Pretransplant Panniculectomy in Patients Previously Denied Access to Renal Transplantation: Addressing Disparities for Candidates With a High-Risk Abdominal Panniculus After Weight Loss
1Transplant Surgery, UC Davis, Sacramento, CA
2Plastic Surgery, UC Davis, Sacto..
Meeting: 2015 American Transplant Congress
Abstract number: B218
Keywords: Infection, Obesity, Risk factors, Surgical complications
Session Information
Session Name: Poster Session B: Obesity/Elderly/Frail
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Some patients (pts) develop a large lower abdominal panniculus following significant weight loss (worsened by age and abdominal wall laxity). CKD pts affected by this weight loss sequela are often denied access to kidney transplantation (Tx) due to chronic skin infections in the infrapannicular skin fold and the high risk for serious wound healing complications (W-comps) of the Tx incision. We hypothesized that preTx panniculectomy (Pannect) in these high-risk pts (i) can be done with acceptable morbidity, (ii) renders them Tx candidates, and (iii) lowers post-Tx W-comp rates.
Methods: We studied all consecutive adult pts evaluated for Tx at our center 01/2008-03/2014 whose panniculus was the only contraindication to Tx based on the evaluation by a Tx surgeon and who subsequently underwent Pannect prior to waitlisting. Our default post-Tx protocol includes polyclonal antibody induction and steroid-free maintenance.
Results: 36 pts denied Tx due to a high-risk panniculus had Pannect (mean weight loss pre-Pannect: 41 kg). Of these 36 pts, 75% were female and 66% diabetic (mean age, 56 yr; median BMI, 31); 3 (10%) pts had a bariatric surgery history. Of the 28 Pannects done at our institution, 3 (11%) required re-operation (2 hematomas, 1 abscess) and 12 (43%) had minor W-comps (all treated nonoperatively).
All 36 Pannect pts became Tx candidates and were waitlisted. To date, disposition of these 36 pts is: (a) 19 pts (53%) had a kidney Tx (median interval Pannect-to-Tx: 21 mos); (b) 13 pts (36%) remain listed for Tx; and (c) 4 pts (11%) initially listed became unsuitable for Tx (3 died, 1 alive).
For the 19 Tx recipients, superficial W-comp rate was 5% (1 minor hematoma—no reintervention). We noted 1 graft loss (death with function at 4 mos, no other deaths). 1-yr graft survival was 94%.
Conclusions: Despite multiple W-comp risk factors in CKD pts, Pannect was highly effective in rendering previously denied pts candidates for Tx. The majority of Pannect pts has thus gained access to renal Tx and its benefits—with minimal post-Tx wound morbidity. Our outcomes suggest that Pannect can be an important adjunct for maximizing Tx opportunities for obese and previously obese pts that have a high-risk abdominal panniculus. This staged approach is particularly pertinent for CKD pts as they are disproportionally affected by the obesity epidemic.
To cite this abstract in AMA style:
Troppmann C, Bailey C, Kuo J, Santhanakrishnan C, Perez R, Wong M. Pretransplant Panniculectomy in Patients Previously Denied Access to Renal Transplantation: Addressing Disparities for Candidates With a High-Risk Abdominal Panniculus After Weight Loss [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/pretransplant-panniculectomy-in-patients-previously-denied-access-to-renal-transplantation-addressing-disparities-for-candidates-with-a-high-risk-abdominal-panniculus-after-weight-loss/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress