A prospective comparison of simultaneous and sequential live-donor renal transplantation.
BACKGROUND
Traditionally, we have performed live- donor renal transplantations sequentially with a cold ischemic time (preservation time) of approximately 3 hr. By performing live-donor renal transplantations simultaneously, cold ischemic times can be reduced to 30 min or less. The purpose of this prospective study was to compare clinical outcomes and biologic markers of kidney function between live-donor renal transplantations performed either simultaneously or sequentially.


METHODS
Nine consecutive live-donor renal transplantations were performed in a simultaneous manner by two transplant surgeons. For comparison, 18 consecutive live-donor transplantations were performed sequentially by a single surgeon. Donor and recipient demographic factors, before transplantation, were compared. Posttransplantation comparisons included daily serum creatinine measurements for 5 days, urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) for 72 hr postoperatively, nuclear glomerular filtration rate (GFR) at 18 hr postoperatively, creatinine clearance at 96 hr postoperatively, and creatinine clearance at 3 and 6 months posttransplantation.


RESULTS
There were no differences in donor and recipient demographic factors preoperatively between the two groups. With simultaneous and sequential recipients, only the cold ischemic times were significantly different (simultaneous: mean=23.6 min; sequential: mean=191.7 min; P<0.01). After transplantation, no differences were detected in the daily fall of serum creatinine, nuclear GFR at 18 hr, or creatinine clearance at 96 hr, 3 months, or 6 months. In both groups, urinary NAG excretion reached a peak at 1 hr postoperatively and then slowly returned to baseline by 72 hr. There was no difference in the amount of NAG excretion between the two groups.


CONCLUSIONS
Our study found that there is no difference in tubular injury or postoperative GFR in live-donor kidney transplantations performed simultaneously or sequentially. Our findings indicate that a modest prolongation of the cold ischemic time has no detectable influence on posttransplantation renal function for live-donor transplantations.
Baverstock
Richard J
RJ
Division of Urology, Providence Health Care, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
Manson
A David C
AD
Liu
Li
L
Gourlay
William A
WA
D000118:Acetylglucosaminidase / Q000652:urine; D000328:Adult; D003404:Creatinine / Q000097:blood; D015925:Cryopreservation; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D003404:Creatinine; D000118:Acetylglucosaminidase