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Identification of factors responsible for wound infection following allograft nephrectomy
Abstract:
The advisability of routine allograft nephrectomy following rejection has not been clearly resolved. Rejected transplants may be a source of sepsis, local inflammatory symptoms, and continued antigenic stimulation. Transplant nephrectomy is, however, attended by a surprisingly high incidence of septic complications and death. In an attempt to analyze the occurrence of these, and identify effective prophylactic maneuvers, the authors retrospectively studied 99 consecutive allograft nephrectomies in 252 consecutive renal transplants. Mortality following allograft nephrectomy was 10 per cent, and usually attributable to sepsis. Wound infections occurred in 24 per cent of these patients and were significantly associated with a preoperative site of infection in the wound, urinary tract, or blood (P less than 0.01). Preoperative antibiotics, wound irrigation, drains, and delay in performing allograft nephrectomy were all found to be insignificant variables. Interestingly, total steroid dose was less in patients who developed wound infections than in those who did not (P less than 0.01). A postoperative wound infection approximately doubled the mean number of hospital days. These data suggest that a significant reduction in morbidity and possibly mortality could be accomplished by complete eradication of infection prior to allograft nephrectomy. Consequent delay in removal of the graft is not associated with increased morbidity, and other maneuvers seem to have little beneficial effect.
Insights
Routine removal of rejected kidney transplants (allograft nephrectomy) carries high sepsis risks. Eradicating infection before surgery significantly reduces complications and mortality, making graft removal safer.
Area of Science:
- Nephrology
- Transplant Surgery
- Infectious Disease
Background:
- The necessity of routine allograft nephrectomy after kidney transplant rejection remains unclear.
- Rejected transplants can lead to sepsis, inflammation, and ongoing immune responses.
- Allograft nephrectomy itself has a high rate of septic complications and mortality.
Purpose of the Study:
- To analyze the incidence of septic complications and mortality following allograft nephrectomy.
- To identify effective prophylactic measures to reduce morbidity and mortality.
- To evaluate the impact of preoperative infection status and surgical variables on outcomes.
Main Methods:
- Retrospective study of 99 allograft nephrectomies in 252 renal transplants.
- Analysis of mortality, wound infections, and associated risk factors.
- Statistical evaluation of preoperative infection, antibiotic use, surgical techniques, and steroid dosage.
Main Results:
- Allograft nephrectomy resulted in a 10% mortality rate, primarily due to sepsis.
- Wound infections occurred in 24% of patients, significantly linked to preoperative infection sites (P < 0.01).
- Preoperative antibiotics, irrigation, drains, and delayed nephrectomy were not significant protective factors. Lower steroid doses correlated with wound infections (P < 0.01).
Conclusions:
- Complete eradication of infection prior to allograft nephrectomy is crucial for reducing morbidity and mortality.
- Delaying graft removal does not increase morbidity and appears to be a safe strategy.
- Focusing on preoperative infection control is more beneficial than other assessed prophylactic maneuvers.