Wound infections in renal transplant wounds: pathogenetic and prognostic factors.

The factors contributing to transplant wound infection, as well as those determining its outcome, have been reviewed in 27 transplant patients with wound infection. Unrelated cadaver kidneys, diabetes, urinary fistulas and wound hematomas are all factors predisposing to wound infection. Overall incidence of wound infection in this series was 6.1% (27/439). When infections secondary to known preventable causes (i.e. hematomas and fistulas) were excluded, the incidence of wound infection was only 1.6%. Furthermore, if diabetics and retransplanted patients were excluded, the incidence of wound infection in non-diabetic patients who had their first transplant was only 0.7%. Perinephric infections are much more serious and carry a worse prognosis than superficial infections. Overall mortality of wound infections was 40% (8/27), most deaths being caused by sepsis from deep infection. Only three patients (11%) healed their wounds and saved their kidneys, whereas the rest of the survivors (15/18) healed their wounds but lost their kidneys. It is emphasized that prevention of hematomas and urinary fistulas is the most important measure in the prevention of transplant wound infection.