PDF(Pubmed)
Abstract：
Hand-assisted laparoscopic donor nephrectomy (HALDN) is widely performed to minimize burden on living kidney donors. However, hand port-site infections after HALDN may occur. This study aimed to assess the impact of donor characteristics including preoperative comorbidities and operative factors on hand port-site infection after HALDN.
In this single-center, retrospective cohort study, 1,260 consecutive HALDNs for living-donor kidney transplantation performed between January 2008 and December 2021 were evaluated. All living donors met the living kidney donor guidelines in Japan. Hand port-site infections were identified in 88 HALDN cases (7.0%). To investigate risk factors for hand port-site infection, donor characteristics including preoperative comorbidities such as hypertension, glucose intolerance, dyslipidemia, obesity, and operative factors such as operative duration, blood loss, preoperative antibiotic prophylaxis, and prophylactic subcutaneous suction drain placement at the hand port-site were analyzed using logistic regression analysis.
In the multivariate analysis, significant differences were identified regarding sex (P = 0.021; odds ratio [OR], 1.971; 95% confidence interval [CI], 1.108-3.507), preoperative antibiotic prophylaxis (P < 0.001; OR, 0.037; 95% CI [0.011-0.127]), and prophylactic subcutaneous suction drain placement at the hand port-site (P = 0.041; OR, 2.005; 95% CI [1.029-3.907]). However, a significant difference was not identified regarding glucose intolerance (P = 0.572; OR, 1.148; 95% CI [0.711-1.856]). Preoperative comorbidities may not cause hand port-site infections within the donors who meet the living kidney donor guidelines. Preoperative antibiotic prophylaxis is crucial in preventing hand port-site infection, whereas prophylactic subcutaneous suction drain placement may increase the risk of hand port-site infection.
In this single-center, retrospective cohort study, 1,260 consecutive HALDNs for living-donor kidney transplantation performed between January 2008 and December 2021 were evaluated. All living donors met the living kidney donor guidelines in Japan. Hand port-site infections were identified in 88 HALDN cases (7.0%). To investigate risk factors for hand port-site infection, donor characteristics including preoperative comorbidities such as hypertension, glucose intolerance, dyslipidemia, obesity, and operative factors such as operative duration, blood loss, preoperative antibiotic prophylaxis, and prophylactic subcutaneous suction drain placement at the hand port-site were analyzed using logistic regression analysis.
In the multivariate analysis, significant differences were identified regarding sex (P = 0.021; odds ratio [OR], 1.971; 95% confidence interval [CI], 1.108-3.507), preoperative antibiotic prophylaxis (P < 0.001; OR, 0.037; 95% CI [0.011-0.127]), and prophylactic subcutaneous suction drain placement at the hand port-site (P = 0.041; OR, 2.005; 95% CI [1.029-3.907]). However, a significant difference was not identified regarding glucose intolerance (P = 0.572; OR, 1.148; 95% CI [0.711-1.856]). Preoperative comorbidities may not cause hand port-site infections within the donors who meet the living kidney donor guidelines. Preoperative antibiotic prophylaxis is crucial in preventing hand port-site infection, whereas prophylactic subcutaneous suction drain placement may increase the risk of hand port-site infection.
摘要：
广泛进行手动腹腔镜供体肾切除术（HALDN），以最大程度地减少活体肾脏供体的负担。然而,HALDN后可能发生手部端口感染。这项研究旨在评估供者特征，包括术前合并症和手术因素对HALDN术后手部港口感染的影响。
在这个单中心，回顾性队列研究，评估了2008年1月至2021年12月期间进行的1,260例连续的活体肾移植HALDN。所有活体捐献者均符合日本活体肾脏捐献者指南。在88例HALDN病例中发现了手部港口感染（7.0％）。探讨手部港口感染的危险因素,供体特征包括术前合并症，如高血压，葡萄糖不耐受,血脂异常,肥胖，和手术因素，如手术持续时间，失血,术前抗生素预防，并使用logistic回归分析在手口部位的预防性皮下吸引引流放置。
在多变量分析中，在性别方面存在显著差异(P=0.021；比值比[OR]，1.971；95%置信区间[CI]，1.108-3.507),术前抗生素预防（P<0.001；OR，0.037；95%CI[0.011-0.127])，并在手口部位放置预防性皮下抽吸引流管(P=0.041；OR，2.005；95%CI[1.029-3.907]）。然而,关于葡萄糖不耐受，没有发现显着差异(P=0.572；OR，1.148；95%CI[0.711-1.856]）。术前合并症可能不会在符合活体肾脏供体指南的供体中引起手部港口部位感染。术前预防抗生素对预防手部港口感染至关重要，而预防性皮下吸引引流的放置可能会增加手部端口部位感染的风险。
在这个单中心，回顾性队列研究，评估了2008年1月至2021年12月期间进行的1,260例连续的活体肾移植HALDN。所有活体捐献者均符合日本活体肾脏捐献者指南。在88例HALDN病例中发现了手部港口感染（7.0％）。探讨手部港口感染的危险因素,供体特征包括术前合并症，如高血压，葡萄糖不耐受,血脂异常,肥胖，和手术因素，如手术持续时间，失血,术前抗生素预防，并使用logistic回归分析在手口部位的预防性皮下吸引引流放置。
在多变量分析中，在性别方面存在显著差异(P=0.021；比值比[OR]，1.971；95%置信区间[CI]，1.108-3.507),术前抗生素预防（P<0.001；OR，0.037；95%CI[0.011-0.127])，并在手口部位放置预防性皮下抽吸引流管(P=0.041；OR，2.005；95%CI[1.029-3.907]）。然而,关于葡萄糖不耐受，没有发现显着差异(P=0.572；OR，1.148；95%CI[0.711-1.856]）。术前合并症可能不会在符合活体肾脏供体指南的供体中引起手部港口部位感染。术前预防抗生素对预防手部港口感染至关重要，而预防性皮下吸引引流的放置可能会增加手部端口部位感染的风险。
