Risk Factors for Surgical Complications After Renal Transplantation and Impact on Patient and Graft Survival

• Published in: Transplantation proceedings Vol. 44; no. 9; pp. 2803 - 2808
• Main Authors: Pillot, P, Bardonnaud, N, Lillaz, J, Delorme, G, Chabannes, E, Bernardini, S, Guichard, G, Bittard, H, Kleinclauss, F
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.11.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Chi-Square Distribution; Delayed Graft Function; Delayed Graft Function - epidemiology; Epidemiology; Female; France; France - epidemiology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Graft Rejection; Graft Rejection - epidemiology; Graft Survival; Histocompatibility; HLA Antigens; HLA Antigens - immunology; Humans; Immunology; Incidence; Isoantibodies; Isoantibodies - blood; Kaplan-Meier Estimate; Kidney Transplantation; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Kidney Transplantation - mortality; Life Sciences; Male; Medical sciences; Middle Aged; Postoperative Complications; Postoperative Complications - epidemiology; Postoperative Complications - immunology; Postoperative Complications - mortality; Public health. Hygiene; Public health. Hygiene-occupational medicine; Renal Dialysis; Renal Dialysis - adverse effects; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Tissue, organ and graft immunology; Treatment Outcome; Urologic Diseases; Urologic Diseases - epidemiology; Vascular Diseases; Vascular Diseases - epidemiology; Young Adult; France; Human; Prognosis; Patient; Homotransplantation; Epidemiology; Survival; Kidney; Medicine; Treatment; Urinary system; Surgery; Risk factor; Complication; Graft; Kidney transplantation
• ISSN: 0041-1345; 1873-2623; 0041-1345
• DOI: 10.1016/j.transproceed.2012.09.030

Abstract Purpose We report herein the incidence of and factors predisposive to surgical complications (SC) after renal transplantation. Methods Between 2004 and 2008, we performed 200 renal transplantation. We retrospectively studied recipient and donor characteristics, cold ischemia time, surgical revision in the month after transplantation, delayed graft function, surgical complications (vascular, urologic, wound, or bleeding), as well as graft and patient 5-year survival rates. Results Sixty-six surgical complications were reported among 49 patients with a preponderance of urologic complications. We noted 6.1% Clavien I, 1.5% Clavien II, 30.3% Clavien IIIa, 53% Clavien IIIb, and 9.1% Clavien IVa SCs. Vascular complications showed a worse prognosis. Among recipients, dialysis duration before transplantation (40.3 ± 50.8 months in SCs versus 28 ± 26.5 months in the control unaffected group, P = .032) and anti-HLA immunization (34.7 ± 48% versus 21.2 ± 41%, P = .05) appeared to be risk factor. No significant factor was identified among donors, although patients with surgical complications received older transplants than the control popuation (49.7 ± 14.5 years versus 45.5 ± 15.1 years, P = .08). A greater percentage of delayed graft function (30.6 ± 46.6% versus 11.4 ± 31.9%; P = .001) and graft rejection episodes (34.7 ± 48.1% versus 17.9 ± 38.4%, P .013) were observed among the SC compared with the control group. No significant difference in patient (89.5% versus 95.6% confidence interval, CI 95% [0.7–10.0]; P = .14) or graft survival (88.7% versus 91.8%, CI 95% [0.4–3.9] P = .63) was observed between the groups. Conclusion Surgical complications, especially urologic complications appear frequently after renal transplantation. Dialysis duration and pre-transplant immunization were linked to the occurrence of a surgical complication, which did not affect graft or patient survival.