Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
BMC Surg. 2021 Feb 5;21(1):74. doi: 10.1186/s12893-021-01081-x.
Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value.
To determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors.
Retrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. did (Drain, D) receive a drain at the time of transplant was performed. The primary outcome was the development of any wound complication (superficial or deep) during the first 12 months post-transplant. Secondary outcomes included the development of superficial wound complications, deep wound complications, DGF, and graft loss during the first 12 months post-transplant.
388 and 112 recipients had DF/D, respectively. DF-recipients were significantly more likely to be younger, not have pre-transplant diabetes, receive a living donor kidney, receive a kidney-alone transplant, have a shorter duration of dialysis, shorter mean cold-ischemia-time, and greater pre-transplant use of anticoagulants/antiplatelets. Wound complications were 4.6% (18/388) vs. 5.4% (6/112) in DF vs. D groups, respectively (P = 0.75). Superficial wound complications were observed in 0.8% (3/388) vs. 0.0% (0/112) in DF vs. D groups, respectively (P = 0.35). Deep wound complications were observed in 4.1% (16/388) vs. 5.4% ((6/112) in DF vs. D groups, respectively (P = 0.57). Higher recipient body mass index and ≥ 1 year of pre-transplant dialysis were associated in multivariable analysis with an increased incidence of wound complications. Once the prognostic influence of these 2 factors were controlled, there was still no notable effect of drain use (yes/no). The lack of prognostic effect of drain use was similarly observed for the other clinical outcomes.
In a relatively large cohort of renal transplant recipients, routine surgical drain use appears to offer no distinct prognostic advantage.
在肾移植时常规放置外科引流管的问题一直存在争议，主要涉及到其预后价值。
确定在控制其他预后因素的情况下，引流管的放置是否会影响伤口并发症的发生率和其他临床结果。
对 500 例连续肾移植患者进行回顾性分析，其中（无引流组，DF）和（有引流组，D）在移植时分别接受或未接受引流管。主要结局是移植后 12 个月内任何伤口并发症（浅表或深部）的发生。次要结局包括浅表伤口并发症、深部伤口并发症、DGF 和移植后 12 个月内移植物丢失的发生。
388 例和 112 例患者分别接受了 DF/D。DF 组患者更年轻、无移植前糖尿病、接受活体供肾、接受单纯肾脏移植、透析时间较短、冷缺血时间较短、移植前抗凝/抗血小板药物使用较多。DF 组和 D 组的伤口并发症发生率分别为 4.6%（18/388）和 5.4%（6/112）（P=0.75）。DF 组和 D 组的浅表伤口并发症发生率分别为 0.8%（3/388）和 0.0%（0/112）（P=0.35）。DF 组和 D 组的深部伤口并发症发生率分别为 4.1%（16/388）和 5.4%（6/112）（P=0.57）。多变量分析显示，受体体重指数较高和移植前透析时间≥1 年与伤口并发症发生率增加相关。一旦控制了这两个因素的预后影响，引流管的使用仍然没有明显的效果（有/无）。引流管使用对其他临床结局也没有明显的预后作用。
在一个相对较大的肾移植受者队列中，常规使用外科引流管似乎没有明显的预后优势。
