Effect of Fibrin Glue on the Incidence of Surgical Complications After Living-Related-Donor Kidney Transplantation: Results of a Randomized Clinical Trial.
Fuentes-Orozco C, Gonzalez-Mercado S, et al.Annals of Transplantation 2016; 21: 587-595.
Aims
To evaluate whether the use of fibrin glue reduces postoperative surgical morbidity in patients undergoing living-donor kidney transplantation.
Interventions
Participants were randomly assigned to receive either 10mL of fibrin glue at the surgical site including the vascular and ureteral anastomoses, and at the surgical bed at the end of renal transplantation surgery (intervention group), versus no application of fibrin glue (control group).
Participants
157 candidates for living-related-donor kidney transplantation aged 16-60 years with no allergies to the components of the fibrin glue.
Outcomes
The primary measured outcome was any surgical complication derived from the kidney transplantation, including wound complications such as dehiscence, superficial and deep site infection, and hernia formation. Secondary outcome measures included lymphatic, vascular, urological and medical complications.
Follow-up
6 months
CET Conclusions
This RCT from Mexico investigated the role of fibrin glue in reducing surgical complications following live renal transplantation. Patients in the study group had 10ml of fibrin glue applied to the vascular and ureteral anastomoses and the surgical bed prior to wound closure. The authors report fewer surgical complications in the study group, although numbers were too small to demonstrate a difference in any individual complication. The study is adequately randomised and the authors attempted to blind outcome assessment by blinding recovery staff and patients to group. It is unclear how this blinding was performed or if it was successful. The main effect seems to be a reduction in bleeding/haematoma formation. The only concern, not addressed in the discussion, is the impact of the use of fibrin glue on scar formation and subsequent graft nephrectomy/retransplantation. As we become more successful in treating transplant recipients, more and more patients are requiring second and third grafts and the implications of technique during first surgery should be considered, particularly for younger patients.
Data analysis
Per protocol analysis
Trial registration
Clinicaltrials.gov - NCT01631448