Quality of Life After Abdominal Wall Reconstruction and the Establishment of a Pathway for Renal Transplant Recipients

PURPOSE: The aims of this study were to evaluate outcomes and impact on quality of life (QoL) for patients undergoing abdominal wall reconstruction (AWR) and to describe the establishment of a pathway for renal transplant recipients. METHODS: A retrospective study of renal transplant recipients undergoing AWR for incisional hernia repair from 2015 to 2024, which included the transition point when the AWR pathway for renal transplant recipients was initiated at a large teaching hospital. Baseline characteristics, operative variables and postoperative complications were collected from electronic patient records. QoL was assessed through the distribution of standardized Hernia-related Quality-of-Life surveys (HerQLes). RESULTS: There were 34 patients with renal transplants who underwent AWR, and 26 were eligible to complete Hernia-related Quality-of-Life survey, with17 responding. Indications for transplantation varied; the most common was polycystic kidney disease (N = 7, 21%), and most patients had comorbidities (N = 33, 97%) and were overweight. Complications occurred in 13 patients (38%), most of which were Clavien-Dindo grades I/II (53%), and there was one death that prompted the formation of the pathway. Key pathway features discussed include prehabilitation, meticulous operative planning, and multidisciplinary input throughout. Following the establishment of the pathway, patients reported statistically significant improvements in all domains of QoL including psychological, physical, and sexual parameters. CONCLUSIONS: Incisional hernias negatively impact QoL; this is the first study to provide insight into the change in QoL for patients receiving renal transplants following AWR and demonstrates how a multidisciplinary pathway can improve outcomes. Patient selection is crucial, and future work should identify risk factors for the development of incisional hernias after renal transplantation.