189 The establishment of an abdominal wall reconstruction pathway for renal transplant recipients and the impact on quality of life

Abstract Introduction Incisional hernias following renal transplantation are uncommon, occurring in approximately seven percent of patients. However, their occurrence can have devastating consequences including loss of transplant, and negative Quality of Life (QoL). Specialised management is required due to patient complexity coupled with ongoing immunosuppression. The aims of this study are to describe the establishment of a pathway for the management of incisional hernias in renal transplant patients, to evaluate outcomes and impact on QoL. Methods A retrospective study including renal transplant recipients undergoing Abdominal Wall Reconstruction (AWR) from September 2015 to March 2024, including the transition point when the AWR pathway was initiated at a large teaching hospital. Baseline characteristics, operative variables and postoperative complications were collected from electronic patient records. QoL was assessed through standardised HerQLes (Hernia-related Quality-of-Life) surveys. Results There were 31 renal transplant recipients who underwent AWR, 26 were eligible to complete the HerQLes and 17 responded. Transplant indication varied, and complications occurred in 14 patients (45.2%), most of which were Clavien-Dindo grade two (57.1%). One death prompted the formation of the AWR pathway. Key successes from the pathway were the use of mesh repair without component separation and input from the multidisciplinary team. Patients reported improvements in all QoL domains including psychological, physical and sexual parameters. Conclusions Incisional hernias are a rare but serious complication following renal transplantation. This study shows that a multidisciplinary team AWR pathway can improve QoL. Patient selection is crucial and future work should focus on identifying risk factors for incisional hernia.