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Background <p>Incisional hernia (IH) is a common complication after kidney transplantation, associated with significant morbidity, graft risk, and healthcare burden. Its etiology is multifactorial, but recent high-quality evidence identified wound closure technique as the most important modifiable predictor&#xa0;Huitfeldt et al.&#xa0;(Hernia: J Hernias Abdom Wall Surg 29(1):256 , <CitationRef CitationID="CR11">2025</CitationRef>).</p> Methods <p>We conducted a systematic review in accordance with PRISMA guidelines, searching databases through August 2025. Twenty studies involving 16,018 kidney transplant recipients were included. Reported risk factors were qualitatively and quantitatively synthesized, and weighted points were assigned to develop the Incisional Hernia Risk Scoring System (IH-RSS).</p> Results <p>The pooled incidence of IH was 4% (95% CI: 3–5%). Among affected patients, 61% required repair and 16% experienced recurrence. Independent predictors included peritoneal dialysis, obesity (BMI &gt; 30), advanced age, prior abdominal surgery, and surgical site infection. The strongest modifiable factor was the wound closure technique (modified Israelsson method), which reduced the odds of IH by 83%. The IH-RSS stratifies patients into low (0–5), moderate (6–10), and high (&gt; 10) risk groups, with corresponding preventive strategies, including reinforced closure, incision selection, and selective prophylactic mesh placement.</p> Conclusion <p>The IH-RSS represents the first comprehensive, transplant-specific, derivation-level risk scoring framework for incisional hernia after kidney transplantation. It is a proposed tool whose clinical utility requires validation. Prospective, multicenter validation is now non-negotiable to establish its predictive accuracy and confirm its role in improving long-term surgical outcomes for kidney transplant recipients before any clinical adoption can be recommended.</p>

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Incisional hernia after kidney transplantation: a systematic review and proposal of a peri-transplant risk scoring system for tailored preventive surgical planning

  • 期刊论文

  • 发表日期：

    2026年3月6日

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  • Hany M. El Hennawy,
  • Omar Safar,
  • Ghaleb A. Aboalsamh,
  • Salahadin Lamy,
  • Abdullah H. Almalki,
  • Laila F. Sadagah,
  • Ibrahim Tawahri,
  • Ahmed Nasr Shazly,
  • Tariq M. Jaber

摘要

Background

Incisional hernia (IH) is a common complication after kidney transplantation, associated with significant morbidity, graft risk, and healthcare burden. Its etiology is multifactorial, but recent high-quality evidence identified wound closure technique as the most important modifiable predictor Huitfeldt et al. (Hernia: J Hernias Abdom Wall Surg 29(1):256 , 2025).

Methods

We conducted a systematic review in accordance with PRISMA guidelines, searching databases through August 2025. Twenty studies involving 16,018 kidney transplant recipients were included. Reported risk factors were qualitatively and quantitatively synthesized, and weighted points were assigned to develop the Incisional Hernia Risk Scoring System (IH-RSS).

Results

The pooled incidence of IH was 4% (95% CI: 3–5%). Among affected patients, 61% required repair and 16% experienced recurrence. Independent predictors included peritoneal dialysis, obesity (BMI > 30), advanced age, prior abdominal surgery, and surgical site infection. The strongest modifiable factor was the wound closure technique (modified Israelsson method), which reduced the odds of IH by 83%. The IH-RSS stratifies patients into low (0–5), moderate (6–10), and high (> 10) risk groups, with corresponding preventive strategies, including reinforced closure, incision selection, and selective prophylactic mesh placement.

Conclusion

The IH-RSS represents the first comprehensive, transplant-specific, derivation-level risk scoring framework for incisional hernia after kidney transplantation. It is a proposed tool whose clinical utility requires validation. Prospective, multicenter validation is now non-negotiable to establish its predictive accuracy and confirm its role in improving long-term surgical outcomes for kidney transplant recipients before any clinical adoption can be recommended.