Ureteric stents, drains, skin staples not necessary for uncomplicated renal transplants

Conventional interventions including wound drains, ureteral stents and stapled skin closures bypass may no longer be needed for uncomplicated renal transplants, suggests a Singapore study.

“Potential complications associated with the placement of these interventions can be avoided without compromising on the safety of patients and the outcome of transplants,” the researchers said.

A series of 33 patients who received stentless, tubeless/drainless, and suture-apposed living donor renal transplants (STAR group) were reviewed. Results were then compared to those of a control non-STAR group of 36 patients for which all three interventions of drains, stents and skin staples were applied.

No significant between-group differences were seen in demographics and clinical characteristics. No substantial differences were noted as well between the STAR and non-STAR groups in overall surgical complications, such as wound infection (1 vs 2; p=0.607), seroma (1 vs 5; p=0.110), perinephric collections (9 vs 7; p=0.441), urinoma (0 vs 0; p=0.00), bactaeriuria (1 vs 6; p=0.282) or vascular implications (1 vs 5; p=0.110). [Singapore Med J 2020;doi:10.11622/smedj.2020052]

Analyses based on the interventions specific for preventing complications revealed a slightly more asymptomatic perinephric collections and two lymphoceles requiring treatment in the STAR group, but these differences did not reach statistical significance. Likewise, there was no significant difference in ureteric or skin complications. Good outcomes for renal function, graft survival and patient survival were similar between the two groups.

“In an effort to reduce the surgical morbidity associated with kidney transplantation, the present study showed that modification of the surgical technique by simplifying surgical site interventions to reduce the use of stents, drains and surgical staples did not result in a significant increase in surgical site complications among selected patients,” the researchers said.

These findings support recent studies that challenge or modify the conventional open kidney transplantation technique, such as recent publications on minimally invasive kidney transplantation. [J Minim Access Surg 2015;11:35-9]

“While robotic or laparoscopic kidney transplantation can only be performed at high-volume centres at high cost, with outcomes as yet unproven to be improved, our study described relatively simple and less radical changes that can be performed at most centres, with reduction in morbidity and costs,” the researchers claimed. [Transplantation 2003;76:1729-1734]

Moreover, previous studies have individually reported the safety of the nonuse of stents, drains or surgical skin staples for open kidney transplantation. [Transplantation 2008;85:986-991; Eur Rev Med Pharmacol Sci 2014;18:3551-3556; Cochrane Database Syst Rev 2013;6:CD004925; Am J Transplant 2017;17:2129-2138]

“Our study uniquely combined the selective use or nonuse of these interventions into a wound management programme for kidney transplantation that was individualized to patients depending on their risk factors,” the researchers said.

The current study was limited by its small sample size and selection bias as surgeons selectively applied the nonuse of stents, drains and skin staples, according to the researchers.