title: Increased early graft failure in right-sided living donor nephrectomy.
abstract: BACKGROUND
  Laparoscopic donor nephrectomy (LDN) is well established; however, there is concern about early graft loss because of technical issues with right-sided LDN. Prior studies on the subject were mostly single centered and not powered to detect clinically significant differences in allograft failure.
  
  
  METHODS
  We conducted a retrospective cohort study of recipients of live donor kidney transplants using national registry data. The primary endpoint was 90-day allograft failure. Multivariable logistic regression analyses were stratified as overall live donor transplantation, transplantation after LDN, and transplantation after open donor nephrectomy (ODN).
  
  
  RESULTS
  Between 2001 and 2006, a total of 2555 right LDNs, 25,387 left LDNs, 2496 right ODNs, and 5552 left ODNs were performed. For the entire cohort compared with ODN, LDN was not associated with early allograft loss (odds ratio [OR]=0.94, P=0.4); however, right-sided nephrectomy increased the risk of allograft loss (OR=1.49, P<0.01). When stratified by procedure type, right LDN (OR=1.58, P<0.01) and right ODN (OR=1.38, P=0.02) demonstrated an association with increased risk of graft failure compared with the left side. The observed risk of allograft failure with right-sided LDN was 3.8% vs. 2.5% with left-sided LDN.
  
  
  CONCLUSIONS
  Right-sided donor nephrectomy is associated with a small increased risk of allograft failure regardless of open or laparoscopic approach. However, the low observed risk of allograft failure with right-sided nephrectomy suggests that recovering the right kidney is a reasonable option for donors with contraindications for donating the left kidney.
authors: Division of Transplantation, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors: John W
authors: JW
authors: Hsu
authors: Peter P
authors: PP
authors: Reese
authors: Ali
authors: A
authors: Naji
authors: Matthew H
authors: MH
authors: Levine
authors: Peter L
authors: PL
authors: Abt
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000706:statistics & numerical data; D016896:Treatment Outcome