Table 2 SSI prevention and management key-points (SSI surgical site infection, VEGF vascular endothelial growth factor, iNPWT incisional negative pressure wound therapy)

General consideration

Suggestion: the very first and fundamental step to reduce SSI rate is the improving of adherence to SSI care bundles and guidelines at all steps of patient management.

Immunosuppressant and wound healing-impairing therapy

Suggestion: immunosuppressant therapy must be carefully evaluated in a multidisciplinary approach in the event of emergency or elective surgery.

Suggestion: immunosuppressant therapy adjustment should be taken into account in the perioperative period in emergency or elective surgery in transplanted patient.

Suggestion: mTOR sparing regimen may be considered in the perioperative period.

Suggestion: in patients under mTOR inhibitors treatment, it may be considered to switch to a calcineurin inhibitor or other immunomodulatory regimens in the perioperative period.

Suggestion: in emergent procedures on patients currently assuming drugs that may affect wound healing or SSI rate (anti VEGF, steroids, etc.), an accurate and balanced multidisciplinary plan for therapy and surgery is mandatory.

Negative pressure wound therapy

Suggestion: iNPWT have shown no harm but it is scarcely effective in reducing SSI in immunocompromised and high-risk patients undergoing surgical procedures.

Suggestion: iNPWT may be considered an option to treat or prevent wound complications after solid organ transplant.

Skin closure

Suggestion: partial skin closure with interrupted stitches is a feasible option to reduce SSI in transplanted patients. This option should be considered even in the event of emergency abdominal surgery in immunocompromised patients.

Suggestion: early definitive skin closure should be considered once the risk of SSI has been reasonably cleared out.

Surgical drain

Suggestion: surgical drains placement in transplant patients seems to not influence the wound complication rate.