Risk factors for wound healing complications in sirolimus-treated renal transplant recipients
Risk factors for wound healing complications in sirolimus-treated renal transplant recipients
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DOI：
10.1016/j.transproceed.2006.10.065
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发表时间：
2006-12-01
影响因子：
0.9
通讯作者：
Clark, N. M.
中科院分区：
文献类型：
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作者：
Grim, S. A.;Slover, C. M.;Clark, N. M.
接受西罗莫司 (SRL) 治疗的肾移植 (RT) 受者中有 20% 至 50% 的手术部位愈合受损，其中大多数患者同时接受了皮质类固醇治疗。我们确定了接受吗替麦考酚酯 (MMF) SRL 的 RT 接受者中手术部位并发症的发生率，其中大多数患者都采取了类固醇避免方案。将移植后 3 个月内出现并发症的 SRL/MMF 患者与 1) 无并发症的 SRL/MMF 患者和 2) 接受他克莫司 (FK)/MMF 的匹配 RT 受者进行比较。 2002 年 1 月至 2005 年 3 月期间，300 名 RT 接受者中有 44 名 (15%) 在移植后 6 周内接受了 SRL。 14 例 (31.8%) 出现淋巴囊肿、膀胱渗漏、伤口裂开、蜂窝织炎或脓肿。肥胖（BMI >= 30 kg/m(2)）与问题显着相关：有并发症的 SRL 病例的平均 BMI 为 29.9 kg/m(2)，而没有并发症的 SRL 患者的平均 BMI 为 25.4 kg/m(2) (P = .047)。 71% 的肥胖 SRL 患者出现并发症，而非肥胖 SRL 患者的这一比例为 24.3% (P =.025)。 29%的患者需要手术治疗。复杂 SRL 病例中维持类固醇的使用率与未使用类固醇的 SRL 患者相似。尽管 FK 对照组的 BMI、排斥反应率和长期使用类固醇与 SRL 组相似，但其并发症发生率较低（14.3%；P = 0.163）。肥胖和移植排斥是并发症的独立预测因素。因此，在接受 SRL 治疗的一组主要不使用类固醇的受者中，伤口并发症的发生率与之前观察到的相似，但在肥胖受者和有急性排斥反应的受者中观察到伤口并发症的风险最高。伤口并发症与显着的发病率相关。
Impaired surgical site healing occurs in 20% to 50% of sirolimus (SRL)-treated renal transplant (RT) recipients, with most patients having received concomitant corticosteroids. We determined the incidence of surgical site complications among RT recipients receiving SRL with mycophenolate mofetil (MMF), with most patients on a steroid-avoidance protocol. SRL/MMF patients with complications within 3 months of transplantation were compared with 1) SRL/MMF patients without them and 2) matched RT recipients receiving tacrolimus (FK)/MMF. Between January 2002 and March 2005, 44 of 300 (15%) RT recipients received SRL within 6 weeks of transplantation. Fourteen (31.8%) developed lymphocele, bladder leak, wound dehiscence, cellulitis, or an abscess. Obesity (BMI >= 30 kg/m(2)) was significantly associated with problems: the mean BMI of SRL cases with complications was 29.9 kg/m(2) vs 25.4 kg/m(2) for SRL patients without them (P = .047). Seventy-one percent of obese SRL patients experienced complications compared with 24.3% (P =.025) of non-obese SRL patients. Surgical treatment was required in 29% of patients. Rates of maintenance steroid use were similar in SRL complicated cases compared with SRL patients without them. The FK control group showed a lower rate of complications (14.3%; P =.163) despite similar BMI, rejection rates, and chronic steroid use as the SRL group. Obesity and graft rejection were independent predictors of complications. Thus, among a group of predominantly steroid-free recipients on SRL, the rates of wound complications were similar to those seen previously, but the highest risk for them was observed in obese recipients and in those with acute rejection episodes. Wound complications were associated with significant morbidity.