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Surgical complications after kidney transplantation: different impacts of immunosuppression, graft function, patient variables, and surgical performance
Author(s) -
Koch Martina,
Kantas Alexandros,
Ramcke Katja,
Drabik Anna I.,
Nashan Björn
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12513
Subject(s) - medicine , immunosuppression , diabetes mellitus , transplantation , kidney transplantation , dialysis , population , surgery , ureter , mycophenolic acid , urology , endocrinology , environmental health
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.