Surgical complications after kidney transplantation: different impacts of immunosuppression, graft function, patient variables, and surgical performance

The population of kidney transplant (KTx) recipients often has complex medical and immunological conditions. Surgical complications (SCs) contribute to the increasing morbidity and costs in these patients. We analyzed the risk factors for SC in 405 KTx patients treated using defined immunosuppressiv...

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Bibliographic Details
Published in:Clinical transplantation 2015-03, Vol.29 (3), p.252-260
Main Authors: Koch, Martina, Kantas, Alexandros, Ramcke, Katja, Drabik, Anna I., Nashan, Björn
Format: Article
Language:English
Subjects:
Adult
Aged
Female
Follow-Up Studies
Graft Rejection - prevention & control
Humans
immunosuppression
Immunosuppressive Agents - therapeutic use
Kidney Transplantation
Logistic Models
Male
Middle Aged
Postoperative Complications - etiology
Retrospective Studies
Risk Factors
surgical complications
surgical skills
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Summary:The population of kidney transplant (KTx) recipients often has complex medical and immunological conditions. Surgical complications (SCs) contribute to the increasing morbidity and costs in these patients. We analyzed the risk factors for SC in 405 KTx patients treated using defined immunosuppressive regimens according to their clinical and immunological risk profile: (1) standard immunosuppression (SIS) with IL‐2 receptor mAb, CNI, and (a) mycophenolic acid (MPA) or (b) mTOR inhibitor; and (2) more intense immunosuppression (IIS) with (a) ATG or (b) the additional use of plasma exchange and B‐ and T‐cell‐depleting agents. In a mixed effects logistic regression model, we identified the following risk factors for SC: male gender, diabetes, and post‐operative dialysis. No difference was found between the patients who received SIS with MPA and those who received mTOR inhibitors. The risk of suffering complications with IIS increases with age. In addition to IIS, diabetes was a risk for wound healing disorders. Therapeutic anticoagulation and a third or subsequent retransplantation increased the rate of bleeding. We did not identify immunosuppression or patient demographics as risk factors for lymphoceles or ureter complications; however, we demonstrated that the surgeon had a significant impact on severe complications, especially those of the ureter.
ISSN:0902-0063
1399-0012
DOI:10.1111/ctr.12513