Open and laparoscopic donor nephrectomy: activity and outcomes from all Australasian transplant centers.
BACKGROUND
Laparoscopic donor nephrectomy (LapDN) has been widely adopted despite a lack of randomized trials comparing recipient outcomes with open surgery. Review of registry data now seems the most realistic mechanism to compare outcomes. The Australia and New Zealand Dialysis and Transplant Registry prospectively captures data on all renal transplants performed in Australia and New Zealand including long-term follow-up of recipients. AIM.: To compare graft outcomes among recipient of kidneys from donors undergoing nephrectomy using open and laparoscopic techniques, through analysis of the Australia and New Zealand Dialysis and Transplant Registry after the introduction of laparoscopic donor surgery in Australia and New Zealand in 1997.


METHODS
Operative technique data for live donor transplants were collected from all surgeons performing live kidney donation procedures from May 1997 to December 2003; the outcomes of all live donor transplants were examined with follow-up to December 2007. Donor and recipient demographic variables and graft outcomes were compared between the laparoscopic and the open donor groups.


RESULTS
One thousand four hundred seventy-four live donor transplants were performed in 27 transplant centers. Of these, 315 (21%) were performed laparoscopically in 11 centers. Nineteen laparoscopic cases (6%) were converted to open. Total ischemic time was longer in the LapDN group (3.16 hr) than in the open donor group (1.61 hr, P<0.0001). The LapDN group experienced a lower incidence of rejection episodes (29.2% vs. 38.6%, P=0.002). Delayed graft function and technical failure rates were statistically equal across the groups. There were a total of 242 graft failures (175 graft losses and 67 deaths with a functioning graft, NS). Among surviving grafts, there was no consistent difference in serum creatinine at any time point. Graft and patient survivals were similar in both groups during 10-year follow-up.


CONCLUSIONS
This study suggests that there is no difference in short- or long-term recipient outcomes for open and laparoscopic live donor nephrectomy.
Brook
Nicholas R
NR
Departments of Urology and Renal Transplantation, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia. nicholasbrook@fastmail.fm
Gibbons
Norma
N
Nicol
David L
DL
McDonald
Stephen P
SP
D000328:Adult; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D007511:Ischemia; D016030:Kidney Transplantation / Q000295:instrumentation* / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods*; D009520:New Zealand; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome