1. A systematic approach to minimizing wound problems for de novo sirolimus-treated kidney transplant recipients.
- Author
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Tiong HY, Flechner SM, Zhou L, Wee A, Mastroianni B, Savas K, Goldfarb D, Derweesh I, and Modlin C
- Subjects
- Adult, Body Mass Index, Female, Humans, Lymphocele chemically induced, Male, Middle Aged, Mycophenolic Acid analogs & derivatives, Mycophenolic Acid therapeutic use, Odds Ratio, Program Evaluation, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Steroids therapeutic use, Suction, Young Adult, Immunosuppressive Agents adverse effects, Kidney Transplantation adverse effects, Lymphocele prevention & control, Sirolimus adverse effects, Wound Healing drug effects
- Abstract
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.
- Published
- 2009
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