title: Kidney transplant outcomes following the introduction of hand-assisted laparoscopic living donor nephrectomy: a comparison of recipient groups.
abstract: BACKGROUND
  Laparoscopic donor nephrectomy has become the procedure of choice for living donor kidney transplantation in many centres. We report on our experience with hand-assisted laparoscopic donor nephrectomy (HALDN). We concentrated on graft function and postoperative surgical complications in the recipient population, and compared outcomes to a similar recipient group who had received kidneys procured by open living-donor nephrectomy (OLDN).
  
  
  METHODS
  Following the receipt of institutional approval, the files of all patients who received a kidney transplant between September 2008 and June 2011 were reviewed. One hundred patients with end-stage renal disease received kidney transplantations from living donors. OLDN was performed in 65 donors, and 35 underwent HALDN. Delayed graft function (DGF) and postoperative complications were recorded.
  
  
  RESULTS
  Six adverse events were reported, during which five patients presented with DGF. One DGF was reported in the HALDN group, and four in the OLDN group. The morbidity in the HALDN group (1/35, 3%) was a graft rupture secondary to acute rejection which required exploration and transplant nephrectomy. Reoperation was required in five patients in the OLDN group (5/65, 8%). This amounted to overall morbidity of 6%, with no recipient mortalities.
  
  
  CONCLUSIONS
  As previously documented, HALDN is safe for the donor, and not inferior to OLDN. In this study, it was associated with neither an increased incidence of DGF, nor a higher complication rate in the transplant recipient, when compared to the cohort that received a kidney harvested using the OLDN technique.
authors.affiliation: Transplant Division, Department of General Surgery, University of the Witwatersrand, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Schamm
authors.affiliation: Transplant Division, Department of General Surgery, University of the Witwatersrand, South Africa.
authors.forename: B
authors.initials: B
authors.lastname: Jugmohan
authors.affiliation: Transplant Division, Department of General Surgery, University of the Witwatersrand, South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Joseph
authors.affiliation: Transplant Division, Department of General Surgery, University of the Witwatersrand, South Africa.
authors.forename: J R
authors.initials: JR
authors.lastname: Botha
authors.affiliation: Transplant Division, Department of General Surgery, University of the Witwatersrand, South Africa.
authors.forename: J F
authors.initials: JF
authors.lastname: Botha
authors.affiliation: Transplant Division, Department of General Surgery, University of the Witwatersrand, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Britz
authors.affiliation: Transplant Division, Department of General Surgery, University of the Witwatersrand, South Africa.
authors.forename: J
authors.initials: J
authors.lastname: Loveland