Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.
Transplantation Center, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.
Transplant Proc. 2023 Mar;55(2):337-341. doi: 10.1016/j.transproceed.2023.01.020. Epub 2023 Feb 21.
Incisional hernias (IH) constitute a complication after kidney transplant (KT). Patients may be particularly at risk because of comorbidities and immunosuppression. The study aim was to assess the incidence, risk factors, and treatment of IH in patients undergoing KT.
This retrospective cohort study included consecutive patients who underwent KT between January 1998 and December 2018. Patient demographics, comorbidities, perioperative parameters, and IH repair characteristics were assessed. Postoperative outcomes included morbidity, mortality, need for reoperation, and length of stay (LOS). Patients who developed IH were compared with those who did not develop one.
Forty-seven patients (6.4%) developed an IH after a median delay of 14 months (IQR, 6-52 months) in 737 KTs. On uni- and multivariate analyses, body mass index (odds ratio [OR], 1.080; P = .020), pulmonary diseases (OR, 2.415; P = .012), postoperative lymphoceles (OR, 2.362; P = .018), and LOS (OR, 1.013; P = .044) were independent risk factors. Thirty-eight patients (81%) underwent operative IH repair, and 37 (97%) were treated with a mesh. The median LOS was 8 days (IQR, 6-11 days). Three patients (8%) developed surgical site infections, and 2 patients (5%) presented hematomas requiring surgical revision. After IH repair, 3 patients (8%) had a recurrence.
The incidence of IH after KT seems rather low. Overweight, pulmonary comorbidities, lymphoceles, and LOS were identified as independent risk factors. Strategies focusing on the modifiable patient-related risk factors and early detection and treatment of lymphoceles may help to decrease the risk of IH formation after KT.
切口疝（IH）是肾移植（KT）后的一种并发症。由于合并症和免疫抑制，患者可能面临特别高的风险。本研究旨在评估接受 KT 的患者 IH 的发生率、危险因素和治疗方法。
这是一项回顾性队列研究，纳入了 1998 年 1 月至 2018 年 12 月期间连续接受 KT 的患者。评估了患者的人口统计学、合并症、围手术期参数和 IH 修复特征。术后结局包括发病率、死亡率、再次手术的需求和住院时间（LOS）。比较了发生 IH 的患者和未发生 IH 的患者。
在 737 例 KT 中，47 例（6.4%）在中位数为 14 个月（IQR，6-52 个月）后出现 IH。在单因素和多因素分析中，体重指数（比值比[OR]，1.080；P=0.020）、肺部疾病（OR，2.415；P=0.012）、术后淋巴囊肿（OR，2.362；P=0.018）和 LOS（OR，1.013；P=0.044）是独立的危险因素。38 例（81%）患者接受了手术 IH 修复，37 例（97%）患者使用了网片。中位 LOS 为 8 天（IQR，6-11 天）。3 例（8%）患者发生手术部位感染，2 例（5%）患者出现血肿需要手术修正。IH 修复后，3 例（8%）患者复发。
KT 后 IH 的发生率似乎较低。超重、肺部合并症、淋巴囊肿和 LOS 被确定为独立的危险因素。专注于可改变的患者相关危险因素以及早期发现和治疗淋巴囊肿的策略，可能有助于降低 KT 后 IH 形成的风险。
