A systematic approach to minimizing wound problems for de novo sirolimus-treated kidney transplant recipients.

Abstract

BACKGROUND:

Wound healing problems and lymphoceles have been reported with greater frequency in kidney recipients given de novo sirolimus. This problem has led to increased patient morbidity and cost; and has been an impediment to the completion of randomized controlled trials in which wound problems have necessitated premature discontinuation of mammalian target of rapamycin inhibitors.

METHODS:

We developed a systematic program to reduce these problems based on patient selection (body mass index [BMI] <32 kg/m2), the use of closed suction drains, modifications of surgical technique, and avoidance of a loading dose of sirolimus. Consecutive series of adult kidney-only recipients given antibody induction followed by de novo sirolimus, mycophenolate mofetil, and steroids were compared; group 1: 204 patients transplanted with few restrictions and group 2: 103 patients transplanted using the above program.

RESULTS:

This approach resulted in a significant reduction (group 2 vs. group 1) in cumulative wound complications (7.8% vs. 19.6%, P=0.007), and nonoperative wound complications (2.9% vs. 14.2%, P=0.001). In addition, the incidence of lymphoceles detected (22.3% vs. 47.1%, P<0.0001), treated (4.8% vs. 24.5%, P<0.0001), or needing surgical intervention (1.9% vs. 14.2%, P=0.001) was significantly reduced. Multivariate analysis demonstrated that a BMI more than 30 to 32 kg/m2 was the most significant variable related to delayed wound healing (odds ratio [OR] 3.01, 0.02) or surgical repair (OR 8.05, P=0.0001), whereas BMI (OR 1.54, P=0.038) and acute rejections (OR 1.34, P=0.03) were most associated with lymphocele treatment.

CONCLUSIONS:

A systematic program of wound care using de novo sirolimus can produce wound healing complications comparable with that reported with other agents.

• Authors: Ho Yee Tiong, Stuart M Flechner, Lingme Zhou, Alvin Wee, Barbara Mastroianni, Kathy Savas, David Goldfarb, Ithaar Derweesh, Charles Modlin
• Journal: Transplantation (Transplantation) Vol. 87 Issue 2 Pg. 296-302 (Jan 27 2009) ISSN: 1534-6080 [Electronic] United States
• PMID: 19155988 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents
• Steroids
• Mycophenolic Acid
• Sirolimus

Topics

• Adult
• Body Mass Index
• Female
• Humans
• Immunosuppressive Agents (adverse effects)
• Kidney Transplantation (adverse effects)
• Lymphocele (chemically induced, prevention & control)
• Male
• Middle Aged
• Mycophenolic Acid (analogs & derivatives, therapeutic use)
• Odds Ratio
• Program Evaluation
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sirolimus (adverse effects)
• Steroids (therapeutic use)
• Suction
• Wound Healing (drug effects)
• Young Adult