Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases.
OBJECTIVE
To review a single-institution 6-year experience with laparoscopic live donor nephrectomy detailing the technical modifications, clinical results, as well as the trends in donor and recipient morbidity.


BACKGROUND
Since 1995, laparoscopic donor nephrectomy has had a significant impact on the field of renal transplantation, resulting in decreased donor morbidity, without jeopardizing procurement of a high-quality renal allograft. This technique has become the preferred method of allograft procurement for many transplantation centers worldwide but still remains technically challenging with a steep learning curve.


METHODS
Records from 381 consecutive laparoscopic donor nephrectomies were reviewed with evaluation of both donor and recipient outcomes. Trends in donor and recipient complications were assessed over time by comparing the outcomes between four equally divided groups.


RESULTS
All 381 kidneys were procured and transplanted successfully with only 8 (2.1%) open conversions. Mean operative time was 252.9 +/- 55.7 minutes, estimated blood loss 344.2 +/- 690.3 mL, warm ischemia time 4.9 +/- 3.4 minutes, and donor length of stay was 3.3 +/- 4.5 days. There was a significant decline in total donor complications, allograft loss, and rate of vascular thrombosis with experience. The rate of ureteral complications declined significantly when comparing our early (Group A) versus later (Groups B-D) experience.


CONCLUSIONS
Laparoscopic donor nephrectomy has remained a safe, less invasive, and effective technique for renal allograft procurement. Over our 6-year experience and with specific refinements in surgical technique, we have observed a decline in both donor and recipient morbidity following laparoscopic live donor nephrectomy.
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA. LSU11@jhmi.edu
Li-Ming
LM
Su
Lloyd E
LE
Ratner
Robert A
RA
Montgomery
Thomas W
TW
Jarrett
Bruce J
BJ
Trock
Vladimir
V
Sinkov
Rachel
R
Bluebond-Langner
Louis R
LR
Kavoussi
D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000592:standards* / Q000639:trends; D010535:Laparoscopy / Q000592:standards* / Q000639:trends; D016014:Linear Models; D019520:Living Donors; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009017:Morbidity / Q000639:trends; D009392:Nephrectomy / Q000379:methods*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome