RT Journal
A1 Chang EI, Galvez MG, Padilla BE, Freise CE, Foster RD, Hoffman WY
T1 TEn-year retrospective analysis of incisional herniorrhaphy following renal transplantation
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD January 1
VO 146
IS 1
SP 21
OP 25
DO 10.1001/archsurg.2010.305
UL http://dx.doi.org/10.1001/archsurg.2010.305
AB Hypothesis 
    Repair of incisional hernias in renal transplant recipients is compromised because of immunosuppressive therapy.Design 
    Retrospective review.Setting 
    University tertiary care institution.Patients 
    Forty-two recipients of renal transplants or combined renal-pancreas transplants who underwent incisional herniorrhaphy were included in our study.Intervention 
    Incisional herniorrhaphy.Main Outcome Measures 
    Postoperative complications and recurrence of incisional hernia.Results 
    Forty-two patients (mean age, 49.6 years) underwent incisional herniorrhaphy (mean area, 99.9 cm2) following renal transplantation (26 cadaveric donor renal, 12 combined renal-pancreas, and 4 living related donor renal) from January 1, 1995, to December 31, 2005. Using various techniques, hernia repairs were performed on average 36.4 months following transplantation. Diabetes mellitus was a frequent cause of end-stage renal disease (16 patients), followed by polycystic kidney disease (6 patients), focal segmental glomerular sclerosis (3 patients), hypertension (2 patients), Alport syndrome (2 patients), and IgA nephropathy (2 patients), with 11 patients having lupus or glomerulonephritis. Four patients developed cellulitis, 2 patients required mesh removal, and 1 patient was admitted for abscess drainage and intravenous antibiotics. Fourteen patients had recurrence of incisional hernias, with 3 patients experiencing 2 recurrences and 1 patient experiencing 4 recurrences.Conclusions 
    To our knowledge, this is the largest series of incisional herniorrhaphies performed among patients following renal transplantation. Although smoking history, the presence of diabetes, and immunosuppressive therapy were not associated with the initial development of an incisional hernia, they were associated with complications. Component separation performed by transplant and plastic and reconstructive surgeons should be considered in the setting of recurrent hernias and large defects.