Surgical-site infections (SSIs) occur in up to 11% of kidney transplant (txp) patients (pts). There is no consensus on the optimal peri-op prophylaxis regimen for renal txp surgery. The joint guideline from ASHP, IDSA, SIS, and SHEA states that peri-op antibiotics be given within 60min of incision and stop within 24h.

Prior to April 2014, our protocol was cefazolin (CFZ) 1g IV intra-op and q8h for 24h post-op. In April 2014, the protocol changed to CFZ 1g IV intra-op only.

Methods: This is a retrospective review of 100 pts who received a kidney txp alone. The historical protocol (Grp A, n=50) was compared to the current (Grp B, n=50). The primary objective is to determine if the change in regimen affected the rate and classification of SSIs, using the CDC definition for SSIs.

Results: Baseline demographics: avg age was 49yr (SD±18.8yr), majority was male, most pts received TAC/MPA/pred, and there was a similar number of DD kidney txp in each group. In Grp A, there was a higher use of antibody induction (n=32 vs 24), incidence of DGF (2 vs 0), and more pts with a BMI>27 (30 vs 20). At time of txp, DM, CAD and use of immunosuppression (IS) were more common in Grp A (16 vs 11, 9 vs 6, 10 vs 5).

No deep incisional nor organ space SSIs were found; 8 superficial incisional SSIs were identified (n=2 Grp A, n=6 Grp B). Risk factors for pts with SSIs are presented in Table 1. Four of the 8 pts with SSIs received surgical antibiotic(s) other than CFZ (n=1 Grp A, n=3 Grp B). The overall SSI rate in Grp A was 4% (2/50) and in Grp B was 12% (6/50). The rate increased to 20% (1/5) in Grp A and 30% (3/10) in Grp B in pts receiving a non-CFZ regimen. No SSIs occurred in pts who received ≥2g of CFZ intra-op (n=25 Grp A, n=18 Grp B).

Conclusion: More pts in Grp B had SSIs, despite a higher incidence of literature-reported risk factors in Grp A. More SSIs occurred when a non-CFZ regimen was used. No SSIs occurred when ≥2g of CFZ was used. Many risk factors for SSIs are non-modifiable at the time of txp, but the choice and dose of antibiotic is modifiable. Based on this retrospective review, the dosing recommendations from the joint guidelines should be implemented to minimize SSIs.

CITATION INFORMATION: Bliven K, Truax C, Snow K, Kenyon N, Carlson A, Yeager S, Smith L. Give One and Done? Evaluating a Change in Surgical Prophylaxis in Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress