title: Determinants of laparoscopic donor nephrectomy outcomes.
abstract: BACKGROUND
  Pure laparoscopic donor nephrectomy (LDN) is a unique intervention because it carries known risks and complications, yet carries no direct benefit to the donor. Therefore, it is critical to continually examine and improve quality of care.
  
  
  OBJECTIVE
  To identify factors affecting LDN outcomes and complications.
  
  
  METHODS
  A retrospective analysis of prospectively collected data for 1204 consecutive LDNs performed from March 2000 through August 2012.
  
  
  METHODS
  LDN performed at an academic training center.
  
  
  METHODS
  Using multivariable regression, we assessed the effect of age, sex, body mass index (BMI), laterality, and vascular variation on operative time, estimated blood loss (EBL), complications, and length of stay.
  
  
  CONCLUSIONS
  The following variables were associated with longer operative time (data given as parameter estimate plus or minus the standard error): female sex (9.09 ± 2.43; p<0.001), higher BMI (1.03 ± 0.32; p=0.001), two (7.87 ± 2.70; p=0.004) and three or more (22.45 ± 7.13; p=0.002) versus one renal artery, and early renal arterial branching (5.67 ± 2.82; p=0.045), while early renal arterial branching (7.81 ± 3.85; p=0.043) was associated with higher EBL. Overall, 8.2% of LDNs experienced complications, and by modified Clavien classification, 74 (5.9%) were grade 1, 13 (1.1%) were grade 2a, 10 (0.8%) were grade 2b, and 2 (0.2%) were grade 2c. There were no grade 3 or 4 complications. Three or more renal arteries (odds ratio [OR]: 2.74; 95% CI, 1.05-7.16; p=0.04) and late renal vein confluence (OR: 2.42; 95% CI, 1.50-3.91; p=0.0003) were associated with more complications. Finally, we did not find an association of the independent variables with length of stay. A limitation is that warm ischemia time was not assessed.
  
  
  CONCLUSIONS
  In our series, renal vascular variation prolonged operative time and was associated with more complications. While complicated donor anatomy is not a contraindication of LDN, surgical decision-making should take into consideration these results.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California Los Angeles, CA, USA. Electronic address: jchu@mednet.ucla.edu.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Treat
authors.affiliation: Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ernest
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Veale
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Carter
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.
authors.forename: Kuo-How
authors.initials: KH
authors.lastname: Huang
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Blumberg
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Schulam
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.
authors.forename: Hans A
authors.initials: HA
authors.lastname: Gritsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complication; Donor nephrectomy; Laparoscopy; Outcomes