New Immunosuppressive Therapies and Surgical Complications After Renal Transplantation

Abstract

Background: To analyze the association between the principal immunosuppressive drugs (mycophenolate mofetil, calcineurin inhibitors and mammalian target of rapamycin [mTOR] inhibitors) used in the routine management of kidney transplant patients and the development of postoperative surgical complications.

Materials and Methods: We analyzed 415 kidney transplants, studying the influence of various immunosuppressive regimens on the main postoperative surgical complications.

Results: The mean follow-up for the entire group was 72.8 months (± 54.2 SD). Patients treated with myeophonolate mofetil (MMF) and cyclosporine (n = 121) experienced a higher frequency of wound eventration odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2–23.5; P = .03) compared with azathioprine and cyclosporine (n = 71). Compared with transplant recipients treated with tacrolimus and MMF (n = 181), transplant recipients treated with cyclosporine and MMF (n = 121) had a significantly greater frequency of wound eventration (OR, 3.7; 95% CI, 1.5–9.5; P = .005), urologic (OR, 2; 95% CI; 1.02–3.9; P = .04), wound (OR; 2.2; 95% CI; 1.07–4.6; P = .03), late (OR, 1.7; 95% CI; 1.01–3.03; P = .04), and Clavien grade 3 surgical complications (OR; 1.9; 95% CI, 1.1–3.37; P = .01). Patients treated with mTOR inhibitors (n = 26) had higher rates of lymphocele (OR, 3.6; 95% CI, (1.1–11.4; P = .002) compared with those who received tacrolimus (n = 197).

Conclusions: New immunosuppressive drugs have improved short-term functional results; however, in some cases they seem to increase surgical complications rates.