Emerging Perspectives in TransplantationRenal transplantationMesh Hood Fascial Closure Is a Safe Alternative to Prevent Renal Allograft Compartment Syndrome During Kidney Transplantation

- Renal abdominal compartment syndrome (RACS) after allograft transplantation is an accepted severe complication.
- If there is high suspicion of RACS, a surgical technique should be used to prevent compression to allow adequate arterial and venous circulation.
- Mesh hood fascial closure can used to prevent or treat RACS with minimal risk.
- The pathophysiology of RACS is not clearly understood.

BackgroundRenal allograft compartment syndrome (RACS) is an under recognized yet important complication of kidney transplantation that can lead to early graft dysfunction and loss. The use of mesh for prevention and treatment of RACS in very selective circumstances has been documented previously in small case reports. However, it is unknown whether patient and graft survival rates are similar in patients undergoing renal transplantation with mesh placement for the prevention or treatment of RACS. The purpose of our study was to examine the risk factors, indications, and outcomes of mesh hood fascial closure (MHFC) use in the context of RACS prevention.MethodsAll patients who underwent kidney transplantation in our center between 2009 and 2013 were reviewed. Patients with mesh placed at the time of initial transplantation and secondarily at the time of reoperation were identified. Patient characteristics, Doppler ultrasound findings, and overall patient and graft survival rates were compared among patients with and without mesh placement.ResultsOf 600 patients who received a kidney transplant, 134 patients underwent mesh placement, 123 primarily and 11 secondarily. Our overall 1-year patient and graft survival rates compared between those with and without MHFC were, respectively, 97.5% and 94.8% compared to 98.5% and 95.5% with P > .05. Our mesh removal rate was 6% (8/134), and the rate of mesh infection was 1.6% (2/134).ConclusionsWe are the first to report the outcomes of MHFC for the prevention of RACS in patients undergoing renal transplantation. We found that MHFC in select circumstances has minimal risks and similar overall patient and graft survival rates when mesh is not used. Prospective studies to better understand the pathophysiology of RACS will aid in determining objective clinical indications for MHFC to improve allograft survival.