Identification of factors responsible for wound infection following allograft nephrectomy.

The advisability of routine allograft nephrectomy following rejection has not been clearly resolved. Rejected transplants may be a source of sepsis, local inflammatory symptoms, and continued antigenic stimulation. Transplant nephrectomy is, however, attended by a surprisingly high incidence of septic complications and death. In an attempt to analyze the occurrence of these, and identify effective prophylactic maneuvers, the authors retrospectively studied 99 consecutive allograft nephrectomies in 252 consecutive renal transplants. Mortality following allograft nephrectomy was 10 per cent, and usually attributable to sepsis. Wound infections occurred in 24 per cent of these patients and were significantly associated with a preoperative site of infection in the wound, urinary tract, or blood (P less than 0.01). Preoperative antibiotics, wound irrigation, drains, and delay in performing allograft nephrectomy were all found to be insignificant variables. Interestingly, total steroid dose was less in patients who developed wound infections than in those who did not (P less than 0.01). A postoperative wound infection approximately doubled the mean number of hospital days. These data suggest that a significant reduction in morbidity and possibly mortality could be accomplished by complete eradication of infection prior to allograft nephrectomy. Consequent delay in removal of the graft is not associated with increased morbidity, and other maneuvers seem to have little beneficial effect.