title: Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability.
abstract: OBJECTIVE
  Laparoscopic nephrectomy with autotransplantation is a viable option when renal preservation is required or ureteral reconstruction is impossible. In this study we report on our long-term experience with laparoscopic nephrectomy with autotransplantation.
  
  
  METHODS
  A retrospective review of data from all patients who underwent laparoscopic nephrectomy with autotransplantation since 2000 revealed data for 52 of 59 patients after study exclusions. Indications for laparoscopic nephrectomy with autotransplantation included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1) and renovascular hypertension (1). Followup included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher.
  
  
  RESULTS
  A total of 52 patients (30 women, 57.6%) underwent laparoscopic nephrectomy with autotransplantation at a median age of 48 years (range 12 to 76). At a median followup of 73.5 months 47 patients (90.3%) had long-term function of the autotransplanted renal unit including 3 of 4 (75%) solitary kidneys. There were 5 patients (9.7%) who experienced renal unit failure at a median of 15 months. Of these patients 3 required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months) and chronic pain (48 months). Overall 4 patients had early complications and 8 had late complications. In the tumor group 4 patients had disease progression and all are alive.
  
  
  CONCLUSIONS
  Laparoscopic nephrectomy with autotransplantation is an excellent long-term surgical option (greater than 90% success rate with longer than 6-year median followup) for complex ureteral and renal conditions that necessitate preservation of renal parenchyma. However, tumor progression is possible after ex vivo tumor excision. Therefore, careful patient selection and followup are mandatory. This report supports the safety, efficacy and durability of laparoscopic nephrectomy with autotransplantation in experienced hands.
authors: School of Medicine (GT), Department of Urology (KR, TC, MM, MLS) and Department of Surgery (CF), University of California, San Francisco, San Francisco, California.
authors: Geraldine
authors: G
authors: Tran
authors: School of Medicine (GT), Department of Urology (KR, TC, MM, MLS) and Department of Surgery (CF), University of California, San Francisco, San Francisco, California.
authors: Krishna
authors: K
authors: Ramaswamy
authors: School of Medicine (GT), Department of Urology (KR, TC, MM, MLS) and Department of Surgery (CF), University of California, San Francisco, San Francisco, California.
authors: Thomas
authors: T
authors: Chi
authors: School of Medicine (GT), Department of Urology (KR, TC, MM, MLS) and Department of Surgery (CF), University of California, San Francisco, San Francisco, California.
authors: Maxwell
authors: M
authors: Meng
authors: School of Medicine (GT), Department of Urology (KR, TC, MM, MLS) and Department of Surgery (CF), University of California, San Francisco, San Francisco, California.
authors: Christopher
authors: C
authors: Freise
authors: School of Medicine (GT), Department of Urology (KR, TC, MM, MLS) and Department of Surgery (CF), University of California, San Francisco, San Francisco, California.
authors: Marshall L
authors: ML
authors: Stoller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064592:Autografts; D002648:Child; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: autologous; kidney transplantation; laparoscopy; transplantation