AIM: Postoperative infection following hand assisted laparoscopic donor nephrectomy (HALDN) confers significant morbidity. Previous reports suggest 1 in 5 patients develop infective complications. No modifiable risk factors are known and recent published UK guidelines on living kidney donation states that the role of antibiotic prophylaxis is unproven. We conducted a UK wide, multicentre, NIHR-funded placebo controlled double-blind randomised controlled trial of antibiotic prophylaxis in living kidney donation.

METHODS: Eligibility criterion was any subject suitable for HALDN, not allergic to penicillin. The study aimed to detect a 5% or greater reduction in the 30 day infection rate with a power of 90% (α 0.05) (sample size of 142-200 patients per arm). The trial was registered (EudraCT Number:2012-000942-36) and approved by an ethics committee[n2] . Donors were randomly and blindly allocated (with sealedenvelope.com) to a single dose of intravenous co-amoxiclav or intravenous saline less than 30 minutes prior to surgery. Patients and assessors were blinded to treatment group assignment. The primary endpoint was any postoperative infection (including surgical site infection, urinary tract infection, lower respiratory tract infection or any other microbiologically proven infection) at 30 days. The main analyses were by intention to treat. Statistical analyses were by Fisher's exact test binary logistic regression.

RESULTS: The trial was conducted between January 2013 and April 2016 in 5 UK transplant centres. 299 consented to the study. 285 subjects completed the study (143 antibiotic arm and 142 placebo arm). The mean age of the cohort was 45.4 years (SD 12.5) and was 42% female. Mean BMI was 26.7kg/m² (SD 7). There was no difference in patients demographic between groups. The total infection rate was 41.4% in the placebo group and 26.6% in the antibiotic group (p=0.006). The administration of perioperative antibiotic reduced the odds of developing infection by 50% (95% CI 31% – 82%). Surgical site infection rates alone were 21.4% (placebo) v 11.9% (antibiotic) (p=0.023). Significant adverse events were similar in both groups (14.7% v 15.7% p=0.514).

CONCLUSIONS: The administration of a single preoperative antibiotic dose confers significant reduction in the risk of developing postoperative infection following HALDN. A large component of this reduction stems from reducing surgical site infections.

CITATION INFORMATION: Ahmed Z., Uwechue R., Kessaris N., Mamode N. Prophylaxis of Wound Infections- Antibiotics in Renal Donation (POWAR): A Multicentre UK Double Blinded Placebo Controlled Randomised Controlled Trial Am J Transplant. 2017;17 (suppl 3).

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