Use of heparin and protamine sulfate during laparoscopic donor nephrectomy.
BACKGROUND
Our aim was to evaluate the necessity of heparin and protamine administration during laparoscopic donor nephrectomy.


METHODS
Data from 52 consecutive living-related laparoscopic donor nephrectomies performed at University of California Los Angeles between August 1999 and August 2001 were used for this analysis. For the purpose of this analysis, the patients were divided into three cohorts: group A received both heparin and protamine; group B received heparin only; and group C received neither. Intraoperative blood loss, length of admission, recipient creatinine at follow-up, and intraoperative and postoperative complications were compared between the groups. Statistical analysis was performed using a two-tailed test.


RESULTS
There were no significant differences between the groups with regard to patient age and gender. Intraoperative blood loss did not differ between group B (99+/-73 mL) and group C (82+/-54 mL) ( =0.4). None of the patients required blood transfusion. No graft loss occurred in any group. Length of hospital stay, excluding any preoperative days, was similar (2.8+/-0.7, 2.9+/-1.6, and 2.5+/-0.8 days, for groups A, B, and C, respectively, ( >0.05). No systemic thromboembolic complications were noted in any of the groups. One patient in group B was converted to an open procedure because of a difficult dissection unrelated to heparin administration. The mean recipient creatinine levels at follow-up in the recipients of kidneys from groups A, B, and C were not significantly different (1.1, 1.3, and 1.3; >0.05) through the extended follow-up period of 691, 286, and 97 days, respectively.


CONCLUSIONS
According to our experience, there is no apparent benefit in the administration of heparin alone or in the administration of protamine sulfate to reverse heparin anticoagulation during laparoscopic donor nephrectomy if heparin is given. This is not only in terms of bleeding complications but is also true in regard to recipient renal function through the follow-up period. It is important to note that our warm ischemic times were less than 2 minutes, because longer warm ischemic times may make the use of heparin a more important consideration. This is the first time that these questions have been studied in the laparoscopic donor nephrectomy population.
Perry
Kent T
KT
University of California Los Angeles, Department of Urology, Los Angeles, CA 90095, USA.
Zisman
Amnon
A
Gritsch
H Albin
HA
Pantuck
Allan
A
Schulam
Peter G
PG
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006494:Heparin Antagonists / Q000008:administration & dosage*; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011479:Protamines / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin