title: Early experience of a living donor kidney transplant program.
abstract: OBJECTIVE
  Laparoscopic nephrectomy has been shown to reduce the morbidity of live donor nephrectomy, but post-transplant kidney function and safety issues with the procedure are still of some concern. The review of our early experience could detect errors that should be avoided in the refining of the technique.
  
  
  METHODS
  Our first sixty consecutive laparoscopic donor nephrectomies were analyzed retrospectively.
  
  
  RESULTS
  There were conversions to open surgery (5%), all three in the first 18 cases. All donors were alive at 1 year with a glomerular filtration rate of 85+/-21 ml/min (78% of the basal). Patient and graft survival at 1 year was 100% and 95%, respectively. Creatinine nadir was achieved on post-transplant day 3 (creatinine, 176+/-122 micromol/l). Late renal function proved a continuous improvement until the 2-year follow-up (creatinine, 135+/-29 micromol/l). Renal function recovery was better in both recipient and donor when the donor was < or =50 years old, compared with older patients. Transplant complications that required reintervention included one ureteral fistula, one ureteral stenosis and one case of low renal flow that was re-vascularised.
  
  
  CONCLUSIONS
  Technical surgical aspects such the use of Haemoloc clips in the clipping of the artery, the hand-assisted extraction of the kidney, a refined surgical technique during the transplant and avoidance of prolonged warm and cold ischemia, taken together with an adequate intraoperative hemodynamic management of the donor aid in avoiding life-threatening complications and achieving a good post-transplant renal function recovery.
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain. aalcaraz@clinic.ub.es
authors.forename: Antonio
authors.initials: A
authors.lastname: Alcaraz
authors.forename: Antonio
authors.initials: A
authors.lastname: Rosales
authors.forename: Lluís
authors.initials: L
authors.lastname: Guirado
authors.forename: Joan M
authors.initials: JM
authors.lastname: Díaz
authors.forename: Mireia
authors.initials: M
authors.lastname: Musquera
authors.forename: Humberto
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications; D007668:Kidney / Q000098:blood supply; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D019520:Living Donors; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D016730:Program Development; D012189:Retrospective Studies