Two hundred one consecutive living-donor nephrectomies.
OBJECTIVE
To assess donor morbidity, recipient outcome, and changing trends during the past decade in donor nephrectomy for living-donor kidney transplantation.


METHODS
Retrospective review at an academic tertiary care referral center.


METHODS
We reviewed 201 consecutive living-donor kidney transplantations performed between January 1988 and June 1997.


METHODS
Donor nephrectomy and living-donor kidney transplantation.


METHODS
Donor surgical complications, correlation of preoperative imaging of donor vascular anatomy and operative findings, and donor lengths of stay in the hospital were analyzed. Recipient delayed graft function and actuarial 1- and 5-year patient and graft survival rates were also analyzed.


RESULTS
Major donor postoperative complications were bleeding (0.5%), pneumothorax requiring a chest tube (1%), wound infection (1%), and pneumonia (1%). Minor postoperative complications were asymptomatic pneumothorax resolving spontaneously (10%), urinary retention (6%), and urinary tract infection (0.5%). Preoperative imaging failed to detect small accessory renal arteries in 12% of donors. The mean donor length of stay in the hospital was 5.0 days but decreased from 6.2 to 4.0 days during the study. Twenty donors (10%) were unrelated (ie, spouse or friend). Three (1.5%) cases of delayed graft function occurred. Overall recipient patient survival at 1 and 5 years was 97% and 90%, and graft survival was 95% and 83%, with no difference between related and unrelated living donors.


CONCLUSIONS
Living-donor nephrectomy is associated with low surgical morbidity. Recent trends include shortened lengths of stay in the hospital, the use of computed tomographic angiography instead of digital subtraction angiography for preoperative imaging of donor vascular anatomy, and an expanded use of unrelated living donors.
Shaffer
D
D
Division of Organ Transplantation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass 02215, USA.
Sahyoun
A I
AI
Madras
P N
PN
Monaco
A P
AP
D000206:Actuarial Analysis; D015901:Angiography, Digital Subtraction; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D007902:Length of Stay / Q000639:trends; D019520:Living Donors; D008297:Male; D009017:Morbidity; D009392:Nephrectomy / Q000706:statistics & numerical data / Q000639:trends; D011182:Postoperative Care / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care / Q000639:trends; D012077:Renal Artery / Q000033:anatomy & histology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome