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Ruch B, Tsering D, Bhati C, Kumar D, Saeed M, Lee SD, Khan A, Imai D, Bruno D, Levy M, Cotterell A, Sharma A. Right versus left fully robotic live donor nephrectomy and open kidney transplantation: Does the laterality of the donor kidney really matter? Asian J Urol 2023; 10:453-460. [PMID: 38024427 PMCID: PMC10659977 DOI: 10.1016/j.ajur.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robotic-assisted live donor nephrectomy (LDN) is being gradually adopted across transplant centers. The left donor kidney is preferred over right due to anatomical factors and ease of procurement. We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys. Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed. Results Out of 196 robotic LDN (49 [right] vs. 147 [left]), 10 (5.1%) donors had intra-operative events (6.1% [right] vs. 4.8% [left], p=0.71). None of the LDN required conversion to open surgery. The operative times were comparable for the two groups. Nausea (13.3%) was the most common post-operative complication. There was no mortality in either LDN group. Herein, we report our outcomes on 156 recipients (39 right and 117 left allografts) excluding robotic implants, exports, and pediatric recipients. There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival (100.0% vs. 98.1%, p=0.45) or graft survival (93.9% vs. 97.1%, p=0.11), or delayed graft function (7.7% vs. 5.1%, p=0.55). Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes. Right LDN was not associated with higher incidence of complications compared to left LDN. Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.
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Affiliation(s)
- Brianna Ruch
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Deki Tsering
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chandra Bhati
- Division of Transplant Surgery, University of Maryland, Baltimore, MD, USA
| | - Dhiren Kumar
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Muhammad Saeed
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Seung Duk Lee
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Aamir Khan
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Daisuke Imai
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - David Bruno
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Marlon Levy
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian Cotterell
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amit Sharma
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
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Roll GR, Cooper M, Verbesey J, Veale JL, Ronin M, Irish W, Waterman AD, Flechner SM, Leeser DB. Risk aversion in the use of complex kidneys in paired exchange programs: Opportunities for even more transplants? Am J Transplant 2022; 22:1893-1900. [PMID: 35181991 PMCID: PMC9543328 DOI: 10.1111/ajt.17008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 01/25/2023]
Abstract
This retrospective review of the largest United States kidney exchange reports characteristics, utilization, and recipient outcomes of kidneys with simple compared to complex anatomy and extrapolates reluctance to accept these kidneys. Of 3105 transplants performed, only 12.8% were right kidneys and 23.1% had multiple renal arteries. 59.3% of centers used fewer right kidneys than expected and 12.1% transplanted zero right kidneys or kidneys with more than 1 artery. Five centers transplanted a third of these kidneys (35.8% of right kidneys and 36.7% of kidneys with multiple renal arteries). 22.5% and 25.5% of centers currently will not entertain a match offer for a left or right kidney with more than one artery, respectively. There were no significant differences in all-cause graft failure or death-censored graft loss for kidneys with multiple arteries, and a very small increased risk of graft failure for right kidneys versus left of limited clinical relevance for most recipients. Kidneys with complex anatomy can be used with excellent outcomes at many centers. Variation in use (lack of demand) for these kidneys reduces the number of transplants, so systems to facilitate use could increase demand. We cannot know how many donors are turned away because perceived demand is limited.
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Affiliation(s)
- Garrett R. Roll
- Department of SurgeryDivision of TransplantUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Matthew Cooper
- Medstar Georgetown Transplant InstituteGeorgetown UniversityWashingtonDistrict of ColumbiaUSA
| | - Jennifer Verbesey
- Medstar Georgetown Transplant InstituteGeorgetown UniversityWashingtonDistrict of ColumbiaUSA
| | - Jeffrey L. Veale
- Department of UrologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | | | - William Irish
- Department of SurgeryEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Amy D. Waterman
- Department of SurgeryJ.C. Walter Transplant CenterHoustonTexasUSA,Terasaki Institute of Biomedical InnovationLos AngelesCaliforniaUSA
| | - Stuart M. Flechner
- Glickman Urological and Kidney InstituteCleveland ClinicClevelandOhioUSA
| | - David B. Leeser
- Department of SurgeryEast Carolina UniversityGreenvilleNorth CarolinaUSA
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Carolan C, Tingle SJ, Thompson ER, Sen G, Wilson CH. Comparing outcomes in right versus left kidney transplantation: A systematic review and meta-analysis. Clin Transplant 2021; 35:e14475. [PMID: 34496090 DOI: 10.1111/ctr.14475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Transplantation of right kidneys can pose technical challenges due to the short right renal vein. Whether this results in inferior outcomes remains controversial. METHOD Healthcare Database Advanced Search (HDAS) was used to identify relevant studies. Two authors independently reviewed each study. Statistical analyses were performed using random effects models and results expressed as HR or relative risk (RR) with 95% confidence intervals. Subgroup analyses were performed in kidneys from deceased donors (DD) and living donors (LD). RESULTS A total of 35 studies (257,429 participants) were identified. Both deceased and living donor right kidneys were at increased risk of delayed graft function (DGF; RR = 1.12[1.06-1.18] and RR = 1.33[1.21-1.46] respectively; both p < .0001). In absolute terms, for each 100 kidney pairs of DD kidneys transplanted there are 2.72 (1.67-3.78, p < .00001) excess episodes of DGF in right kidneys. Graft thromboses and graft loss due to technical failure was also significantly more likely in right kidneys, in both DD and LD settings. There was no evidence that laterality alters long term graft survival in LD or DD. CONCLUSION Right kidneys have inferior early outcomes, with higher rates of DGF, technical failure and graft thrombosis. However, these differences are small in absolute terms, and long-term graft survival is equivalent.
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Affiliation(s)
- Caitlin Carolan
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Samuel J Tingle
- Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Emily R Thompson
- Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Gourab Sen
- Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne, UK
| | - Colin H Wilson
- Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
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Akin EB, Soykan Barlas I, Dayangac M. Hand-assisted retroperitoneoscopic donor nephrectomy offers more liberal use of right kidneys: lessons learned from 565 cases - a retrospective single-center study. Transpl Int 2021; 34:445-454. [PMID: 33340167 DOI: 10.1111/tri.13806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/08/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023]
Abstract
The introduction of laparoscopic donor nephrectomy caused a shift toward' left donor nephrectomy. Some centers report a significantly low rate of endoscopic right donor nephrectomy. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP-DN) was introduced as a novel surgical technique, which aims to avoid intra-abdominal complications. It was also reported to provide technical advantages for right-sided DN. In this retrospective single-center study, we evaluated the impact of HARP-DN technique on utilization of right-sided DNs. After the implementation of HARP-DN on February 2009, a total of 565 DNs were performed until December 2015. The introduction of HARP-DN technique resulted in an immediate increase in the utilization of right kidneys from 6.1% to an average of 19.6% annually. The donors 'outcome was similar to the left-sided and right-sided DN groups, excluding the increased incidence of incisional hernias in left kidney donors. None of the donors developed intra-abdominal complications. In conclusion, the implementation of HARP technique significantly increased the use of right-sided DNs, which enables a more liberal use of donors in LDKT.
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Affiliation(s)
- Emin Baris Akin
- Department of General Surgery, Division of Transplantation, Demiroglu Bilim University, Istanbul, Turkey
| | - Ilhami Soykan Barlas
- Department of General Surgery, Division of Transplantation, Demiroglu Bilim University, Istanbul, Turkey
| | - Murat Dayangac
- Center for Organ Transplantation, Medipol University, Istanbul, Turkey
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Risk factors for delayed graft function and their impact on graft outcomes in live donor kidney transplantation. Int Urol Nephrol 2021; 53:439-446. [PMID: 33394282 DOI: 10.1007/s11255-020-02687-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Delayed graft function (DGF) is a manifestation of acute kidney injury uniquely framed within the transplant process and a predictor of poor long-term graft function1. It is less common in the setting of living donor (LD) kidney transplantation. However, the detrimental impact of DGF on graft survival is more pronounced in LD2. PURPOSE To study the effects of DGF in the setting of LD kidney transplantation. METHODS We performed a retrospective analysis of LD kidney transplantations performed between 2010 and 2018 in the UNOS/OPTN database for DGF and its effect on graft survival. RESULTS A total of 42,736 LD recipients were identified, of whom 1115 (2.6%) developed DGF. Recipient dialysis status, male gender, diabetes, end-stage renal disease, donor age, right donor nephrectomy, panel reactive antibodies, HLA mismatch, and cold ischemia time were independent predictors of DGF. Three-year graft survival in patients with and without DGF was 89% and 95%, respectively. DGF was the greatest predictor of graft failure at three years (hazard ratio = 1.766, 95% CI: 1.514-2.059, P = 0.001) and was associated with higher rates of rejection (9% vs. 6.28%, P = 0.0003). Among patients with DGF, the graft survival rates with and without rejection were not different. CONCLUSION DGF is a major determinant of poor graft functional outcomes, independent of rejection.
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Khan TT, Ahmad N, Siddique K, Fourtounas K. Implantation of Right Kidneys: Is the Risk of Technical Graft Loss Real? World J Surg 2017; 42:1536-1541. [PMID: 29063227 DOI: 10.1007/s00268-017-4314-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The left kidney (LK) is preferred by transplant surgeons, because its vein is always of good length and has a thick wall that enables safe suturing. On the other hand, the right renal vein is generally shorter and thinner walled, and well known for its technical difficulty during venous anastomosis, and can result in graft loss. We examined our living (LD) and deceased donor (DD) recipient data and compared the incidence of technical graft loss and early graft function in right and left kidneys. METHODS A cohort of 58 adult and pediatric recipients received an LD or DD kidney between January 2015 and December 2016. The donor and recipient data were retrieved and retrospectively analyzed. Technical graft loss was defined as graft thrombosis within the 7Â days after transplant. RESULTS Right kidneys (RKs) were not a risk factor for technical graft loss, and no graft was lost for technical reasons in either LD or DD transplants. Early graft function in LK and RKs was also comparable in the LD cohort, and there were no LKs in the DD cohort. CONCLUSION Based on our data, the use of RKs was not a risk factor for technical graft loss and early graft function was comparable to LKs.
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Affiliation(s)
- Taqi T Khan
- Institution Division of Transplant Surgery, Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
| | - Nadeem Ahmad
- Institution Division of Transplant Surgery, Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Kashif Siddique
- Department of Medical Biostatistics, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Konstantinos Fourtounas
- Institution Division of Nephrology, Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries. Surg Radiol Anat 2017; 40:381-388. [PMID: 28980056 PMCID: PMC5880851 DOI: 10.1007/s00276-017-1930-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/19/2017] [Indexed: 11/20/2022]
Abstract
Background An in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries. Materials and methods Computed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply. Results The frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219). Conclusions The classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.
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Is the Reluctance for the Implantation of Right Kidneys Justified?: Reply. World J Surg 2017; 41:2972. [PMID: 28477157 DOI: 10.1007/s00268-017-4043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Khan TT, Ahmad N. Right Donor Kidneys in Living Donor Kidney Transplantation. World J Surg 2017; 41:2970-2971. [PMID: 28258462 DOI: 10.1007/s00268-017-3940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Nadeem Ahmad
- King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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Özdemir-van Brunschot DMD, Warlé MC. Is the Reluctance for the Implantation of Right Kidneys Justified: Reply. World J Surg 2016; 41:326-327. [PMID: 27853814 PMCID: PMC5209412 DOI: 10.1007/s00268-016-3808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
| | - Michiel C Warlé
- Department of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Khan TT, Ahmed N. Is the Reluctance for the Implantation of Right Kidneys Justified? World J Surg 2016; 41:324-325. [PMID: 27549592 DOI: 10.1007/s00268-016-3695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Taqi T Khan
- Department of Surgery, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
| | - Nadeem Ahmed
- Department of Surgery, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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