Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation.

Abstract

OBJECTIVE:

To investigate the effect of placing a prophylactic drain during renal transplantation on the incidence of lymphocele, wound complication and deep venous thrombosis (DVT) in renal transplant recipients induced with sirolimus vs calcineurin inhibitors (CNI), as sirolimus-based immunosuppression is a risk factor for the formation of fluid collections after transplantation.

PATIENTS AND METHODS:

We analysed 165 consecutive adult renal transplant patients at our institution between January 2004 and February 2005. Group 1 (84) did not receive an intraoperative drain and group 2 (81) did. Recipients were analysed within each group based on immunosuppression (sirolimus or CNI) and whether they had wound complication, fluid collection, lymphocele treatment, or DVT.

RESULTS:

In group 1 and 2, respectively, the wound complication rate was 22.6% vs 13.6% (P = 0.134), the fluid collection rate 45.2% vs 16.% (P < 0.001), the lymphocele treatment rate 19.0% vs 2.5% (P = 0.001) the DVT rate 14.3% vs 4.9% (P = 0.043) the fluid collection rate (for CNI) 26.5% vs 16.0% (P = 0.246), the lymphocele treatment rate (for CNI) 5.9% vs 0% (P = 0.084), the fluid collection rate (sirolimus) 58.0% vs 16.1% (P < 0.001) and lymphocele treatment rate (sirolimus) 28% vs 6.5% (P = 0.018). Multivariate analysis of risk factors for fluid collection showed significance for no drain (odds ratio 3.30, P = 0.002), associated wound complication (2.41, P = 0.041) and sirolimus (2.48, P = 0.015).

CONCLUSIONS:

Placing a drain during transplantation decreased the incidence of fluid collection, lymphocele treatment and DVT. The reduction of fluid collection and lymphocele were significant for patients treated with sirolimus. We recommend placing a drain in patients undergoing induction with sirolimus-based immunosuppression.

• Authors: Ithaar H Derweesh, Hazem R Ismail, David A Goldfarb, Motoo Araki, Lingmei Zhou, Charles Modlin, Venkatesh Krishnamurthi, Stuart M Flechner, Andrew C Novick
• Journal: BJU international (BJU Int) Vol. 101 Issue 11 Pg. 1415-9 (Jun 2008) ISSN: 1464-410X [Electronic] England
• PMID: 18190623 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents

Topics

• Adolescent
• Adult
• Aged
• Drainage (methods)
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Intraoperative Care (methods)
• Kidney Transplantation (adverse effects, methods)
• Lymphocele (etiology, prevention & control)
• Male
• Middle Aged
• Multivariate Analysis
• Postoperative Complications (etiology, prevention & control)
• Risk Factors
• Treatment Outcome
• Venous Thrombosis (etiology, prevention & control)