Panniculectomy in end-stage renal disease: Six-year experience of performing panniculectomy in preparation for renal transplant

Background: Patients with end-stage renal disease evaluated for renal transplantation are frequently declined secondary to obesity and decreased functional status. As a result, many of these patients lose weight intentionally in an effort to gain candidacy on the transplant waiting list. This frequently produces a panniculus encompassing the lower abdominal surgical site used for renal transplantation. These patients are declined for renal transplantation secondary to predictable wound-healing complications. Materials and Methods: We previously identified significant weight loss (>10 kg) before renal transplantation as a risk factor for wound-healing complications after kidney transplant. Since that time, we have successfully performed 21 panniculectomies in renal transplant candidates (5 men and 16 women) with an average age of 55 years (range, 27-67 years) and an average body mass index of 30.2 kg/m² (range, 24.5-38.7 kg/m²) after significant weight loss, with an average maximum weight loss before panniculectomy of 37.7 kg (range, 5.5-83.2 kg), and median body mass index decrease before panniculectomy of 14 kg/m² (range, 2.0-23.6 kg/m²). Results: We observed minor wound-healing complications (cellulitis or superficialwound separation) in 8 patients (38%), major wound-healing complications (hematoma, seroma, or unplanned return to the operating room) in 3 patients (14%), and no medical complications (defined as urinary tract infection, pulmonary embolism, pneumonia, deep venous thrombosis, central venous access loss, or myocardial infarction). Seventeen patients have been relisted on the transplant waiting list. Of the patients who have not been relisted on the transplant waiting list, no patient had his or her candidacy delayed secondary to complications of their panniculectomy. Of the patients who have been relisted, 6 have undergone transplantation. Of these 6 patients, no one has experienced wound-healing complications, 1 patient experienced delayed graft function and 1 patient experienced mild transaminitis resolved by discontinuing statin therapy. Conclusions: Panniculectomies in preparation for renal transplant may be performed in patients with end-stage renal disease with an acceptable complication rate, converting previously ineligible patients into eligible candidates for kidney transplant. It also seems those who undergo panniculectomy before kidney transplant may expect to have lower rates of wound complications after their transplant had they not had a panniculectomy.