title: Hand-assisted Laparoscopic Donor Nephrectomy and Cytokine Changes.
abstract: BACKGROUND
  Laparoscopic living-donor nephrectomy (LDN) exerts systemic effects causing transaminitis and increased urinary neutrophil gelatinase-associated lipocalm (NGAL) excretion. Hand-assisted laparoscopic donor nephrectomy, which tends to be shorter with less pneumoperitoneum, may be hypothesized to produce less systemic stimulation than total laparoscopic LDN.
  
  
  METHODS
  Serial urine and serum samples were collected from 15 patients undergoing HALDN. Samples were analyzed for NGAL and kidney injury molecule 1 (KIM-1) levels preoperatively and 24 hours post-surgery. Data relating to alanine aminotransferase, creatinine, and estimated glomerular filtration rate was also analyzed in 48 live donors preoperatively and at 24 hours and 48 hours post-surgery and compared to published data on LDN.
  
  
  RESULTS
  Expected changes to creatinine and estimated glomerular filtration rates were observed in the donors. Compared to the preoperative levels, alanine aminotransferase levels showed a significant decrease at 24 hours (P = .004) and were not significantly different from baseline levels at 48 hours (P = .08). Serum KIM-1 and NGAL levels remained unchanged (P = .89 and P = .14, respectively) at 24 hours after donation. Similarly, urinary levels of KIM-1 and NGAL were not statistically significantly different after donation. Mean operating time for this cohort was 1 hour, 36 minutes.
  
  
  CONCLUSIONS
  In contrast to other published data, our cohort did not exhibit changes to liver function tests or biomarker changes after donor nephrectomy. This could be because of the lower operative time (96 minutes vs. 216 minutes) or because of the intermittent release of the pneumoperitoneum in the hand-assisted method which may exert less of a systemic inflammatory response.
authors.affiliation: Department of Renal Transplantation, Queen Elizabeth Medical Centre, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom; MRC Centre for Immune Regulation, School of Immunity and Infection, Medical School, University of Birmingham, Birmingham, United Kingdom. Electronic address: melfield@doctors.org.uk.
authors.forename: M
authors.initials: M
authors.lastname: Field
authors.affiliation: Department of Renal Transplantation, Queen Elizabeth Medical Centre, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom; MRC Centre for Immune Regulation, School of Immunity and Infection, Medical School, University of Birmingham, Birmingham, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Guy
authors.affiliation: Department of Renal Transplantation, Queen Elizabeth Medical Centre, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom.
authors.forename: A R
authors.initials: AR
authors.lastname: Ready
authors.affiliation: MRC Centre for Immune Regulation, School of Immunity and Infection, Medical School, University of Birmingham, Birmingham, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Cobbold
authors.affiliation: Department of Renal Transplantation, Queen Elizabeth Medical Centre, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Inston
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000601:surgery* / Q000652:urine; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D020858:Tissue and Organ Harvesting / Q000379:methods*
chemical_list: D015415:Biomarkers; D016207:Cytokines