Long-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient rats.
OBJECTIVE
To investigate the long-term impact of pneumoperitoneum used for 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, function of laparoscopically procured kidneys might be at risk due to ischemia as a consequence of elevated intra-abdominal pressure during laparoscopy.


METHODS
In experiment 1, 30 Brown Norway rats were randomized to three procedures: 2 hours of CO2 insufflation, 2 hours of helium insufflation, and 2 hours of gasless laparoscopy. After this, a unilateral nephrectomy was performed in all animals. Another six rats were used as controls. In experiment 2, 36 donor Brown Norway rats were subjected to a similar insufflation protocol, but after nephrectomy a syngeneic renal transplantation was performed. All rats had a follow-up period of 12 months. Urine and blood samples were collected each month for determination of renal function. After 1 year, donor and recipient kidneys were removed for histomorphologic and immunohistochemical analysis.


RESULTS
In donors as well as in recipients, no significant changes in serum creatinine, proteinuria, or glomerular filtration rate were detected between the CO2, the helium, and the gasless control group after 1 year. No histologic abnormalities due to abdominal gas insufflation were found. Immunohistochemical analysis did not show significant differences in the number of infiltrating cells (CD4, CD8, ED1, OX62, and OX6) and adhesion molecule expression (ICAM-1) between the three groups.


CONCLUSIONS
Abdominal gas insufflation does not impair renal function in the donor 1 year after LDN. One year after transplantation, no differences in renal function or histomorphology were detected between kidney grafts exposed to either pneumoperitoneum or a gasless procedure.
Hazebroek
Eric J
EJ
Department of Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands.
de Bruin
Ron W F
RW
Bouvy
Nicole D
ND
Marquet
Richard L
RL
Bonthuis
Fred
F
Bajema
Ingeborg M
IM
Hayes
Don P
DP
Ijzermans
Jan N M
JN
Bonjer
H Jaap
HJ
D000818:Animals; D002245:Carbon Dioxide; D003404:Creatinine / Q000097:blood; D006371:Helium; D007150:Immunohistochemistry; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D007668:Kidney / Q000737:chemistry / Q000166:cytology / Q000502:physiology*; D016030:Kidney Transplantation / Q000502:physiology*; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy; D009929:Organ Size; D011028:Pneumoperitoneum, Artificial; D011507:Proteinuria; D051381:Rats; D011914:Rats, Inbred BN; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D014556:Urine
D018799:Intercellular Adhesion Molecule-1; D002245:Carbon Dioxide; D006371:Helium; D003404:Creatinine