Short-term impact of carbon dioxide, helium, and gasless laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient.
BACKGROUND
Laparoscopic donor nephrectomy has the potential to increase the number of living kidney donations by reducing donor morbidity. However, studies have shown that raised intraabdominal pressure can result in transient renal dysfunction. Therefore, laparoscopically procured kidneys might be at higher risk for suffering a period of ischemia during pneumoperitoneum. The objective of this study was to investigate the short-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient.


METHODS
EXPERIMENT 1: KIDNEY DONOR: Initially, 36 brown Norway (BN) rats were randomized for three procedures: 2 h of carbon dioxide (CO2) insufflation (8 mmHg), 2 h of helium insufflation (8 mmHg), and 2 h of gasless technique (0 mmHg). After this, a unilateral nephrectomy was performed in all the animals. EXPERIMENT 2: RECIPIENT: Subsequently, 36 donor BN rats were subjected to a similar insufflation protocol, but after nephrectomy, a syngeneic kidney transplantation (BN-BN) was performed. Urine and blood samples were collected on postoperative days 1, 3, 7, and 14 for determination of renal function. Subsequently, donor and recipient kidneys were removed for histomorphologic and immunohistochemical analysis.


RESULTS
In both donors and recipients, no significant changes in serum creatinine, proteinuria, or glomular filtration were detected between the CO2, the helium, and the gasless control groups. In both experiments, histologic analysis of Kidney specimens did not show any deleterious effects from abdominal gas insufflation. Although kidney grafts exposed to CO2 showed significantly higher numbers of CD45+ leukocytes 3 days after transplantation, immunohistochemical analysis did not show significant differences in number of infiltrating cells (CD4, CD8, ED1, OX6, OX62) between the two insufflation groups and the gasless control subjects.


CONCLUSIONS
Abdominal gas insufflation does not have an adverse effect on the renal function of the kidney donor 1 week after laparoscopic donor nephrectomy. No differences in renal function or histomorphology were detected between syngeneic kidney grafts exposed to pneumoperitoneum and gasless control subjects.
Hazebroek
E J
EJ
Department of Surgery, University Hospital Rotterdam-Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
de Bruin
R W F
RW
Bouvy
N D
ND
van Duikeren
S
S
Bonthuis
F
F
Marquet
R L
RL
Bajema
I M
IM
Hayes
D P
DP
IJzermans
J N M
JN
Bonjer
H J
HJ
D000818:Animals; D002245:Carbon Dioxide / Q000009:adverse effects*; D006371:Helium / Q000009:adverse effects*; D007150:Immunohistochemistry; D007668:Kidney / Q000033:anatomy & histology / Q000166:cytology / Q000187:drug effects*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D051381:Rats; D011914:Rats, Inbred BN; D014185:Transplantation, Isogeneic / Q000379:methods
D002245:Carbon Dioxide; D006371:Helium