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Ten-year retrospective analysis of incisional herniorrhaphy following renal transplantation

Abstract:

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. ©2011 American Medical Association. All rights reserved.