Prophylactic intra-abdominal drainage following kidney transplantation: a systematic review and meta-analysis

Introduction: An ongoing debate concerns the need for routine placement of prophylactic intra-abdominal drains following kidney transplantation. Aim: We conducted a systematic review and meta-analysis to determine whether such an approach brings any advantages in the prevention of perirenal transplant fluid collection, surgical site infection, lymphocele, hematoma, urinoma, wound dehiscence, graft loss, and need for reoperation. Methods: We conducted a random-effects meta-analysis of non-randomized studies of intervention comparing drained and drain-free adult renal graft recipients regarding perirenal transplant fluid collection and other wound complications. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the risk of bias. Results: Five studies at moderate to critical risk of bias were included. A total of 2094 renal graft recipients were evaluated. Our analysis revealed no significant differences between drained and drain-free patients regarding perirenal transplant fluid collection (pooled odds ratio [OR], 0.77; 95% confidence interval [CI], 0.28–2.17; I 2 = 72%), surgical site infection (OR, 1.64; 95% CI, 0.11–24.88; I 2 = 80%), lymphocele (OR, 0.61; 95% CI, 0.02–15.27; I 2 = 0%), hematoma (OR, 0.71; 95% CI, 0.12–3.99; I 2 = 71%), and wound dehiscence (OR, 0.75; 95% CI, 0.21–2.70; I 2 = 0%). There was insufficient data concerning urinoma, graft loss, and need for reoperation. Conclusions: The available evidence is weak. Our findings show that the use of intra-abdominal drains after kidney transplantation seems to have neither beneficial nor harmful effects on perirenal transplant fluid collection and other wound complications. The present study does not support the routine placement of surgical drains after kidney transplantation. In this systematic review and meta-analysis we summarize the most up-to-date evidence for and against the routine use of intra-abdominal drain following renal transplantation.