Prediction of incisional hernia after kidney transplantation: analysis of wound closure technique and risk factors.

Abstract

Purpose: Incisional hernia (IH) is a common complication after kidney transplantation, impacting morbidity and quality of life. This retrospective study aimed to identify IH risk factors and develop a predictive model.

Methods: We retrospectively analysed 667 adult kidney transplant recipients (2010-2017) from two transplant centres. Medical records were screened for symptoms of abdominal wall impairment, postoperative CT scans assessed, and factors associated with IH analysed. Using the Penn Hernia Calculator, hernia probability was calculated. Adult kidney recipients transplanted 2018-2019 in Region Stockholm served as verification cohort. In a subgroup with preoperative CT scans after progression to stage 5 chronic kidney disease, muscle quality was assessed. A wound closure technique using self-locking knots, two-layer parietal running suture, and a suture-to-wound length ratio ≥ 4:1 was termed "modified Israelsson."

Results: Logistic regression identified age, BMI, renal replacement therapy duration, and wound closure technique as independent IH risk factors (pseudo R² = 0.15). The "modified Israelsson method" reduced IH odds by 83% (OR = 0.17). Sarcopenia and myosteatosis were not significant predictors. In the verification cohort, the model had 76% sensitivity for high-risk patients (≥ 10% predicted IH risk), outperforming the Penn Hernia Calculator.

Conclusion: Wound closure technique is the strongest modifiable predictor of symptomatic IH identified in this cohort. The "modified Israelsson method" is a straightforward technique that shows strong promise for reducing incisional hernia (IH) rates and appears highly implementable. Our findings also underscore the value of developing specific predictive models for kidney transplant recipients, as generic tools may not capture crucial intraoperative factors.