Living donor of the kidney—open—video

Perioperative Events and Complications in Minimally Invasive Live Donor Nephrectomy: A Systematic Review and Meta-Analysis

BACKGROUND

Minimally invasive live donor nephrectomy has become a fully implemented and accepted procedure. Donors have to be well educated about all risks and details during the informed consent process. For this to be successful, more information regarding short-term outcome is necessary.

METHODS

A literature search was performed; all studies discussing short-term complications after minimally invasive live donor nephrectomy were included. Outcomes evaluated were intraoperative and postoperative complications, conversions, operative and warm ischemia times, blood loss, length of hospital stay, pain score, convalescence, quality of life, and costs.

RESULTS

One hundred ninety articles were included in the systematic review, 41 in the meta-analysis. Conversion rate was 1.1%. Intraoperative complication rate was 2.3%, mainly bleeding (1.5%). Postoperative complications occurred in 7.3% of donors, including infectious complications (2.6%), of which mainly wound infection (1.6%) and bleeding (1.0%). Reported mortality rate was 0.01%. All minimally invasive techniques were comparable with regard to complication or conversion rate.

CONCLUSIONS

The used techniques for minimally invasive live donor nephrectomy are safe and associated with low complication rates and minimal risk of mortality. These data may be helpful to develop a standardized, donor-tailored informed consent procedure for live donor nephrectomy.

[Is the traditional open donor nephrectomy in living donor renal transplantation still up to date?]

BACKGROUND

Living donor kidney transplantation is a well-established method to reduce time on the waiting list. Although the laparoscopic donor nephrectomy has already been established worldwide, more than 80% of the living donor nephrectomies are performed as a traditional open donor nephrectomy in Germany. The aim of our study was to analyze perioperative data and long-term outcome of donors and recipients following open donor nephrectomy.

METHODS

From February 2004 to July 2008, a total of 51 open donor nephrectomies were performed in Tuebingen University Hospital. Forty-five data of corresponding transplant donors and recipients were analyzed. The Kocak classification which provides a format to compare postoperative complications after living donor nephrectomy was used.

RESULTS

Five-year graft survival was 100%. No intraoperative complications occurred. Postoperatively Grad I complications were observed in 10 donors (22.2%). In the long term no major complications occurred. Two donors (4.4%) had newly diagnosed hypertension and required antihypertensive medication. None of the donors developed proteinuria. Right-sided transabdominal donor nephrectomy was associated with a shorter mean hospital stay compared to left-sided lumbar nephrectomy. (7.8 ± 2.4 vs. 9.2 ± 1.8 days, p < 0.05).

CONCLUSION

Open donor nephrectomy is a safe procedure with an excellent graft survival. Complication rates in our center are comparable to recent results in laparoscopic living donor nephrectomy. Therefore, the open donor nephrectomy remains important.