Teamwork Makes the Dream Work: Maximizing Surgical Intervention at the Time of Living Donor Renal Transplantation

Patients with obesity and end-stage renal disease represent a surgical population with multiple comorbidities and high risk for postoperative complications. One method for reducing the incidence of postoperative adverse events in this patient population is to limit the number of operations through combining operations into 1 operative encounter.

We conducted a retrospective review of adult patients at a single institution who underwent renal transplant, panniculectomy, and at least 1 additional abdominal or pelvic surgery concurrently. For those patients, we collected demographics, intraoperative variables, and postoperative data and analyzed surgical outcomes and postoperative complications.

Thirteen patients met inclusion criteria. Most of the patients were female (85%) with ages ranging 33 to 70 years old and mean body mass index of 36.5 (SD 4.7). Three quarters of patients (77%) underwent 3 procedures and the remaining underwent 4 or 5 procedures with a median hospital length of stay of 5 days (range, 3-10 days). There was a single mortality. Overall, 8 patients (61.5%) experienced complications in the first 90 postoperative days. The wound complication rate was 46.2%, the overall readmission rate within 90 days was 38.5%, and the reoperation rate was 30.8%. All patients experienced immediate graft function, and the 12 patients that survived to postoperative day 90 maintained survival at 1 year.

This study demonstrates that the combination of more than 2 surgical procedures with living donor renal transplant is a possible treatment option in high-risk obese patients in need of multiple operations.