de agudos. Informe de España. [Internet]. 2021 [consultado 10 Feb 2022]. p. 1-89. Disponible en: https://epine.es/api/documento-publico/2021EPINE Informe España 27122021.pdf/reports-esp
Organización Nacional de Trasplantes. Balance de actividad donación y trasplante 2021 ONT [Internet]. 2021 [consultado Feb de 2022]. p. 1-42. Disponible en: http://www.ont.es/Documents/Balance de actividad Donación y Trasplante 2021_ONT.pdf.
Gioco R, Sanfilippo C, Veroux P, Corona D, Privitera F, Brolese A, et al. Abdominal wall complications after kidney transplantation: A clinical review. Clin Transplant 2021;35(12). DOI: https://doi.org/10.1111/ctr.14506
Warzyszyńska K, Zawistowski M, Karpeta E, Ostaszewska A, Jonas M, Kosieradzki M. Early Postoperative Complications and Outcomes of Kidney Transplantation in Moderately Obese Patients. Transplant Proc 1 octubre 2020;52(8):2318-23. DOI: https://doi.org/10.1016/j.transproceed.2020.02.110
Alonso Nates R, Menezo Viadero R, Zudaire Arana MT, Cabeza Guerra MV, Arias Ramos N, Las complicaciones de la herida quirúrgica en el trasplante renal. Enferm Nefrol [Internet]. 2005 [consultado 10 Ago 2022];8(1):23-6. Disponible en: https://www.redalyc.org/articulo.oa?id=359833116005. DOI: https://doi.org/10.4321/S1139-13752005000100005
Peluso G, Incollingo P, Campanile S, Menkulazi M, Scotti A, Tammaro V, et al. Relation Between Wound Complication and Lymphocele After Kidney Transplantation: A Monocentric Study. Transplant Proc 2020;52(5):1562-5. DOI: https://doi.org/10.1016/j.transproceed.2020.02.053
Martins LS, Malheiro J, Pedroso S, Almeida M, Dias L, Henriques AC, et al. Pancreas-Kidney transplantation: Impact of dialysis modality on the outcome. Transpl Int 2015;28(8):972-9. DOI: https://doi.org/10.1111/tri.12565
Padillo-Ruiz J, Arjona-Sánchez A, Muñoz-Casares C, Ruiz-Rabelo J, Navarro MD, Regueiro JC. Impact of peritoneal dialysis versus hemodialysis on incidence of intra-abdominal infection after simultaneous pancreas-kidney transplant. World J Surg 2010;34(7):1684-8. DOI: https://doi.org/10.1007/s00268-010-0527-z
Alonso M, Villanego F, Vigara LA, Aguilera A, Ruíz E, García A, et al. Surgical Wound Dehiscence in Kidney Transplantation: Risk Factors and Impact on Graft Survival. Transplant Proc 2022;54(1):27-31. DOI: https://doi.org/10.1016/j.transproceed.2021.09.066
Vedove Rosales L, Marrero Fernández M del P, Dorta Hernández A, Álvarez Rodríguez Ó, Martín Fleitas AE. Revisión de los factores de riesgo relacionados con la dehiscencia y/o infección de la herida quirúrgica en el trasplantado renal. En: Libro Comunicaciones Presentadas al XXXIV Congreso Nacional SEDEN. Madrid: Sociedad Española de Enfermería Nefrológica; 2009. p. 191-5.
Røine E, Bjørk IT, Øyen O. Targeting risk factors for impaired wound healing and wound complications after kidney transplantation. Transplant Proc 2010;42(7):2542-6. DOI: https://doi.org/10.1016/j.transproceed.2010.05.162
Toon CD, Lusuku C, Ramamoorthy R, Davidson BR, Gurusamy KS. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane database Syst Rev. 2015;2015(9). DOI: https://doi.org/10.1002/14651858.CD010259.pub3
Lumbers M. Selecting appropriate postoperative dressings to support wound healing and reduce surgical site infection. Br J Nurs. 2018;27(6):S32-5. DOI: https://doi.org/10.12968/bjon.2018.27.6.S32