Comparison of Both Sides for Retroperitoneal Laparoscopic Donor Nephrectomy: Experience From a Single Center in China

doi:10.1016/j.transproceed.2017.02.062

Transplantation Proceedings

Volume 49, Issue 6, July–August 2017, Pages 1244-1248

https://doi.org/10.1016/j.transproceed.2017.02.062 Get rights and content

Highlights

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This is currently the largest case series of retroperitoneoscopic LDN in China.
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Retroperitoneoscopic LDN is a safe and effective operative method with a low incidence of complications.
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Right-side retroperitoneoscopic LDN can achieve equally safe and effective transplantation outcomes.

Abstract

Background

Laparoscopic donor nephrectomy (LDN) has gradually become the main approach to obtain live donor kidneys. However, the shorter right renal vein limits its wider application. The aim of this study was to compare the outcomes of left- and right-side retroperitoneal LDN.

Methods

We reviewed the perioperative data of 527 consecutive donors receiving retroperitoneal pure LDN with a new method at our center between April 2009 and April 2014. The patients were divided into group A (the first 100 patients) and group B (the remaining 427 patients). A total of 423 cases of left donor surgery and 104 cases of right donor surgery were compared. The comparison of the laterality of LDN was also performed between group A and group B.

Results

This is currently the largest case series of LDN in our country. Although right-side LDN patients had longer operation time and a slightly higher incidence of intraoperative complications compared with left-side LDN patients, the operation time was shorter in both the groups compared with previous reports. In group B, patients undergoing right-side LDN had longer operation time and more frequent complications. Once the learning curve of 100 cases was completed, the incidence of complications and operation time were greatly reduced in both sides for LDN. There was no significant difference in the serum creatinine levels in recipients at 6 months of follow-up.

Conclusions

Despite a slightly higher incidence of complications and longer operation time, right-side LDN can achieve equally safe and effective transplantation outcomes. This expands the source of potential donor kidneys.

Section snippets

Methods

A total of 527 consecutive living-relative retroperitoneal pure LDNs were performed at our center between April 2009 and April 2014. All operations were completed by the same transplant surgeon (T. Lin), using the retroperitoneal approach. There were no coercions or intimidations of the donors to donate their kidneys. All donors volunteered to donate their kidneys to their relatives. The living donors were evaluated by separate nephrologists and a donor advocate, who were not involved in the

Results

Patient data are shown in Table 1. There was no significant difference in the preoperative data between left and right donors, except for preoperative creatinine (66.49 ± 14.27 vs 63.16 ± 13.23 μmol/L, P = .032) and blood glucose levels, which marginally differed (5.23 ± 0.90 vs 4.98 ± 0.55 mmol/L, P = .008). We make no discovery of any factor affecting the measured outcomes of creatinine and glucose. This can only be attributed to chance.

All donors were discharged from the hospital at 4 days

Discussion

LDN is a safe operative method with a low incidence of complications. LDN does not affect the transplantation outcome and can reduce the surgical trauma and shorten the hospital stay, facilitating a quick return to normal activity.

This is currently the largest case series compilation of LDN in our country. Because of the shorter right renal vein and associated increased operative difficulties, most transplant surgeons prefer left-side donor kidneys. The transplantation outcome of left- and

Conclusions

LDN is a safe and effective operative method with a low incidence of complications. Although right-side LDN has a slightly higher incidence of complications and longer operation time, it can achieve equally safe and effective outcomes with skilled surgical techniques, comprehensive preoperative assessment of renal vessels, and selection of proper operation method. This expands the source of potential donor kidneys, providing more benefits to patients.

Acknowledgments

The authors acknowledge the collaboration of the transplantation team at West China Hospital, Sichuan University.

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Citation Excerpt :
These contrast some studies describing a better outcome in left donor nephrectomies, while other report on a worse outcome. However, all reported differences were minimal [22–24]. Although there was a clear decline in kidney function post operation, none of the donors required dialysis.
Studies on the surgical outcome in living kidney donors mainly report perioperative complications with short follow-up.
The objectives of this study are to evaluate the long-term surgical outcome in living kidney donors and to identify donors with an increased risk for a complicated postoperative course.
A prospectively collected database of 496 living kidney donors at the Department of General, Visceral, and Transplantation Surgery of the Ruprecht Karls University Heidelberg was retrospectively analyzed in a retrospective, observational single-center study.
The median follow-up time was 37 months. The perioperative severe complication (Clavien-Dindo IIIb) rate was 2.8%, the early postoperative (PO) severe complication rate (1-3 months post operation) was 0.7%, and the late PO severe complication rate (> 3 months post operation) was 8.4%. In multivariate analyses, male sex was associated with higher overall perioperative complication rate (odds ratio [OR], 1.930; P = .005) as well as higher rate of late PO complications (OR, 2.243; P = .014). An increased body mass index was associated with a higher late and severe (Clavien-Dindo ≥ IIIb) PO complication rate (OR, 1.107; P = .009 and OR, 1.105; P = .008, respectively).
Long-term surgery-associated severe complications occur in 8.4% of kidney donors. Older age is associated with an increased operative time, greater intraoperative blood loss, and longer PO hospital stay. Male donors and donors with an increased body mass index have a higher risk for a complicated PO course after kidney donation. Within a shared decision-making process before living kidney donation, special awareness should be brought to these facts.
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: This work was supported by a grant from the Natural Science Foundation of China (No. 30872579, No. 81470980).

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Advances in TransplantationKidney transplantationComparison of Both Sides for Retroperitoneal Laparoscopic Donor Nephrectomy: Experience From a Single Center in China

Highlights

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgments

Am J Transplant

Urology

Am J Transplant

Transplant Proc

Urology

Transplant Proc

Transplant Proc

Transplant Proc

Transplant Proc

Laparoscopic versus open nephrectomy for live kidney donors

Cochrane Database Syst Rev

Laparoscopic live donor nephrectomy

Transplantation

Advances in Transplantation
Kidney transplantation
Comparison of Both Sides for Retroperitoneal Laparoscopic Donor Nephrectomy: Experience From a Single Center in China