Dear Editor:

We read the interesting article by Dr. Sidebottom and associates published in your journal.¹ There is controversy in the literature about the necessity and duration of drains after transplant. Drains can act as a gateway for entry of organisms. In contrast, drains can give early warning of bleeding, urine leakage, or lymphatic leakage.^2-4 Drains can decrease the incidence of deep vein thrombosis and lymphocele formation and treatment.⁵ The study attempted to determine the association between drains and wound complications. There were some important limitations of this report. The most important limitation was the presence of selection bias. In this study, Patients at greater risk of wound complications had drains, and low-risk patients did not have drains. This important bias is a serious limitation in interpreting the results. We believe that in the high-risk group, early recognition of wound complications can minimize the morbidity of patients and decrease the incidence of complications. In addition, we believe that selective drain placement in high-risk patients can minimize cost and morbidity. Therefore, further investigations must define the selection criteria for drain placement.

References:

1. Sidebottom RC, Parsikia A, Chang PN, et al. No benefit when placing drains after kidney transplant: a complex statistical analysis. Exp Clin Transplant. 2014;12(2):106-112.
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2. Eufrásio P, Parada B, Moreira P, et al. Surgical complications in 2000 renal transplants. Transplant Proc. 2011;43(1):142-144.
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3. Mehrabi A, Fonouni H, Wente M, et al. Wound complications following kidney and liver transplantation. Clin Transplant. 2006;20(suppl 17):97-110.
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4. Watson CJE, Friend PJ. Surgical techniques of kidney transplantation. In: Morris P, Knechtle SJ. Kidney Transplantation - Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:161-175.
   PubMed
5. Derweesh IH, Ismail HR, Goldfarb DA, et al. Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation. BJU Int. 2008;101(11):1415-1419.
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