Impact of intraoperative donor management on short-term renal function after laparoscopic donor nephrectomy.
OBJECTIVE
To determine whether intraoperative diuresis, postoperative recovery, and early graft function differ between laparoscopic open nephrectomy (LDN) and open donor nephrectomy (ODN).


BACKGROUND
Laparoscopic donor nephrectomy can reduce donor complications in terms of decreased pain and shorter convalescence. Although its technical feasibility has been established, concerns have been raised about the impaired renal function resulting from pneumoperitoneum and short- and long-term function of kidneys removed by LDN.


METHODS
Between December 1997 and December 2000, 89 LDNs were performed at the authors' institution. These were compared with 83 conventional ODNs performed between January 1994 and December 1997. Graft function, intraoperative variables, and clinical outcome were compared.


RESULTS
Laparoscopic donor nephrectomy was attempted in 89 patients and completed in 91% (81/89). Length of hospital stay was significantly shorter in the laparoscopic group. During kidney dissection, the amount of fluids administered and intraoperative diuresis were significantly lower for LDN. In recipients, mean serum creatinine was higher after LDN compared with ODN 1 day after surgery. From postoperative days 2 until 28, there were no differences in serum creatinine. Graft survival rates were similar for LDN and ODN.


CONCLUSIONS
Donors can benefit from an improvement in postoperative recovery after LDN. Assessment of an adequate perioperative hydration protocol is mandatory to ensure optimal kidney quality during laparoscopic procurement. The initial graft survival and function rates justify continued development and adoption of LDN.
Department of Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Eric J
EJ
Hazebroek
Diederik
D
Gommers
Michiel A
MA
Schreve
Teun
T
van Gelder
Joke I
JI
Roodnat
Willem
W
Weimar
H Jaap
HJ
Bonjer
Jan N M
JN
IJzermans
D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications; D016896:Treatment Outcome