Outcomes of laparoscopic donor nephrectomy without intraoperative systemic heparinization.
OBJECTIVE
Intravenous heparin has traditionally been given during living donor laparoscopic nephrectomy despite the paucity of evidence supporting its use. We present the results of our experience with laparoscopic donor nephrectomy done without intraoperative systemic heparinization.


METHODS
We retrospectively reviewed the records of 167 consecutive laparoscopic donor nephrectomies done without intravenous heparin from July 2005 to October 2007 at our institution. We evaluated preoperative donor characteristics, intraoperative and postoperative complications, recipient renal function and graft outcomes.


RESULTS
All 138 left nephrectomies were done using a conventional laparoscopic approach while 25 of 29 right nephrectomies were done using the hand assisted technique. Warm ischemia time was approximately 3.0 minutes in each group. Mean +/- SE estimated blood loss was 183 +/- 29 ml for left and 115 +/- 16 ml for right nephrectomy. Postoperatively hematocrit decreased an average of 4.5%. There were no intraoperative complications or open conversion requirements. The postoperative complication rate was 4.8%, including 2 patients (1.2%) in whom retroperitoneal hematoma developed. Only 1 of these patients (0.6%) required blood transfusion. Two grafts (1.2%) were lost due to vascular thrombosis in the immediate postoperative period and another 2 recipients experienced delayed graft function. Average 6, 12 and 24-month serum creatinine was 1.5, 1.5 and 1.6 mg/dl, respectively. Renal allograft survival was 97% 2 years after transplantation.


CONCLUSIONS
Results indicate that laparoscopic donor nephrectomy can be successfully done without systemic heparinization with few donor complications, and excellent recipient graft survival and renal function up to 2 years after transplantation.
Cheng
Elaine Y
EY
Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA. eyc2002@nyp.org
Leeser
David B
DB
Kapur
Sandip
S
Del Pizzo
Joseph
J
D000328:Adult; D000368:Aged; D005260:Female; D006493:Heparin; D006801:Humans; D007430:Intraoperative Care; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D006493:Heparin