Taha Mohamed, Davis Niall F, Power Richard, Mohan Ponusamy, Forde James, Smyth Gordon, Little Dilly M
Department of Transplant Surgery and Urology, Beaumont hospital, Dublin, Ireland.
Clin Transplant. 2017 May;31(5). doi: 10.1111/ctr.12960. Epub 2017 Apr 4.
Kidney transplant recipients are at an increased risk of developing surgical site wound complications due to their immunosuppressed status. We aimed to determine whether increased mid-abdominal circumference (MAC) is predictive for wound complications in transplant recipients. A prospective study was performed on all kidney transplant recipients from October 2014 to October 2015. "Controls" consisted of kidney transplant recipients without a surgical site wound complication and "cases" consisted of recipients that developed a wound complication. In total, 144 patients underwent kidney transplantation and 107 patients met inclusion criteria. Postoperative wound complications were documented in 28 (26%) patients. Patients that developed a wound complication had a significantly greater MAC, body mass index (BMI), and body weight upon renal transplantation (P<.001, P=.011, and P=.011, respectively). On single and multiple logistic regression analyses, MAC was a significant predictor for developing a surgical wound complication (P=.02). Delayed graft function and a history of preformed anti-HLA antibodies were also predictive for surgical wound complications (P=.003 and P=.014, respectively). Increased MAC is a significant predictor for surgical wound complications in kidney transplant recipients. Integrating clinical methods for measuring visceral adiposity may be useful for stratifying kidney transplant recipients with an increased risk of a surgical wound complication.
肾移植受者由于免疫抑制状态,发生手术部位伤口并发症的风险增加。我们旨在确定中腹围(MAC)增加是否可预测移植受者的伤口并发症。对2014年10月至2015年10月期间所有肾移植受者进行了一项前瞻性研究。“对照组”由无手术部位伤口并发症的肾移植受者组成,“病例组”由发生伤口并发症的受者组成。共有144例患者接受了肾移植,107例患者符合纳入标准。28例(26%)患者记录了术后伤口并发症。发生伤口并发症的患者在肾移植时的MAC、体重指数(BMI)和体重显著更高(分别为P<0.001、P=0.011和P=0.011)。在单因素和多因素逻辑回归分析中,MAC是发生手术伤口并发症的显著预测因素(P=0.02)。移植肾功能延迟和预先存在抗HLA抗体史也是手术伤口并发症的预测因素(分别为P=0.003和P=0.014)。MAC增加是肾移植受者手术伤口并发症的显著预测因素。整合测量内脏脂肪的临床方法可能有助于对手术伤口并发症风险增加的肾移植受者进行分层。