*Purpose: Wound complications and surgical site infections (SSIs) are common but morbid complications of transplant in immunosuppressed patients. Kidney transplant patients who are obese, highly immunosuppressed and diabetic are at further risk. These patients often end up with open incisions that require return to the OR, antibiotics, and weeks of routine dressing changes. New technologies, such as incisional wound vacuum assisted closure (VAC) devices, have been proven to reduce SSIs and wound complications other surgical fields. This aim of this pilot project was to study the impact of this technology in the kidney transplant population.

*Methods: Based on a historical cohort of kidney transplant patients at a large academic medical center, risk factors for wound complications were analyzed to inform inclusion criteria for incisional wound VAC (IWV) application. Patients with 1) BMI over 35 or 2) BMI over 30 and history of diabetes or thymoglobulin induction had an IWV applied with a JP drain during the transplant operation. The incisional vac was left in place for 7 days post-discharge. Patients were monitored for surgical site infection or fluid collection requiring intervention.

*Results: Between August 2019 and October 2020, 37.9% of our transplant patients met criteria for IWV placement. Eleven patients were able to be included in this pilot project. Four (36%) met criteria based on BMI≥35 all of whom were diabetic, one (9%) for BMI 30-35 & diabetes, and six (55%) were included for a BMI 30-35 & thymoglobulin induction. One patient’s IWV had to be removed early due to skin blistering. Three patients (27%) in the higher risk IWV group had a wound complication, in line with the overall benchmark. Over that time period, the programmatic SSI rate decreased from 14.1% to 10.1% (figure 1) and a reduction in wound complications from 32.9% to 22.5% (figure 2).

*Conclusions: A clinically significant decrease in the number of wound complications and SSIs was demonstrated over the study period. Though limited by small sample size and non-randomized design, incisional wound vacs appear safe to use in kidney transplant recipients. Further study is warranted to elicit the full impact of this technology in a population at high risk for wound complications.

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