title: Evolution of Living Donor Nephrectomy at a Single Center: Long-term Outcomes With 4 Different Techniques in Greater Than 4000 Donors Over 50 Years.
abstract: The development of minimally invasive surgical approaches to donor nephrectomy (DN) has been driven by the potential advantages for the donor, with questions remaining about long-term outcomes.
  
  
  
  All living DN performed from June 1963 through December 2014 at the University of Minnesota were reviewed. Outcomes were compared among 4 DN techniques.
  
  
  
  We performed 4286 DNs: 2759 open DN (ODNs), 1190 hand-assisted (HA) laparoscopic DNs (LDNs), 203 pure LDN (P-LDNs), and 97 robot-assisted-LDN. Laparoscopic DN was associated with an older (P < 0.001) and heavier (P < 0.001) donor population. Laparoscopic DN was associated with a higher probability of left kidney procurement (P < 0.001). All 3 LDN modalities required a longer operative time (P < 0.001); robot-assisted-LDN took significantly longer than HA-LDN or P-LDN. Laparoscopic DN decreased the need for intraoperative blood transfusion (P < 0.001) and reduced the incidence of intraoperative complications (P < 0.001) and hospital length of stay (P < 0.001). However, LDN led to a significantly higher rate of readmissions, both short-term (<30 day, P < 0.001) and long-term (>30 day, P < 0.001). Undergoing HA-LDN was associated with a higher rate of an incisional hernia compared with all other modalities (P < 0.001). For recipients, LDN seemed to be associated with lower rates of graft failure at 1 year compared with ODN (P = 0.002). The odds of delayed graft function increased for kidneys with multiple arteries procured via P-LDN compared with HA-LDN (OR 3 [1,10]) and ODN (OR 5 [2, 15]).
  
  
  
  In our experience, LDN was associated with decreased donor intraoperative complications and hospital length of stay but higher rates of readmission and long-term complications.
authors.affiliation: 1 Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN. 2 Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. 3 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: Oscar Kenneth
authors.initials: OK
authors.lastname: Serrano
authors.forename: Varvara
authors.initials: V
authors.lastname: Kirchner
authors.forename: Ananta
authors.initials: A
authors.lastname: Bangdiwala
authors.forename: David M
authors.initials: DM
authors.lastname: Vock
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: Erik B
authors.initials: EB
authors.lastname: Finger
authors.forename: William D
authors.initials: WD
authors.lastname: Payne
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.forename: John S
authors.initials: JS
authors.lastname: Najarian
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Matas
authors.forename: Raja
authors.initials: R
authors.lastname: Kandaswamy
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D015992:Body Mass Index; D015331:Cohort Studies; D051799:Delayed Graft Function; D005260:Female; D006085:Graft Survival; D006801:Humans; D007431:Intraoperative Complications; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D008910:Minnesota; D009392:Nephrectomy / Q000379:methods*; D010149:Postoperative Pain; D010359:Patient Readmission; D011183:Postoperative Complications; D011184:Postoperative Period; D011336:Probability; D065287:Robotic Surgical Procedures; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome; D014495:Universities; D055815:Young Adult