Treatment of incisional hernias in kidney transplant patients utilizing onlay acellular dermal matrix: a case series

Evaluate the use of component separation with onlay ADM placement in the treatment of incisional hernias following kidney transplantation. An IRB-approved retrospective study was conducted to examine the senior author's experience utilizing the multipoint suture technique with onlay biological mesh placement. We identified patients by searching CPT codes for ventral hernia repairs (49565–49566, 49560–49561) and myofascial flaps (15734) from January 2012 to December 2022, allowing for at minimum a year of follow-up data. We identified 6 patients who had previously undergone kidney transplantation. We gathered demographics, comorbidities, immunosuppressive regimens, laboratory values, and operative information. The primary outcome measures were complications and recurrences. This study included 6 transplant patients with a mean age of 59.7 years and an average BMI of 29.3 kg/m3. The time between the kidney transplant and abdominal wall reconstruction averaged 55.7 months. The average hernia defect size was 165 cm2 with a range between 30 and 450 cm2. The average follow-up time was 5.81 years. Postoperative complications were minimal with 1 patient (17%) developing an infection, that was adequately managed, and no patients developing a recurrence. The component separation technique with onlay ADM placement proved to be a reliable and safe approach for managing incisional hernias in renal transplant patients, demonstrating minimal complications and no recurrences. These findings support its use as an effective solution for this challenging population.