title: How can we increase living related donor renal transplantations?
abstract: BACKGROUND
  In Japan, living donor renal transplantation has gained momentum due to an increased number of patients with end-stage renal disease. Living donation not only provides better outcomes, but also the recipients usually need less medications, thereby increasing the quality of life and reducing the potential side effects of immunosuppression.
  
  
  METHODS
  For the past 25 years, our center had performed 140 open donor nephrectomy (OPNx) renal transplantations. Since July 2003, we changed our procurement operation to living hand-assisted laparoscopic donor nephrectomy (HALNx) in 49 cases. Our operative technique consisted of two 12-mm ports placed in the midaxillary line at the superior and inferior levels of the umbilicus. Next, a 5-cm incision was made in the midline periumbilicus and the hand port system fitted through a midline abdominal incision.
  
  
  RESULTS
  In 49 cases, HALNx was completed successfully; no patient required conversion to laparotomy. The estimated blood loss was 33.0 +/- 43.4 g and no patient required blood transfusion. In comparison, in OPNx the blood loss was 426.5 +/- 247.6 g (P < .001). The mean operative times were 167.4 +/- 39.7 minutes for HALNx and 228.4 +/- 35.7 minutes for OPNx (P < .001). The postoperative hospital stays were 9.1 +/- 3.8 days for HALNx and 13.0 +/- 1.9 days for OPNx (P < .001). For 3 years prior to introduction of HALNx, we had performed only 10 living donor renal transplantations. Since the introduction of HALNx in 2003, the number of living donors has tripled during the following 3 years.
  
  
  CONCLUSIONS
  Herein we have reported that HALNx was superior in terms of less operative time and blood loss, postoperative pain and recovery, and shorter hospital stay. Overall donor patient satisfaction was also better in the HALNx group. HALNx is a safe procedure that makes kidney donation more appealing to potential live donors and has increased the living donor pool at our center.
authors.affiliation: Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan. yukinakamura70@hotmail.com
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.forename: O
authors.initials: O
authors.lastname: Konno
authors.forename: N
authors.initials: N
authors.lastname: Matsuno
authors.forename: T
authors.initials: T
authors.lastname: Yokoyama
authors.forename: K
authors.initials: K
authors.lastname: Kuzuoka
authors.forename: Y
authors.initials: Y
authors.lastname: Kihara
authors.forename: S
authors.initials: S
authors.lastname: Taira
authors.forename: Y
authors.initials: Y
authors.lastname: Jojima
authors.forename: I
authors.initials: I
authors.lastname: Akashi
authors.forename: H
authors.initials: H
authors.lastname: Iwamoto
authors.forename: K
authors.initials: K
authors.lastname: Hama
authors.forename: T
authors.initials: T
authors.lastname: Iwahori
authors.forename: T
authors.initials: T
authors.lastname: Ashizawa
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: T
authors.initials: T
authors.lastname: Tojimbara
authors.forename: I
authors.initials: I
authors.lastname: Nakajima
authors.forename: T
authors.initials: T
authors.lastname: Nagao
mesh_terms: D000328:Adult; D002102:Cadaver; D005190:Family; D005260:Female; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D014019:Tissue Donors / Q000706:statistics & numerical data; D020858:Tissue and Organ Harvesting / Q000379:methods / Q000706:statistics & numerical data*