The association between skin-to-vessel distance and surgical complications in renal transplantation

INTRODUCTION: Obesity is common among renal transplant recipients and increases the risk of perioperative complications. This study evaluated whether the distance from the skin to the external iliac vessels (SVD) is associated with adverse surgical outcomes in renal transplant recipients. METHODS: A retrospective cohort study of 167 consecutive patients with preoperative cross-sectional imaging who underwent renal transplantation was conducted at a single center. SVD was measured as the distance from the skin to the anterior edge of the external iliac vein at its bifurcation through the musculoaponeurotic layer of the transversus abdominis and oblique muscles. The primary outcome was the rate of postoperative complications, classified by the Clavien-Dindo system. RESULTS: SVD was associated with wound dehiscence (area under the curve [AUC] 0.696, 95% confidence interval [CI] 0.55-0.84, p=0.007) and wound complications (AUC 0.719, 95% CI 0.60-0.84, p<0.001). Using an SVD threshold of ≥19 cm, we observed an overall accuracy of 87.4% for predicting wound dehiscence and 85.6% for any wound complication. The retrospective, single-center design and absence of standardized criteria for CT imaging are inherent limitations that can introduce several biases. CONCLUSIONS: SVD is associated with adverse perioperative outcomes in renal transplantation. Given the indication for preoperative imaging only in high-risk patients, prospective data with a more general renal transplant population is warranted to further evaluate SVD.