Skin Closure Technique Matters: Fewer Wound Infections After Kidney Transplant in Patients With Class 2 Obesity Using Subcuticular Sutures.

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.