title: Factors related to delayed graft function after laparoscopic live donor nephrectomy.
abstract: OBJECTIVE
  Delayed graft function after live donor transplantation affects 5% to 10% of recipients regardless of procurement technique. This delay in function is associated with an increased risk of rejection and decreased graft survival. In the present study we critically assess allograft recovery to identify the risk factors related to delayed graft function.
  
  
  METHODS
  We retrospectively reviewed donor and recipient medical records from 100 consecutive laparoscopic live donor nephrectomies from August 1997 to October 2001. Four criteria were used to classify delayed graft function: I) requirement of dialysis in postoperative week 1, II) creatinine 2.5 mg/dl or greater at postoperative day 5, III) time to half peak activity (mercaptoacetyltriglycine renal scan) at postoperative day 5 greater than 12.2 minutes (normal range 1 to 12.2) and IV) time to peak activity (mercaptoacetyltriglycine renal scan) at day 5 greater than 6.5 minutes (normal range 2.1 to 6.5). Patients could qualify for multiple outcome categories. Patients who did not match any of these criteria were classified as having normal renal function (outcome 0).
  
  
  RESULTS
  The number of patients in the delayed graft function categories were 5 with outcome I, 14 with outcome II, 39 with outcome III and 24 with outcome IV. There were 23 patients represented in more than 1 category and 59 patients were classified as having normal function. Recipient age, donor/recipient gender relationship, unrelated highly mismatched donors and cold/total preservation time were identified as risk factors related to impaired early renal function recovery. None of the variables related to the laparoscopic technique itself represented risk factors for delayed graft function.
  
  
  CONCLUSIONS
  Female donor kidneys into male recipients and highly HLA mismatched donors represent factors that may be controlled by donor selection when feasible. All attempts should be made to decrease cold ischemia time and, therefore, total preservation time. Prolonged carbon dioxide pneumoperitoneum, warm ischemia time, renal artery length or use of right kidney did not adversely affect the functional outcome of the allografts procured laparoscopically.
authors.affiliation: Section of Laparascopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Abreu
authors.forename: David A
authors.initials: DA
authors.lastname: Goldfarb
authors.forename: Ithaar
authors.initials: I
authors.lastname: Derweesh
authors.forename: Julie
authors.initials: J
authors.lastname: Thornton
authors.forename: Jean L
authors.initials: JL
authors.lastname: Urbain
authors.forename: Edward
authors.initials: E
authors.lastname: Mascha
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steinberg
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Stuart
authors.initials: S
authors.lastname: Flechner
authors.forename: Charles
authors.initials: C
authors.lastname: Modlin
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Krishnamurthi
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Novick
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000000981:diagnostic imaging / Q000502:physiology*; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011877:Radionuclide Imaging; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors