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Published on: July 22, 2022
A systematic approach to minimizing wound problems for de novo sirolimus-treated kidney transplant recipients
Ho Yee Tiong1, Stuart M Flechner, Lingme Zhou
1The Transplant Center/Glickman Kidney and Urological Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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.
Insights
A new systematic wound care program significantly reduced wound complications and lymphoceles in kidney transplant patients receiving sirolimus. This approach improves outcomes for patients on mammalian target of rapamycin inhibitors.
Area of Science:
- Nephrology
- Transplantation Surgery
- Immunosuppression
Background:
- Sirolimus (mammalian target of rapamycin inhibitor) use in kidney transplantation is associated with increased wound healing problems and lymphoceles.
- These complications raise patient morbidity, healthcare costs, and can impede clinical trials by necessitating early drug discontinuation.
- Existing challenges highlight the need for strategies to mitigate sirolimus-related adverse events in renal transplant recipients.
Purpose of the Study:
- To implement and evaluate a systematic program aimed at reducing wound complications and lymphoceles in kidney transplant recipients treated with de novo sirolimus.
- To compare outcomes between patients transplanted under a restrictive protocol versus those transplanted with fewer restrictions.
Main Methods:
- Development of a comprehensive program including patient selection (BMI <32 kg/m2), use of closed suction drains, surgical technique modifications, and avoidance of sirolimus loading dose.
- Comparison of consecutive adult kidney-only recipients receiving antibody induction, de novo sirolimus, mycophenolate mofetil, and steroids.
- Group 1: 204 patients transplanted with few restrictions; Group 2: 103 patients transplanted using the systematic program.
Main Results:
- The systematic program significantly reduced cumulative wound complications (7.8% vs. 19.6%, P=0.007) and nonoperative wound complications (2.9% vs. 14.2%, P=0.001).
- Incidence of detected lymphoceles (22.3% vs. 47.1%, P<0.0001), treated lymphoceles (4.8% vs. 24.5%, P<0.0001), and surgically treated lymphoceles (1.9% vs. 14.2%, P=0.001) were significantly lower in the program group.
- Multivariate analysis identified BMI >30-32 kg/m2 as a key factor for delayed wound healing and surgical repair, while BMI and acute rejections were associated with lymphocele treatment.
Conclusions:
- A systematic wound care program effectively minimizes wound healing complications in kidney transplant recipients on de novo sirolimus.
- This protocol achieves wound complication rates comparable to those observed with alternative immunosuppressive agents.
- The findings support the integration of this systematic approach to improve patient outcomes in sirolimus-treated kidney transplant recipients.
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