Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Despite advances in perioperative and post-transplant management over time, complications still occur following deceased donor (DD) kidney transplantation. This study aimed to determine the number and type of complications up to 12months post-operatively over two periods at our Centre.
*Methods: Data was collected retrospectively from the NHS Blood and Transplant database and local electronic medical records from DD renal transplant recipients in 2012/13 and 2016/17. Patient demographics, donor/recipient characteristics and 12month post-operative surgical and urological complications were collected. Rejection episodes were also included. Complications were classified according to the Clavien-Dindo (CD) grading system.
*Results: N=188 patients were included from 2012/13 and n=192 patients from 2016/17. A total of n=161 (85.6%) patients experienced complications in the first year post-operatively in 2012/13 and n=145 (75.5%) experienced complications in 2016/17 which was significantly less (p=0.013). Both groups were comparable in terms of their general patient demographics (age, gender, ethnicity), with significant differences found only in the donor type, where there were significantly more recipients of donation after brain death (DBD) kidneys in 2016-17 versus 2012-13 (114 (59.4%) vs 86 (45.7%) recipients; p=0.008 respectively). The most common complication was the need for a blood transfusion in 2012/13 (n=78;41.5% patients) at a median of 14 days post-transplant, whilst both lymphoceles and urinary tract infections were most common in 2016/17 (n=47 each; 24.4% patients) followed by blood transfusions (n=23 patients; 22.3%). The most commonly reported CD grade was CD II in both cohorts (46.4% and 54.7% patients in 2012/13 and 2016/17 respectively). There were no significant differences in graft failure and death rates between both groups (p=0.31 and p=0.18 respectively).
*Conclusions: Most studies concentrate on early complications. Here we showed that a large number of complications occurred throughout the first-year post-transplant in both cohorts compared to literature findings (15-60%), but there was significantly less in 2016/17. Improvement in surgical technique and peri/post-operative management is likely to account for these differences. Prevention, a high index of suspicion and timely treatment are still essential to ensure the impact of post-operative complications is minimized. Moreover, such longer follow-up studies, help inform patients better about what to expect in the first year following DD transplantation.
|Vascular complication||Urological complication||Fluid collection||Wound related problem||Rejection||Graft failure||Death|
|2012/13 Number of patients (%)||64(34.0%)||85(45.2%)||84(44.6%)||24(12.8%)||53(28.2%)||18(9.6%)||6(3.2%)|
|2016/17 Number of patients (%)||23(12.0%)||69(35.9%)||63(32.8%)||28(14.6%)||26(13.5%)||13(6.8%)||2(1.0%)|
To cite this abstract in AMA style:Mekhaimar A, Maple H, Mamode N, Zakri RH, Kessaris N. Comparing Surgical and Urological Complications Over Time in Deceased Donor Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/comparing-surgical-and-urological-complications-over-time-in-deceased-donor-kidney-transplantation/. Accessed March 8, 2021.
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