Surgical complications after kidney transplantation: different impacts of immunosuppression, graft function, patient variables, and surgical performance

The population of kidney transplant ( KT x) recipients often has complex medical and immunological conditions. Surgical complications ( SC s) contribute to the increasing morbidity and costs in these patients. We analyzed the risk factors for SC in 405 KT x patients treated using defined immunosuppressive regimens according to their clinical and immunological risk profile: (1) standard immunosuppression ( SIS ) with IL ‐2 receptor mAb, CNI , and (a) mycophenolic acid ( MPA ) or (b) m TOR inhibitor; and (2) more intense immunosuppression ( IIS ) with (a) ATG or (b) the additional use of plasma exchange and B‐ and T‐cell‐depleting agents. In a mixed effects logistic regression model, we identified the following risk factors for SC : male gender, diabetes, and post‐operative dialysis. No difference was found between the patients who received SIS with MPA and those who received m TOR inhibitors. The risk of suffering complications with IIS increases with age. In addition to IIS , diabetes was a risk for wound healing disorders. Therapeutic anticoagulation and a third or subsequent retransplantation increased the rate of bleeding. We did not identify immunosuppression or patient demographics as risk factors for lymphoceles or ureter complications; however, we demonstrated that the surgeon had a significant impact on severe complications, especially those of the ureter.