Huitfeldt Sola Kristoffer, Brismar Torkel B, Lorant Tomas, Lange Klaus, Rollvén Erik, Tzortzakakis Antonios, Zhang Yi-Hua, Fränneby Ulf, Genberg Helena
Unit of Radiology, CLINTEC, Karolinska Institutet, Solna, Sweden.
Department of Radiology, Karolinska University Hospital, Solna, Sweden.
Eur Radiol. 2025 Jul 31. doi: 10.1007/s00330-025-11841-5.
Incisional hernia (IH) following kidney transplantation is underdiagnosed, with reported incidence rates of 1-7%. This study aimed to evaluate IH prevalence using computed tomography (CT), propose a novel classification system correlated with symptomatology, and evaluate its effect on interobserver IH detection rates.
A retrospective review of adults undergoing kidney-alone transplantation (2010-2017) at two Swedish centres was conducted. Patients with previous ipsilateral transplantation or poor-quality CT were excluded. Abdominal CT scans obtained ≥ 30 days postoperatively were reviewed by a multidisciplinary team (radiologist, transplant surgeon, and hernia specialist, all with > 20 years of experience), blinded to clinical data. Four subtypes of IHs after kidney transplantation were identified: 1A (normal contour, incomplete hernia), 1B (normal contour, complete hernia), 2A (abnormal contour, incomplete hernia), and 2B (abnormal contour, complete hernia). Symptomatology was assessed via medical records. Four external radiologists evaluated the classification's impact on detection rates.
Of 673 participants, 361 (54%) had evaluable CT scans. IHs were detected in 243 (68%), of which 36% were symptomatic. The proposed classification improved detection rates from 54% to 76% (p = 0.03) after an educational intervention. Symptom prevalence increased with hernia severity: 11% in type 1A, 13% in type 1B, 36% in type 2A, and 86% in type 2B (p < 0.01). Only 55% of symptomatic participants referred for IH mapping were correctly diagnosed prior to study reassessment.
IHs are prevalent and underdiagnosed after kidney transplantation. The proposed classification improves diagnostic accuracy, correlates with symptomatology, and facilitates clinical management and research.
Question The lack of a generally accepted definition of lateral abdominal wall defects (IH) results in a low detection rate after kidney transplantation. Findings The low detection rate of lateral abdominal wall defects (IH) improved significantly after self-study of the new classification system presented here. Clinical relevance Accurate detection of lateral abdominal wall defects will facilitate surgical repair and improvement of surgical suture techniques.
肾移植术后切口疝（IH）的诊断不足，报告发病率为1%-7%。本研究旨在使用计算机断层扫描（CT）评估IH的患病率，提出一种与症状相关的新分类系统，并评估其对观察者间IH检测率的影响。
对瑞典两个中心接受单纯肾移植（2010-2017年）的成年人进行回顾性研究。排除既往同侧移植或CT质量差的患者。术后≥30天获得的腹部CT扫描由多学科团队（放射科医生、移植外科医生和疝专科医生，均有超过20年经验）进行评估，且对临床数据不知情。确定了肾移植术后IH的四种亚型：1A（轮廓正常，不完全疝）、1B（轮廓正常，完全疝）、2A（轮廓异常，不完全疝）和2B（轮廓异常，完全疝）。通过病历评估症状。四名外部放射科医生评估了该分类对检测率的影响。
673名参与者中，361名（54%）有可评估的CT扫描。检测到243例（68%）IH，其中36%有症状。在进行教育干预后，提出的分类将检测率从54%提高到76%（p=0.03）。症状患病率随疝严重程度增加：1A 型为11%，1B型为13%，2A型为36%，2B型为86%（p<0.01）。在研究重新评估之前，转诊进行IH定位的有症状参与者中只有55%被正确诊断。
肾移植术后IH很常见且诊断不足。提出的分类提高了诊断准确性，与症状相关，并便于临床管理和研究。
问题 缺乏对侧腹壁缺损（IH）的普遍接受的定义导致肾移植后检测率较低。发现 此处提出的新分类系统自学后，侧腹壁缺损（IH）的低检测率显著提高。临床意义 准确检测侧腹壁缺损将有助于手术修复和手术缝合技术的改进。
