Assessing the perioperative gain of weight (Δweight) as a determinant of morbidity after kidney transplantation: a retrospective exploratory study.

Kidney transplantation (KT) is associated with a substantial risk of postoperative complications (POC) for which performant predictors are lacking. Data showed that a perioperative gain of weight (ΔWeight) was associated with higher risk of POC, but it remains unexplored in KT. This retrospective study aimed to investigate the association between ΔWeight and POC after KT. ΔWeight was calculated on postoperative day (POD) 2. POC were graded according to the Dindo-Clavien classification. Primary endpoint was overall POC. A total of 242 patients were included and 174 (71.9%) complications were reported. Patients showed a rapid gain of weight after KT. Mean ΔWeight was 7.83 kg (± 3.20) compared to 5.3 kg (± 3.56) in patients with and without complication, respectively (p = 0.0005). ΔWeight showed an accuracy of 0.74 for overall POC. A cut-off of 8.5 kg was determined. ΔWeight ≥ 8.5 kg was identified as an independent predictor of overall POC on multivariable analysis (OR 2.04; 95% CI 1.08-3.84; p = 0.025). ΔWeight ≥ 8.5 kg appeared as an independent predictor of POC after KT. These results stress the need to monitor weight in KT and to further investigate this surrogate with future studies assessing its clinical relevance.

Early peristomal complications: detailed analysis, classification and predictive risk factors.

INTRODUCTION: Peristomal complications are frequently neglected by surgeons. Our aim was to assess peristomal complications occurring within 30 days after surgery and identify predictive risk factors. METHODS: All patients who underwent stoma creation from January 2014 to June 2016 in our institution were included unless patients who died, had their stoma reversed or were lost to follow-up. Peristomal complications were retrospectively analysed using a photography database, a validated scale for peristomal skin lesions and the Clavien-Dindo score. Peristomal complications were categorized as absent, mild or relevant. Univariate and multivariate analysis were performed to identify risk factors for a) incidence of and b) persistence of relevant peristomal complications at 30 postoperative days. RESULTS: 111 patients were included, 16 (14%) patients had mild and 65 (59%) patients had relevant complications. The most common event was mucocutaneous separation in 57 (51%) patients. Complications were still present at 30 days in 36 (32%) patients. Double-barrel (vs end stoma) was an independent risk factor for significant morbidity (OR=2.394 (95%CI=1.082-5.293), p=0.030). Persistence of relevant complications at 30 days was more likely associated to urgent surgery (OR=4.239 (95%CI=1.105-16.257), p=0.035) and to ASA score III/IV (OR=5.963 (95%CI=1.447-24.569), p=0.013). Male sex (OR=0.246 (95%CI=0.069-0.874), p=0.030) and age over 70 years (OR=0.121 (95%CI=0.029-0.515), p=0.004) appeared to be protective. CONCLUSIONS: Early peristomal complications are common, usually mild. They are most likely to persist beyond 30 days in patients operated as emergencies and with an ASA score of III-IV. KEY WORDS: Complications, Complications, Stoma, Mucocutaneous separation.

The Typical Presentation Spectrum of Deep Vein Thrombosis Associated with Inferior Vena Cava Malformations.

Congenital malformations of the inferior vena cava (IVC) are rare and underreported. They can be a risk factor for deep venous thrombosis (DVT) as a result of inadequate venous drainage of the lower extremities through collateral circulation. The significant number of cases reported in the literature highlights their importance, warranting investigating their existence in younger individuals with idiopathic DVT of the lower extremities and pelvic veins. In this systematic review, we depict the typical presentation of IVC malformations, their management, and the management of their associated DVT.