title: Increased transplantation of kidneys with multiple renal arteries in the laparoscopic live donor nephrectomy era: surgical technique and surgical and nonsurgical donor and recipient outcomes.
abstract: BACKGROUND
  For anatomical and technical reasons, many transplant centers restrict laparoscopic live donor nephrectomy (in contrast with open live donor nephrectomy) to left kidneys.
  
  
  OBJECTIVE
  This change in surgical practice increases procurement and transplantation rates of live donor kidneys with multiple renal arteries (RAs), without affecting donor and recipient outcomes.
  
  
  METHODS
  Retrospective review at an academic tertiary care referral center comparing laparoscopically procured single vs multiple-RA kidney grafts (April 1997 to October 2000).
  
  
  METHODS
  Seventy-nine consecutive left laparoscopic live kidney donors and 78 transplant recipients.
  
  
  METHODS
  Donor and recipient complications and postoperative length of stay; cold and warm ischemia time; operating time; short-term and long-term graft function; and survival.
  
  
  RESULTS
  We noted multiple RAs in 21 (27%) of all kidneys. The proportion of donors with 1 or more perioperative complications was 19% in the single-RA group vs 10% in the multiple-RA group (P was not significant). For the recipients, we noted no significant differences between groups with respect to surgical complications, quality of early and late graft function, rejection rates, graft losses (all immunologic), and graft survival. Cold and warm ischemia time and length of stay were similar for donors and recipients in both groups. Median operating times were significantly longer for the multiple-RA vs single-RA group (difference, 41 minutes for donors and 45 minutes for recipients; P<.02).
  
  
  CONCLUSIONS
  While the introduction of laparoscopic live donor nephrectomy has significantly increased the number of grafts with multiple RAs (compared with historical open controls), this change in practice is safe for both donors and recipients from a patient outcome-based perspective. However, from an economic perspective, the longer operating time associated with multiple-RA grafts provides strong added rationale for optimization of surgical instruments and techniques to make right-sided laparoscopic nephrectomy a routine intervention.
authors.affiliation: Department of Surgery, University of California Davis Medical Center, 2315 Stockton Blvd, HSF #2021, Sacramento, CA 95817, USA. christoph.troppmann@ucdmc.ucdavis.edu
authors.forename: C
authors.initials: C
authors.lastname: Troppmann
authors.forename: K
authors.initials: K
authors.lastname: Wiesmann
authors.forename: J P
authors.initials: JP
authors.lastname: McVicar
authors.forename: B M
authors.initials: BM
authors.lastname: Wolfe
authors.forename: R V
authors.initials: RV
authors.lastname: Perez
mesh_terms: D000328:Adult; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007511:Ischemia / Q000209:etiology; D007668:Kidney / Q000098:blood supply* / Q000276:immunology / Q000378:metabolism / Q000601:surgery; D007674:Kidney Diseases / Q000097:blood / Q000276:immunology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012077:Renal Artery / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine