Panniculectomy in Preparation for Renal Transplant Candidates: A 10-Year Experience
Yunfeng Xue, MD1, Pope Rodnoi, BS1, Ping Song, MD1, Jennifer Kuo, MD2, Christoph Troppmann, MD1, Chad Bailey, MD1, Michael S. Wong, MD1.
1University of California, Davis Medical Center, Sacramento, CA, USA, 2NewYork Presbyterian/Columbia, New York, NY, USA.
PURPOSE: Candidates for renal transplant are frequently denied access to transplant surgery due to obesity and poor functional status. Many patients are required to lose significant weight in order to maintain candidacy. Successful weight loss commonly produces a panniculus encompassing the lower abdominal surgical site used for transplant surgery. These patients are declined for renal transplantation secondary to predictable wound healing complications. To decrease post-transplant wound and graft complications, we implemented a Transplant/Plastic Surgery Program where patients underwent panniculectomy in an effort to regain candidacy on the renal transplant waiting list. We previously published our results of 21 patients in 2015, here we present our updated 10-year experience.
METHODS: We performed a retrospective review of all patients deemed high-risk for post-kidney transplant wound complications who underwent panniculectomy in preparation for renal transplantation at our institution from 2008 to 2018. All patients had a minimum of 3 months follow-up. Patient characteristics (age, BMI, medical comorbidities, maximum BMI and weight lost prior to panniculectomy) and surgical outcomes (specimen weight, operation length, time to drain removal, wound complications, time to treat complication) were analyzed after panniculectomy as well as after transplantation.
RESULTS: We performed 60 panniculectomies in renal transplant candidates. Wound complications occurred in 29 patients (48%). Minor wound complications (wound separation, cellulitis, skin necrosis) occurred in 21 patients (35%), major wound complications (hematoma, seroma, abscess, unplanned return to the operating room) occurred in 10 patients (17%). 30 patients have since undergone renal transplantation. No patients have had post-transplant wound healing complication.
CONCLUSION: Panniculectomy in preparation for renal transplantation can be performed in patients with end-stage renal disease with a high but manageable complication rate, converting previously ineligible patients into eligible candidates for kidney transplantation. These wound complications are more easily managed prior to institution of immunosuppression required for renal transplant. While performing panniculectomies in these high-risk patients clearly shifts the burden of complications from Transplant Surgery to Plastic Surgery, it improves patient access to a life-extending procedure, further supporting Plastic Surgery's vital role in our comprehensive healthcare system.
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