title: Risk Factors Associated with Decreased Renal Function after Hand-Assisted Laparoscopic Donor Nephrectomy: A Multivariate Analysis of a Single Surgeon Experience.
abstract: Background:Hand-assisted laparoscopic donor nephrectomy is a minimally invasive procedure for living kidney donation. The surgeon operative volume is associated with postoperative morbidity and mortality. We evaluated the risk factors associated with decreased renal function after hand-assisted laparoscopic donor nephrectomy performed by a single experienced surgeon.Methods:We included living renal donors who underwent hand-assisted laparoscopic donor nephrectomy by a single experienced surgeon between 2006 and 2013. Decreased renal function was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2on postoperative day 4. The donors were categorized into groups with postoperative eGFR < 60 mL/min/1.73 m2or ≥ 60 mL/min/1.73 m2. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors associated with decreased renal function after hand-assisted laparoscopic donor nephrectomy. The hospital stay duration, intensive care unit admission rate, and eGFR at postoperative year 1 were evaluated.Results:Of 643 patients, 166 (25.8%) exhibited a postoperative eGFR of < 60 mL/min/1.73 m2. Multivariate logistic regression analysis demonstrated that the risk factors for decreased renal function were age [odds ratio (95% confidence interval), 1.062 (1.035-1.089),P< 0.001], male sex [odds ratio (95% confidence interval), 3.436 (2.123-5.561),P< 0.001], body mass index (BMI) [odds ratio (95% confidence interval), 1.093 (1.016-1.177),P= 0.018], and preoperative eGFR [odds ratio (95% confidence interval), 0.902 (0.881-0.924),P< 0.001]. There were no significant differences in postoperative hospital stay duration and intensive care unit admission rate between the two groups. In addition, 383 of 643 donors were analyzed at postoperative year 1. Sixty donors consisting of 14 (5.0%) from the group of 279 donors in eGFR ≥ 60 mL/min/1.73 m2, and 46 (44.2%) from the group of 104 donors in eGFR < 60 mL/min/1.73 m2had eGFR < 60 mL/min/1.73 m2at postoperative year 1 (P< 0.001).Conclusions:Increased age, male sex, higher BMI, and decreased preoperative eGFR were risk factors for decreased renal function after hand-assisted laparoscopic donor nephrectomy by a single experienced surgeon. These results provide important evidence for the safe perioperative management of living renal donors.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jinwook
authors.initials: J
authors.lastname: Lim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Yu-Gyeong
authors.initials: YG
authors.lastname: Kong
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Young-Kug
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Bumsik
authors.initials: B
authors.lastname: Hong
mesh_terms: D000328:Adult; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: decreased renal function; hand-assisted laparoscopic donor nephrectomy; single surgeon.