*Purpose: The advantages of Anterior Rectus Sheath (ARS) incision over traditional Gibson (GB) incision have been described for kidney transplantation. Therefore, we decided to compare those two incisions in regards to surgical site complication rates (SSC) in our center.

*Methods: We analyzed retrospectively data from 45 subsequent adults submitted to unilateral kidney transplantation utilizing ARS incision and compared to outcomes in 99 subsequent adults treated with the same operation applying a standard GB incision. All procedures were performed by the same attending surgeon within last 3 years.

*Results: There were significantly more patients 60 years old and older in ARS group- 55% comparing to 28% in GB group (p=0.006). Otherwise kidney donor and recipient characteristics did not differ between the groups. 60% of patients were male, median BMI was 27 (16-40), and 35% were diabetic. The donors were mostly deceased (90%), brain dead (54%) and median KDPI was 60%, (3-100). Delayed graft function rate was around 50% and length of hospital stay around (4-5 days) did not differed between the groups. The rate of surgical site complication (SSC) (wound infection or dehiscence) did not differ statistically: 14% in ARS vs 5% in GB group. All SSCs after ARS incision (6/6) were found in patient over 60 years old. Accordingly, SSC rate was significantly higher after ARS incision- 25% (6/24) in this age subgroup versus none after GB incision (p=0.002). In contrast, 80% of SSCs in GB group were found in obese (BMI>30) patients. Accordingly, the rate of SSC was significantly higher in GB versus ARS group in obese cohort: 12% vs 0 (p=0.015).

*Conclusions: We found significantly less SSCs in obese patient subpopulation after utilizing ARS versus Gibson incision for kidney transplantation. However, Gibson incision was superior in patients over 60 years old resulting in significantly less SSCs.

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