Living Kidney Donors With Adrenal Incidentalomas: Are They Appropriate Donors?
OBJECTIVE
To determine the incidence of adrenal incidentalomas (AIs) in a single-center series of living renal donors, to describe an evaluation algorithm for AIs in this patient population, and to compare the complication rates of hand-assisted laparoscopic donor nephrectomy (HALDN) with those of combined HALDN and adrenalectomy.


METHODS
We performed a single-center, retrospective study of consecutive living kidney donors who underwent laparoscopic nephrectomy for transplantation, with or without simultaneous ipsilateral adrenalectomy, between January 2008 and September 2014.


RESULTS
During the study period, AIs were detected in 18 of 1033 potential living renal donors who underwent computerized tomographic angiography. Application of additional donor selection criteria and of an adrenal mass assessment algorithm resulted in 849 HALDN, of which 13 were combined with simultaneous adrenalectomy. The hospital length of stay (2.4 vs 2.6 days), perioperative (0.025 vs 0.077), early (0.073 vs 0.077), and late (0.014 vs 0.077) postoperative complication rates, and conversion to open donor nephrectomy (0.008 vs 0.00) were not significantly different. Mean operative time was significantly longer in the adrenalectomy group. None of the adrenal masses were malignant.


CONCLUSIONS
Here, we presented our algorithm to manage the living kidney donors with AIs. Although donor population with AIs was relatively small in number, simultaneous adrenalectomy and ipsilateral nephrectomy seemed to be technically safe and conferred no identifiable increased risk of malignancy for the kidney transplant donor, when the incidentaloma is nonfunctional and less than or equal to 4 cm as assessed by preoperative imaging.
Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey. Electronic address: arpali@surgery.wisc.edu.
Emre
E
Arpali
Department of Radiology, Memorial Sisli Hospital, Istanbul, Turkey.
Atilla
A
Aslan
Division of Transplantation, Department of Surgery and Urology, University of Wisconsin, Madison, WI.
Joseph
J
Scalea
Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey.
Cihan
C
Karatas
Department of Organ Transplantation, Turkish Kidney Foundation Hizmet Hospital, Istanbul, Turkey.
Serkan
S
Akinci
Department of Urology, Turkish Kidney Foundation Hizmet Hospital, Istanbul, Turkey.
Mert
M
Altinel
Department of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey.
Burak
B
Kocak
D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting