Are there anatomical barriers to laparoscopic donor nephrectomy?
BACKGROUND
The aim of this study was to analyse the effect of the right donor kidney and multiple arteries, on donor and recipient outcomes in the era of laparoscopic live donor nephrectomy (LLDN).


METHODS
e retrospectively analysed the 200 donors and recipients who underwent a planned laparoscopic nephrectomy at two hospitals between September 1998 and December 2006. The impact of donor right kidney and multiple donor renal arteries on operative time, hospital stay, graft function, and donor and recipient complications were analysed.


RESULTS
Of the total cohort (n=200), 140 (70%) were classified as Simple LLDN (left live donor kidney with single renal artery). The Complex LLDN group (n=60) contained all right-sided kidney (n=28) and left-sided kidneys with multiple renal arteries (n=32). Baseline characteristics, extraction time, conversion to open, length of admission, overall graft function and complication rates were similar between the simple and complex groups. The second warm ischaemic time in the Simple LLDN group was slightly shorter than the Complex LLDN group (32 versus 36 min P=0.016). The 1-month post-operative recipient serum creatinine level was lower in the Simple LLDN group when compared with the Complex LLDN group (117 versus 125 µmol/L P=0.025). There was no difference in post op dialysis, acute rejection within 3 months or graft survival between the Simple and Complex LLDN groups.


CONCLUSIONS
Laparoscopic procurements of right kidneys and kidneys with multiple arteries were safe and yielded kidneys with excellent function comparable with those of laparoscopic left donor nephrectomy with single artery.
Crane
Catherine
C
Discipline of Surgery, University of Sydney Department of Surgery, Westmead Hospital Transplantation Services, Royal Prince Alfred Hospital, Sydney, Australia.
Lam
Vincent W T
VW
Alsakran
Abdulrahman
A
Vasilaras
Arthur
A
Lau
Howard
H
Ryan
Brendan
B
Pleass
Henry C C
HC
Allen
Richard D M
RD
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012077:Renal Artery / Q000033:anatomy & histology / Q000601:surgery; D012082:Renal Veins / Q000033:anatomy & histology / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D055815:Young Adult