Efficacy and Risk Assessment of Single-Dose Antibiotic Prophylaxis in Living Donor Kidney Transplantation: A Retrospective Cohort Study.

Background

Surgical site infections (SSIs) and UTIs are common complications following kidney transplantation. The optimal duration of perioperative antibiotic prophylaxis remains controversial, but recent evidence supports the use of single-dose regimens.

Methods

We conducted a retrospective study of 100 consecutive living donor kidney transplant recipients at our institution between October 2012 and April 2023. All patients received a single intraoperative dose of intravenous cefazolin (1 g) as antibiotic prophylaxis. The primary outcomes were the incidence of SSI and UTI within 30 postoperative days. Univariate and multivariate analyses were performed to identify associated risk factors.

Results

The incidence rates of SSI and UTI were 7.0% and 9.0%, respectively. Multivariate analysis identified higher BMI as an independent risk factor for SSI (OR: 2.35; 95% CI: 1.17-4.72; P = .016), while ureteral stent placement was strongly associated with UTI (OR: 28.34; 95% CI: 8.78-119.83; P = .001). Female sex also showed a significant association with UTI (OR: 10.17; 95% CI: 1.92-22.56; P = .041).

Conclusions

Single-dose intraoperative antibiotic prophylaxis appears safe and effective for kidney transplantation, with infection rates comparable with those reported for extended regimens. However, our findings suggest that targeted prolongation of prophylaxis in patients with an elevated BMI or ureteral stents may enhance postoperative infection control without the need for universal extended regimens. These findings support the need for individualized prophylactic strategies. Further prospective studies are necessary to validate this approach.