Lam Susanna, Huynh Annie, Ying Tracey, Sandroussi Charbel, Gracey David, Pleass Henry C, Chadban Steve, Laurence Jerome M
Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Transplantation Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Front Nephrol. 2024 Feb 27;4:1352363. doi: 10.3389/fneph.2024.1352363. eCollection 2024.
Wound complications can cause considerable morbidity in kidney transplantation. Closed-incision negative pressure wound therapy (ciNPWT) systems have been efficacious in reducing wound complications across surgical specialties. The aims of this study were to evaluate the use of ciNPWT, Prevena™, in kidney transplant recipients and to determine any association with wound complications.
A single-center, prospective observational cohort study was performed in 2018. A total of 30 consecutive kidney transplant recipients deemed at high risk for wound complications received ciNPWT, and the results were compared to those of a historical cohort of subjects who received conventional dressings. Analysis for recipients with obesity and propensity score matching were performed.
In total, 127 subjects were included in the analysis. Of these, 30 received a ciNPWT dressing and were compared with 97 subjects from a non-study historical control group who had conventional dressing. The overall wound complication rate was 21.3% (27/127). There was no reduction in the rate of wound complications with ciNPWT when compared with conventional dressing [23.3% (7/30) and 20.6% (20/97), respectively, = 0.75]. In the obese subset (BMI ≥30 kg/m), there was no significant reduction in wound complications [31.1% (5/16) and 36.8% (7/19), respectively, = 0.73]. Propensity score matching yielded 26 matched pairs with equivalent rates of wound complications (23.1%, 6/26).
This is the first reported cohort study evaluating the use of ciNPWT in kidney transplantation. While ciNPWT is safe and well tolerated, it is not associated with a statistically significant reduction in wound complications when compared to conventional dressing. The findings from this study will be used to inform future studies associated with ciNPWT in kidney transplantation.
伤口并发症会给肾移植带来相当高的发病率。封闭式切口负压伤口治疗（ciNPWT）系统在减少各外科专业的伤口并发症方面已显示出成效。本研究的目的是评估ciNPWT（Prevena™）在肾移植受者中的使用情况，并确定其与伤口并发症之间的任何关联。
2018年进行了一项单中心前瞻性观察队列研究。共有30名连续的被认为有伤口并发症高风险的肾移植受者接受了ciNPWT治疗，并将结果与接受传统敷料的历史队列受试者的结果进行比较。对肥胖受者进行了分析并进行了倾向评分匹配。
总共127名受试者纳入分析。其中，30名接受了ciNPWT敷料，并与97名来自非研究历史对照组且使用传统敷料的受试者进行比较。总体伤口并发症发生率为21.3%（27/127）。与传统敷料相比，ciNPWT并未降低伤口并发症发生率[分别为23.3%（7/30）和20.6%（20/97），P = 0.75]。在肥胖亚组（BMI≥30 kg/m²）中，伤口并发症也没有显著降低[分别为31.1%（5/16）和36.8%（7/19），P = 0.73]。倾向评分匹配产生了26对匹配对，伤口并发症发生率相当（23.1%，6/26）。
这是首次报道的评估ciNPWT在肾移植中使用情况的队列研究。虽然ciNPWT安全且耐受性良好，但与传统敷料相比，它与伤口并发症的统计学显著降低无关。本研究的结果将用于为未来与ciNPWT在肾移植中的相关研究提供参考。
