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Tirtayasa PMW, Situmorang GR, Duarsa GWK, Mahadita GW, Ghinorawa T, Myh E, Nugroho EA, Kandarini Y, Rodjani A, Rasyid N. Risk factors of delayed graft function following living donor kidney transplantation: A meta-analysis. Transpl Immunol 2024; 86:102094. [PMID: 39053613 DOI: 10.1016/j.trim.2024.102094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Delayed graft function (DGF) is a common condition that necessitates dialysis during the first week after transplantation. Although DGF rarely occurs following living-donor kidney transplantation (LDKT), it may eventually lead to acute or chronic graft rejection. This study aimed to assess the risk factors for DGF in patients who underwent LDKT. METHODS A systematic review and meta-analysis of studies published before August 2022 was conducted using the PubMed, Science Direct, Cochrane, and Directory of Open Access Journal (DOAJ) databases. The review included studies that assessed the incidence of DGF following LDKT, and examined its risk factors, while excluding studies involving deceased donors. Potential risk factors were analyzed using pooled mean differences or odds ratios with 95% confidence intervals (CIs). Review Manager 5.3 was used for the meta-analysis. RESULTS Among the 13 included studies, 3685 cases of DGF were identified in a total of 113,261 patients (3.25%). Potential risk factors for DGF following LDKT were examined across several aspects, including donor, recipient, donor/recipient relationship, and immunological and intraoperative factors. The identified risk factors included older donors (P = 0.07), male recipients (P < 0.0001), higher recipient body mass index (BMI) (P < 0.0001), non-white recipients (P < 0.0001), pre-existing diabetes (P < 0.0001), pre-existing hypertension (P = 0.01), history of dialysis (P < 0.0001), re-transplantation (P = 0.004), unrelated donor/recipient (P = 0.02), ABO incompatibility (P < 0.0001), higher panel reactive antibody (PRA) levels (P < 0.0001), utilization of right kidney (P < 0.0001), and longer cold ischemia time (CIT) (P = 0.004). CONCLUSION Several factors related to the donor, recipient, donor/recipient relationship, and immunological and intraoperative aspects were identified as potential risk factors for the development of DGF following LDKT. Addressing and optimizing these factors may improve the long-term outcomes of LDKT.
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Affiliation(s)
- Pande Made Wisnu Tirtayasa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Universitas Udayana Teaching Hospital, Bali, Indonesia.
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Gede Wirya Kusuma Duarsa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia
| | - Gede Wira Mahadita
- Department of Nephrology, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia
| | - Tanaya Ghinorawa
- Department of Urology, Faculty of Medicine, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Etriyel Myh
- Department of Urology, Faculty of Medicine, Universitas Andalas, Dr. M.Djamil General Hospital, Padang, Indonesia
| | - Eriawan Agung Nugroho
- Department of Urology, Faculty of Medicine, Universitas Diponegoro, Dr. Kariadi General Hospital, Semarang, Indonesia
| | - Yenny Kandarini
- Department of Nephrology, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia
| | - Arry Rodjani
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Nur Rasyid
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
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Hirose T, Hotta K, Iwami D, Harada H, Morita K, Tanabe T, Sasaki H, Fukuzawa N, Seki T, Shinohara N. Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopic Living Donor Nephrectomy. J Endourol 2018; 32:1120-1124. [DOI: 10.1089/end.2018.0669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takayuki Hirose
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Daiki Iwami
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Harada
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hajime Sasaki
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuyuki Fukuzawa
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Toshimori Seki
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Widmer JD, Schlegel A, Kron P, Schiesser M, Brockmann JG, Muller MK. Hand-assisted living-donor nephrectomy: a retrospective comparison of two techniques. BMC Urol 2018; 18:39. [PMID: 29747596 PMCID: PMC5946389 DOI: 10.1186/s12894-018-0355-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 05/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Living-donor nephrectomy (LDN) is challenging, as surgery is performed on healthy individuals. Minimally invasive techniques for LDN have become standard in most centers. Nevertheless, numerous techniques have been described with no consensus on which is the superior approach. Both hand-assisted retroperitoneoscopic (HARS) and hand-assisted laparoscopic (HALS) LDNs are performed at Zurich University Hospital. The aim of this study was to compare these two surgical techniques in terms of donor outcome and graft function. METHOD Retrospective single-center analysis of 60 consecutive LDNs (HARS n = 30; HALS n = 30) from June 2010 to May 2012, including a one-year follow-up of the recipients. RESULTS There was no mortality in either group and little difference in the overall complication rates. Median warm ischemia time (WIT) was significantly shorter in the HARS group. The use of laxatives and the incidence of postoperative vomiting were significantly greater in the HALS group. There was no difference between right- and left-sided nephrectomies in terms of donor outcome and graft function. CONCLUSIONS Both techniques appear safe for both donors and donated organs. The HARS technique is associated with a shorter WIT and a reduced incidence of postoperative paralytic ileus. Therefore, we consider HARS LDN a valuable alternative to HALS LDN.
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Affiliation(s)
- Jeannette D Widmer
- Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland.
| | - Andrea Schlegel
- Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
| | - Philipp Kron
- Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
| | - Marc Schiesser
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jens G Brockmann
- Department of Surgery, Kidney and Pancreas Transplantation, King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Markus K Muller
- Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
- Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland
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Alberts V, Idu MM, Minnee RC. Risk factors for perioperative complications in hand-assisted laparoscopic donor nephrectomy. Prog Transplant 2014; 24:192-8. [PMID: 24919737 DOI: 10.7182/pit2014240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Living donor kidney transplant is the preferred treatment for end-stage renal disease; however, the shortage of kidney donors remains a big problem. One of the major reasons for the shortage of living donors is the risk of potentially serious surgical complications of a procedure in which the donor has no personal medical benefit. Therefore it is important to understand the risk factors for perioperative complications associated with donor nephrectomy. Hand-assisted laparoscopic donor nephrectomy is the preferred approach for kidney procurement in many medical centers. This review gives an overview of the risk factors in donor nephrectomy and more specifically in hand-assisted laparoscopic donor nephrectomy.
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Affiliation(s)
| | - Mirza M Idu
- Academic Medical Center, Amsterdam, The Netherlands
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Cannon RM, Eng M, Marvin MR, Buell JF. Laparoscopic Living Kidney Donation at a Single Center: An Examination of Donor Outcomes with Increasing Experience. Am Surg 2011; 77:911-5. [DOI: 10.1177/000313481107700730] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was undertaken to examine short-term outcomes of laparoscopic donor nephrectomy performed by transplant surgeons at a medium volume institution, with the specific goal of determining the presence of a learning curve effect. With institutional review board approval, a retrospective chart review was performed examining patient demographics, operative factors, and in-hospital outcomes over a 12-year period. Specific attention was paid to differences in outcomes between patients undergoing operation in the first versus the most recent 6-year period. Continuous and categorical variables were examined using the Wilcoxon rank sum test and χ2 analysis, respectively. The study group consisted of 129 patients. Median operative time was 234 minutes with a median estimated blood loss of 100. The median preoperative creatinine was 0.9, with a postoperative median creatinine of 1.3. The overall complication rate was 12.4 per cent, with ileus being the most common. There were two cases of post op acute renal failure, both of which were self limited and did not require dialysis. No patients died. Patients in the most recent 6 years (n = 77) enjoyed a shorter length of stay (2 vs 3 days, P < 0.001) than patients in the first 6-year period (n = 52). Additionally, there was a trend towards decreased complications in the second era that did not reach significance (9.1% vs 17.3%, P = 0.17). Laparoscopic donor nephrectomy is an attractive means of donation, and can be performed with low risk to the donor and minimal learning curve effect.
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Affiliation(s)
- Robert M. Cannon
- Division of Transplantation, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Mary Eng
- Division of Transplantation, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Michael R. Marvin
- Division of Transplantation, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Joseph F. Buell
- Tulane Abdominal Transplant Institute, Department of Surgery, Tulane University, New Orleans, Louisiana
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