Kidney transplant surgery is a complex procedure that involves making a surgical incision to access the blood vessels required for the transplant. The incision is typically made in the lower part of the abdomen and can measure up to 20cm (8 inches) in length. However, patients with larger body sizes may require longer incisions, which can increase their susceptibility to wound infections. Unfortunately, wound infections are common after kidney transplant surgery, with up to 4 in 10 patients requiring treatment for this complication.

Patients with higher body mass index (BMI) and those with diabetes have an increased risk of developing wound infections after surgery. Such infections can be painful and may require additional hospital admission and sometimes even further surgery. In an effort to reduce the incidence of wound infections, several measures are routinely employed, including the use of antibiotics and sterilization of the skin before making the incision. However, new methods to reduce infections are still being sought.

One technique that may help reduce the risk of wound infection is the use of a subcutaneous drain placed before the wound is closed. This drain is positioned beneath the skin but above the muscle layer that protects the kidney. It collects any fluid produced by the wound and carries it into a container attached to the tube. Studies have shown that patients who undergo bowel operations with a drain experience fewer wound infections than those without a drain.

To determine whether the use of a wound drain can reduce the incidence of wound infections in kidney transplant patients, a study will be conducted in which patients will be randomly assigned to receive a subcutaneous wound drain or not (in addition to the deep sited surgical drain which is standard of care). The number of wound infections in each group will then be compared to determine the effectiveness of this technique.

Junior doctors from any Renal Transplant Unit are welcome to participate in the TWIST study. Please contact herrick-society@googlegroups.com to take part or for any questions about the project.