title: Laparoscopic donor nephrectomy does not compromise outcomes for pediatric transplant recipients.
abstract: BACKGROUND
  Despite the apparent safety of laparoscopic kidney procurement (laparoscopic donor nephrectomy [LDN]) in adults, doubts have persisted about its use in pediatric recipients, following the publication of a United Network for Organ Sharing analysis, which suggested that rejection rates were higher after LDN when compared with open procurement (open donor nephrectomy [ODN]) for children. The aim of this study was to determine whether acute rejection rates, and graft and patient survival, were worse after LDN for pediatric recipients. The analysis included both short and medium term outcomes.
  
  
  METHODS
  The UK Transplant Registry, a validated database with mandatory reporting, was interrogated from 2000 to 2007 for outcomes of pediatric recipients. A total of 306 recipients were identified, 119 of which had LDN.
  
  
  RESULTS
  Acute rejection was higher in the ODN group, compared with LDN (40.6% vs. 24.3% P=0.007). Graft survival at 1 year (99.2% vs. 94.3% P=0.03) and 3 years (99.2% vs 91.4%, P=0.01) was worse after ODN. There were more deaths after ODN (4 vs. 0), but this did not reach statistical significance. Cox proportional hazards modeling showed that the negative effect of ODN on graft survival was reduced when adjusted for acute rejection.
  
  
  CONCLUSIONS
  LDN seems to be safe for pediatric recipients in both the short and longer terms.
authors.affiliation: Department of Transplantation, Guy's Hospital, London, United Kingdom. 2 NHSBT, Bristol, United Kingdom. nizam.mamode@gstt.nhs.uk
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Johnson
authors.forename: Vassilis G
authors.initials: VG
authors.lastname: Hadjianastassiou
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D016016:Proportional Hazards Models; D012042:Registries; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom