The Anterior Rectus Sheath Approach Resulted in No Difference in Wound Complication Rates in Obese versus Non-Obese Renal Transplant Recipients
1Glickman Institute, Cleveland Clinic - Charleston Area Medical Center, Cleveland, OH
2Urology and Renal Transplant, Charleston Area Medical Center, Charleston, WV.
Meeting: 2018 American Transplant Congress
Abstract number: D268
Keywords: Obesity, Outcome, Surgical complications, Weight
Session Information
Session Name: Poster Session D: Surgical Issues (Open, Minimally Invasive): All Organs
Session Type: Poster Session
Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
The anterior rectus sheath (ARS) approach is a modification of the conventional Kuss procedure for kidney transplant (KT). We have previously described the ARS approach and showed decreased wound complication rates when compared with the conventional procedure in our center. A large proportion of our KT candidates and recipients are obese.
We compared the outcomes of obese (BMI>30) versus non-obese KT recipients undergoing ARS procedure. We hypothesized that there is no difference in outcomes, specifically in wound complication rates.
METHODS: KT recipients from 11/1/12-12/31/14 were reviewed. Exclusion: patients who did not undergo the ARS procedure, had intra-peritoneal KTs and those with simultaneous surgery. Statistical tests (X2, Fisher's exact, t-test) were used accordingly.
RESULTS: 91 KTs were done: 84 patients were analyzed (7 excluded). Median follow up: 18 months. 48% (40/84) of the KTs were obese. There was no difference in wound complication rates, delayed graft function (DGF), length of stay (LOS), acute rejection and graft survival. More deaths were noted in the obese group (n=4: 2 occurred over a year after KT [sepsis], 2 in the perioperative period [anesthetic complication and respiratory failure]).
| Non-Obese (n=44) | Obese (n=40) | P value | |
| Age(mean) | 54 | 55 | |
| Gender(M) | 29(67%) | 25(63%) | |
| Donor
Living(LD) Deceased(DD) SCD ECD DCD |
3(7%)
41(93%) 22 (54%) 11(26%) 8(20%) |
2(5%)
38(95%) 28(74%) 6(16%) 4(10%) |
NS |
| Operative Time(DD only, min) | 159(+36) | 173(+31) | NS |
| Patients w/ Complication
Types Skin dehiscence Fascial dehiscence Fluid collection SSI Incisional hernia Internal hernia |
2(5%)
6 0 1(2%) 2(5%) 2(5%) 1(2%) 0 |
4(10%)
4 0 0 2(5%) 0 1(3%) 1(3%) |
0.42
NS |
| DGF | 2(5%) | 5(13%) | NS |
| Acute rejection | 4(9%) | 2(5%) | NS |
| LOS(mean, d) | 6.9(+2.9) | 6.8(+3.8) | NS |
| Graft failure | 2(5%) | 2(5%) | NS |
| Patient death | 0 | 4(10%) | 0.05 |
CONCLUSION: There was no difference in wound complication rates between obese and non-obese KT recipients with the ARS approach. This is a simple and effective technique that may be employed for obese patients undergoing renal transplant.
CITATION INFORMATION: King S., Hill S., Lipscomb L., Jones A., Jeffries R., Africa J. The Anterior Rectus Sheath Approach Resulted in No Difference in Wound Complication Rates in Obese versus Non-Obese Renal Transplant Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
King S, Hill S, Lipscomb L, Jones A, Jeffries R, Africa J. The Anterior Rectus Sheath Approach Resulted in No Difference in Wound Complication Rates in Obese versus Non-Obese Renal Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/the-anterior-rectus-sheath-approach-resulted-in-no-difference-in-wound-complication-rates-in-obese-versus-non-obese-renal-transplant-recipients/. Accessed May 13, 2025.« Back to 2018 American Transplant Congress