Surgical Complications in Kidney Transplant Recipients in the Modern Era: Types, Rates and Impact on Clinical Outcomes

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Abstract

Background

Kidney transplantation increases the quality of life of patients with end stage renal disease (ESRD). However, surgical complications (SC) of transplantation pose risks to clinical outcomes and increase healthcare burden. Literature on the topic is fragmented, with no studies examining multiple types of SC. We examined trends in perigraft collections, vascular, urological and wound-related SC within one month of kidney transplant, and their associated clinical outcomes in a Canadian cohort of kidney transplant recipients.

Methodology

We conducted a single centre, retrospective cohort study examining adult patients (≥18 years) who received a kidney transplant between January 1st, 2005 and December 31st, 2015 with a one year follow up period (n = 1,303). All non-kidney or simultaneous multi-organ transplants were excluded. Univariable and multivariable Cox proportional hazard models were fitted to analyze the relationship between SC (exposure levels: 0, 1, and >1 SC within 1 month of transplant) and clinical outcomes.

Results

The incidence rate of SC within 1 year post-transplant was 10.7 (95% C.I.: 10.0, 11.9). The most common SC were perigraft collections, of which hematomas were most prevalent. Risk factors associated with having SC included older recipient age (p= 0.02), deceased donor (p= 0.02), and delayed graft function (p< 0.001). Univariable analyses showed significant relationships between having more than 1 SC within a month of transplant and increased risk for readmission (p= 0.04) as well as reduced estimated glomerular filtration rate (eGFR) (p= 0.03) at 1 year post-transplant. Multivariable analyses resulted in no clear significant relationships between SC and clinical outcomes including graft and patient survival.

Conclusions

The incidence of SC at TGH is comparable to that reported in the literature, which ranges from 3 to 20%. Although common, SC were not independently associated with adverse graft and patient outcomes. The impact of SC on morbidity outcomes requires further study.

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