Faculty Collaboration Database

Skin Closure Technique Matters: Fewer Wound Infections After Kidney Transplant in Patients With Class 2 Obesity Using Subcuticular Sutures. Clin Transplant 2025 Nov;39(11):e70371

Date

11/05/2025

Pubmed ID

41191601

DOI

10.1111/ctr.70371

Scopus ID

2-s2.0-105020993386 (requires institutional sign-in at Scopus site)

Abstract

INTRODUCTION: Obesity remains a challenge for kidney transplantation, with risks of surgical site infection (SSI). Good data do not exist to indicate if the closure method correlates with infection rates. Our goal was to examine sutured and stapled closures to assess differences in wound complications through a retrospective cohort analysis.

METHODS: We reviewed records from 2017 to 2025, reviewing kidney recipients with class 2 obesity (BMI ≥ 35 kg/m²). We compared the outcomes of recent transplants using sutured closures or stapled closures. Charts were reviewed for 7 weeks following transplant to assess for wound complications.

RESULTS: Cohorts were equivalent regarding age, sex, race, and diabetes status. Those receiving sutured closures had longer dialysis length, higher BMI, lower median cPRA, and more use of subcutaneous drains. Patients with sutured closures received kidneys from younger donors with a lower KDPI, and were pumped less often. Wound separation was equivalent between groups (24% vs. 18%, p = NS). There were fewer episodes of erythema (2% vs. 12%, p = NS) and purulence (0% vs. 7.4%, p = NS) with sutures and a statistically lower rate of antibiotic prescription (2% vs. 15%, p = 0.023). Univariate logistic regression showed sutured closure as the strongest factor associated with decreased risk of composite infectious complications.

CONCLUSION: Our results indicate that the use of subcuticular sutures, surgical glue dressing, and incision planning away from the abdominal pannus may result in fewer infections relative to stapled closure. Multicenter, prospective trials may establish an optimal approach to minimize wound infection risk following kidney transplantation in obese patients.

Author List

Cerise A, Jethwani P, Liaqat A, Balaraman V, Talwar M, Vanatta JM, Helmick RA

Author

Ryan Helmick MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Body Mass Index
Female
Follow-Up Studies
Graft Survival
Humans
Kidney Failure, Chronic
Kidney Transplantation
Male
Middle Aged
Obesity
Prognosis
Retrospective Studies
Risk Factors
Surgical Wound Infection
Suture Techniques
Sutures