Warm ischemic time during laparoscopic live donor nephrectomy: effects on graft function.
BACKGROUND
Laparoscopic live donor nephrectomy (LDN) has become established as a safe and effective alternative to the open procedure. However, the effect of prolonged warm ischemia time (WIT) during retrieval of the kidney remains unclear. The aim of this study was to analyze the effects of WIT on short-term and long-term graft outcomes after LDN.


METHODS
In this retrospective analysis of LDN the effects of WIT on delayed graft function, rate of decline in serum creatinine concentration (SCr) in the first 10 days, changes in SCr at 3 months, acute rejection rate changes in Delta creatinine, biopsy-proved chronic allograft rejection and graft survival were assessed according to duration of WIT. Analysis was made by comparing WIT < or =3 versus >3 minutes and WIT <5, 5-10, and >10 minutes.


RESULTS
The WIT, which ranged from 1 to 15 minutes, appeared to be related to the learning curve and to technical difficulties. Prolonged WIT did not appear to have an effect on early graft function or the rate of decline in SCr during the first 3 months posttransplantation, but may be associated with an increased rate of acute rejection. Changes in Delta creatinine over time were not affected by the length of WIT during LDN.


CONCLUSIONS
WIT encountered during LDN has no effect on either short-term or long-term graft outcome.
Soulsby
R E
RE
Nottingham Kidney Transplant Centre, Nottingham City Hospital NHS Trust, Nottingham, UK.
Evans
L J
LJ
Rigg
K M
KM
Shehata
M
M
D000208:Acute Disease; D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000473:pathology / Q000502:physiology*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*
D003404:Creatinine