Anterior vertical mini-incision vs. retroperitoneoscopic nephrectomy in living kidney donation: a prospective study on donors' quality of life and clinical outcome.
BACKGROUND
A fundamental goal in living kidney donation (LKD) is to maximize donor safety while minimizing post-operative impairments. We evaluated clinical outcome and health-related quality of life (QOL) comparing anterior vertical mini-incision donor nephrectomy (MIDN) and retroperitoneoscopic donor nephrectomy (RPDN).


METHODS
Thirty-eight MIDN and 45 RPDN donors were analyzed. In a subsample (n = 18 MIDN; n = 32 RPDN), QOL was prospectively assessed with the WHOQOL-Bref questionnaire before and three months after LKD.


RESULTS
Skin-to-skin time (169 vs. 116 min, p < 0.001) and hospital stay (6.6 vs. 4.9 d, p < 0.001) were significantly shorter in RPDN. In total, 26% of MIDN patients and 13% of RPDN patients developed post-operative complications (p = 0.14). While in MIDN the QOL domains physical health (p = 0.03) and psychological (p = 0.03) and the overall QOL facet (p = 0.003) were significantly lower three months post-LKD compared to baseline, there were no significant QOL decreases in RPDN. However, no significant post-operative QOL differences were found between groups. RPDN donors retrospectively reported significantly less post-operative pain (p = 0.007) and physical strain (p = 0.05) caused by LKD than MIDN donors.


CONCLUSIONS
It may be possible to further reduce the surgical burden of LKD by introducing RPDN. Post-operative QOL was not significantly different between groups, but the QOL decrease appeared to be less pronounced in RPDN.
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Sylvia
S
Kroencke
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Karl-Heinz
KH
Schulz
University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Björn
B
Nashan
University Transplant Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Martina
M
Koch
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012187:Retroperitoneal Space / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods*
WHOQOL-Bref; living kidney donation; mini-incision donor nephrectomy; prospective study; quality of life; retroperitoneoscopic donor nephrectomy