Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry.
BACKGROUND
We assessed postoperative complication rates in living donor nephrectomies (LDN) during the last decade (1997-2008).


METHODS
Postoperative complications were classified by the Clavien grading system. We defined Clavien grade more than or equal to 3 as major complications. A total of 1022 LDNs performed during the period 1997-2008 were included.


RESULTS
Median age at donation was 47.7 years (range 18.4-78.9), and mean body mass index was 25.4 (SD 3.2). There was no peri- or postoperative mortality. Laparoscopic nephrectomy was performed in 244 (23.9%) donors. Three of these needed surgical conversion. A total of 30 major (2.9%) and 184 (18%) minor complications were registered. There was a higher frequency of major complications in the laparoscopic group (4.1% vs. 2.6%), but the difference was not statistically significant. Twenty-three donors underwent early re-operations. Wound infection developed in 3.7% of donors. Increased risk was associated with body mass index more than 25 (OR 4.03; 95% CI 1.80, 9.04) and smoking (OR 4.38; 95% CI 2.30, 9.96). Significant perioperative bleeding occurred in 1.6%. There were seven cases of renal artery laceration. Increased risk for a combined endpoint of intraoperative incidents, major complications and significant bleeding were seen in relation to laparoscopic surgery (OR 2.63; 95% CI 1.33, 5.19).


CONCLUSIONS
The risk of major complications related to LDN is low, but do represent a potential hazard to the donor. The special nature of LDN and the constantly evolving operative technique requires vigilant surveillance, by the use of national or supranational registries/databases.
Mjøen
Geir
G
Department of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. geir.mjoen@rikshospitalet.no
Øyen
Ole
O
Holdaas
Hallvard
H
Midtvedt
Karsten
K
Line
Pål-Dag
PD
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality*; D019520:Living Donors / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality*; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality; D012042:Registries; D012077:Renal Artery / Q000293:injuries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D014946:Wound Infection / Q000209:etiology / Q000401:mortality; D055815:Young Adult