Audit of an Initial 100 Cases of Laparoscopic Live Donor Nephrectomy

Kidney transplantation: A new era of laparoscopic living donor nephrectomy in Indonesia

BACKGROUND

Since its introduction in 1995, laparoscopic living donor nephrectomy (LLDN) has been a standard procedure in many transplantation centers worldwide. In 2011, LLDN was performed for the first time in Indonesia and became a standard procedure at our institution. The aim of this study is to evaluate the first 250 cases of LLDN at our institution.

METHODS

Retrospective analyses were conducted of the first 250 cases of LLDN. All operations were performed between November 2011 and July 2015 at Cipto Mangunkusumo Hospital, Jakarta. We grouped each 100 consecutive cases and the last 50 cases (three groups) to evaluate operation-related parameters, and complications.

RESULTS

Significant decreases in the first warm ischemic time, blood loss, length of stay, and number of complications were observed among the three groups. There was only one conversion to open case during LLDN surgery and no mortality case observed.

CONCLUSION

Laparoscopic living donor nephrectomies had been performed successfully with improvement of surgical parameter in due time. Thus, laparoscopic approach has entered a new era for kidney procurement in Indonesia.

Creatinine-based equations predicting chronic kidney disease after kidney donation

BACKGROUND

Kidney donation is associated with few adverse outcomes in living donors. The aim of this study was to evaluate the outcomes of living kidney donors and the utility of creatinine-based equations to predict chronic kidney disease.

METHODS

The study population was selected among 154 living kidney donors from 2001 to 2009. Seventy-eight patients underwent medical consultation to review demographic data and perform laboratory evaluations. Estimated glomerular filtration rate (GFR) values were obtained by three equations: Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault (C-G) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Receiver operating characteristic (ROC) analysis was performed to determine the area under the curve of each equation to predict evolution to chronic kidney disease.

RESULTS

The overall median age was 39 years including 64% of women subjects. The mean follow-up after kidney donation was 65 ± 34 months. During follow-up, 20.5% of patients developed hypertension. Serum creatinine values above 1.5 mg/dL were detected in 14.1% of cases. Dyslipidemia was present in 33.3% of donors at the last follow-up. According to measured creatinine clearance and the C-G equation, only four and six donors had renal failure (defined as GFR < 60 mL/min), a number that increased to 23 (29.4%) when considering the MDRD or CKD-EPI equations (P < .05). ROC curves performed to explore the GFR measurements to predict renal failure occurrence after donation showed the CKD-EPI to be the only one with a significant area under the curve (0.7442, P = .003).

CONCLUSION

Living kidney donors should receive careful long-term follow-up. Assessment of renal function before donation using CKD-EPI creatinine-based equations must be performed preferentially. A careful approach should be adopted for the detection and treatment of other complications such as hypertension and dyslipidemia.

Laparoscopic Living Kidney Donation at a Single Center: An Examination of Donor Outcomes with Increasing Experience

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.