Laparoscopic donor nephrectomy--an Iranian model for developing countries: a cost-effective no-rush approach.
OBJECTIVE
This study aimed to evaluate donor and graft outcome in kidney transplantations from laparoscopic donor nephrectomies.


METHODS
From June 2000 to June 2004, 341 laparoscopic donor nephrectomies were performed. Demographics and hospital records were reviewed. Mean ages of donors and recipients were 27.59+/-4.80 years (range, 20-56 years) and 35.36+/-14.85 years (range, 3-75 years).


RESULTS
Nephrectomy was left sided in 96.2%. Mean follow-up was 13.32+/-35.98 months. Mean warm ischemia time was 8.17 minutes (range, 2.5-19 minutes). Mean operative time was 260.34 minutes. Median serum creatinine levels (mg/dL) of the recipients were 1.30, 1.45, and 1.20 at day 7, and at 1 and 12 months. One-year graft survival was 92.7%, 94.6%, and 92.6% in the laparoscopic donor nephrectomy groups with warm ischemia times of less than 6, 6-10, and more than 10 minutes (P=NS). Conversion to open surgery occurred in 2.1% of donors, and reoperation was performed in 3.8% of laparoscopic donor nephrectomies. Blood transfusion was required in 7.1% of donors. Ureteral complications were observed in 2.1% of recipients. Vascular control was performed using medium-large clips instead of endo GIA, and the kidney was extracted via a suprapubic approach using the hand instead of an ENDOCATCH bag; hence, $600 was saved in each nephrectomy. No vascular accident occurred from pedicular vessels.


CONCLUSIONS
Laparoscopic donor nephrectomy can be performed with a less-expensive setup (to be expanded in developing countries) without jeopardizing results. Because warm ischemic time in our study did not affect graft outcome significantly, there appears to be no need to rush harvesting the kidney to achieve a better quality kidney. Vascular control using nonautomatic clips instead of more costly endo GIA and hand extraction of the kidney is safe, practical, and economical.
Simforoosh
Nasser
N
Department of Urology & Renal Transplantation, Urology Nephrology Research Center, Shahid Labbafinejad Hospital and Shahid Beheshti University of Medical Science, Tehran, Iran. Simforoosh@iurtc.org.ir
Basiri
Abbas
A
Tabibi
Ali
A
Shakhssalim
Nasser
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006085:Graft Survival; D006801:Humans; D007492:Iran; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics / Q000379:methods*; D013997:Time Factors