*Purpose: According to the CDC (2015-2016), 71.6% of the adult population in the United States has a BMI equal or higher than 25kg/m², and the living kidney donors are not exempt. This study aims to determine how the Body Mass Index (BMI) affects intraoperative and postoperative complications after hand-assisted laparoscopic living donor nephrectomies (HALLDN).

*Methods: We assessed complications of all HALLDNs (1/2000 to 7/2018) from surgery to discharge and per our center’s protocolized follow-up to 120 days. Baseline pre-donation characteristics were obtained at the moment of pre-donation evaluation. BMI was obtained one week before the HALLDN.

*Results: Of the 2837 HALLDNs, 2764 had research consent. The average age was 44.3 yrs. (18-77), 87.3% Caucasians, and 58.3% females. 35.9% had a history of abdominopelvic surgery, and 14.9% were current smokers. 1897 (68.6%) patients had a BMI > 25kg/m2. Among these donors, infraumbilical midline incision (1509, 79.5%) was more common compared to Pfannenstiel and paramedian incision. As seen in Table, the postoperative complications were 197 (10.4%, RR= 0.989 (0.782-1.251)), the need for readmission was 57 (3%, RR=0.651 (0.438-0.967)), and reoperation was 31 (1.6%, RR=0.83 (0.463-1.497)). There were more wound infections (56, 2.9%) in the donors with BMI≥ 25kg/m2 with RR= 2.3 (1.225-4.418) compared with the referent population. The Cochrane Armitage Trend expressed Z=2.24, (0.0127).

*Conclusions: Patients with a BMI ≥25kg/m2 have a 2.3-fold increase in having a wound infection after a HALLDN. Although higher BMI didn’t increase the overall complications, we consider that measurements should be taken to prevent wound infection after HALLDN.

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