CT-Assisted Visceral Fat Area Measurement Outperforms BMI as a Predictor of Wound Complications in a Predominantly Hispanic Population

Background: Wound complications, including surgical site infections (SSIs) and wound dehiscence, are significant contributors to morbidity following kidney transplantation (KT), particularly in patients with elevated body mass index (BMI). This study investigates whether visceral fat area (VFA), measured using CT imaging, provides a more accurate predictor of post-transplant wound complications than BMI in a predominantly Hispanic population. Methods: This single-center retrospective study reviewed 123 KT recipients with a BMI ≥30, transplanted between January 2016 and July 2024. Demographics, VFA, sutures vs staples, wound complications within three months post-transplant (PT), and graft function were analyzed. Wound complications included surgical site infections (SSI), wound dehiscence, and the need for vacuum-assisted wound closure. VFA was quantified from abdominal/pelvic CT scans. Results: Among the 123 patients, 48.8% were male, 51.2% female, 31.7% American Indian, 11.4 % non-Hispanic White, 52.% Hispanic White, 2.4% Black, 0.9% Asian, and 1.6% unknown. BMI ranged from 30–39 among the 19.5% of patients who developed wound complications, but BMI did not correlate with SSIs or wound dehiscence. 13% required vacuum-assisted wound closure, and 4.1% developed SSIs within the first month PT. 70.8% of patients with wound complications had diabetes mellitus (DM) as a comorbidity. Notably, VFA ≥4 cm was observed in 91.7% of patients with wound complications. All female patients with wound complications had a VFA ≥4.9 cm, with most exceeding 5.6 cm. Furthermore, 50% of patients with VFA ≥8 cm experienced wound complications. Wound complications occured in 21.7% of patients with staples vs 9.1% of patients with sutures. Conclusion: VFA measured via CT imaging is a more reliable predictor of wound complications than BMI in post-renal transplant patients. Sutures for wound closure were also found to reduce the wound complication rate by more than half in this study. Given these findings, incorporating VFA assessment into KT evaluations may enhance risk stratification, and using sutures for wound closure may be preferred. Further studies are needed to explore whether VFA thresholds could serve as a relative contraindication for KT wait-listing, particularly in patients with BMI ≥40.