Transplant Trial Watch

Prophylaxis of Wound Infections-antibiotics in Renal Donation (POWAR): A UK Multicentre Double blind Placebo Controlled Randomised Trial.

Ahmed, Z., Uwechue, R. et al. (2019).

Annals of Surgery [record in progress].


Aims
This study aimed to assess if a single preoperative antibiotic dose can reduce post hand-assisted laparoscopic donor nephrectomy (HALDN) infections.

Interventions
Patients were randomized to receive either intravenous co-amoxiclav 1.2g or the equivelant volume of normal saline (0.9% saline) at the time of induction of anesthesia.

Participants
293 adult renal transplant donors undergoing HALDN. Patients who had a known allergy or previous adverse rection due to antibiotics were excluded.

Outcomes
Primary outcomes being assessed comprised postoperative infections, including, surgical site infections (SSIs), urinary tract infections (UTIs) and lower respirtory tract infections (LRTIs). Secondary outcomes included postoperative hospital stay, 30-day readmission rates and reoperation rates.

Follow-up
30 days

CET Conclusions
This multicentre UK study investigated the use of single-dose pre-operative antibiotics in hand-assisted donor nephrectomy. The study is randomised and blinded by use of a saline placebo. The investigators demonstrate a significant reduction in the risk of post-operative infection, including surgical site and lower respiratory tract infections. The study is well designed and reported, with clear outcome definitions. It is interesting that the baseline infection rate is considerably higher that that reported in the previous literature, which is likely due to under-reporting in retrospective studies rather than an excess of infection in the current study. Given the burden of infection in these patients, and the size of the reduction seen, it would appear that antibiotic prophylaxis is warranted. It is, however, not clear whether these findings extend to patients undergoing fully laparoscopic nephrectomy.

Jadad score
5

Data analysis
Strict intention-to-treat analysis

Allocation concealment
Yes

Trial registration
EudraCT Number: 000942-36

Funding source
Non-industry funded