141 Patient Perceptions and Practice Variability in Surgical Drain Use for High BMI Kidney Transplant Patients: Insights from a Large Multicentre Randomised Trial

Introduction
Wound infections are a common complication following kidney transplantation, affecting around 30% of obese recipients. Prophylactic subcutaneous drains are effective at reducing wound infection rates in some surgical procedures but are untested in transplantation. We present the findings of patient experience questionnaire as part of The Trial of Wound drain In Surgical site infection in kidney (TWIST), a trainee-led UK multi-centre randomised controlled trial.

Methods
Participants with a BMI of >30 were recruited between April 2019 and April 2024, and were randomised to subcutaneous drain or no subcutaneous drain and stratified by BMI (30-34.9, 35-35.9, 40+) and diabetes. The use of a simultaneous deep drain was at the surgeon's discretion. Participants completed a patient-reported outcome measures (PROM) questionnaire at discharge.

Results
330 patients were recruited from nine UK transplant centres. No significant differences were identified in patient-reported outcomes for pain, mobility, or sleep quality among groups receiving no drains, a superficial drain, a deep drain, or both. Similarly, no significant differences were found in wound or drain site leakage however, a notable 18.9% of patients indicated they would refuse a drain in future. One centre did not use deep drains in any patients, while two centres used them in 100% of patients. In the remaining six centres, deep drain usage ranged from 27% to 93%.

Conclusions
Drains were well tolerated by the majority of kidney transplant recipients although an unexpected number would refuse future drain use and there was wide variation in drain use between UK transplant centres.