[Clinical analysis on effect of retroperitoneoscopic nephrectomy in elderly donors for renal transplantation].
OBJECTIVE
To evaluate the safety and effectiveness of retroperitoneoscopic donor nephrectomy in elderly donors for renal transplantation.


METHODS
A retrospective analysis was conducted with 123 cases of retroperitoneoscopic living donor kidney transplantation in 309th Hospital of PLA from March 2011 to March 2014, including 44 elderly donors (age≥55 years) and 79 young to middle-aged donors (age <55 years). Comparisons were made in terms of postoperative complications in both donors and recipients, renal function recovery in the donors and function of graft in the recipients.


RESULTS
The clinical baseline data of the two groups shows that glomerular filtration rate (GFR) of donors in the elderly donor group was lower than the young donor group (P=0.04). The 123 donors all underwent retroperitoneoscopic donor nephrectomy successfully. Postoperative complications in donors and recipients of both groups had no significant differences (P=0.60; P=1.00). In the elderly donor group, the mean serum creatinine level of donors was significantly higher than that in the young donors group [(115.8±22.3) vs (102.5±16.3) μmol/L, P<0.01] 3 days after operation; and estimated GFR (eGFR) was lower [(53.0±9.1)vs(59.6±8.3)ml·min(-1)·(1.73 m(2))(-1,) P<0.01]. Serum creatinine and eGFR of the two groups showed no significant differences one week and six months after surgery (all P>0.05). Four recipients in the elderly donor group had delayed graft function (DGF), 3 had acute rejection; 8 recipients in the young donor group had DGF, 5 had acute rejection; no statistically significant differences were observed between the 2 groups (both P=1.00). Recipients' eGFR were higher in the young donor group than in the elderly donor group at 1 week, 1 month, 3 months, 6 months and 12 months after surgery, but with no statistically significant differences(all P>0.05). After (27.8±12.6) months follow-up, 1 recipient in the elderly donor group died from pulmonary infection; two recipients in the young donor group had kidney dysfunction. Graft survival in the two groups showed no significant difference(P=0.95).


CONCLUSIONS
Retroperitoneoscopic donor nephrectomy is safe and feasible for elderly donors. With careful preoperative evaluation, precise operation, and close postoperative monitoring and follow-up, it could provide satisfactory clinical outcome.
Ward 2, Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, Beijing 100091, China.
Y W
YW
Luo
G
G
Li
Z
Z
Wang
Y
Y
Fan
H W
HW
Bai
J Y
JY
Chang
T H
TH
He
Y Y
YY
Qian
D000368:Aged; D051799:Delayed Graft Function; D004724:Endoscopy; D005919:Glomerular Filtration Rate / Q000502:physiology; D006085:Graft Survival; D006801:Humans; D007431:Intraoperative Complications; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome