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Bordes SJ, Montorfano L, West-Ortiz W, Valera R, Cracco A, Alonso M, Pinna AD, Ebaid S. Trends in US Kidney Transplantation During the COVID-19 Pandemic. Cureus 2020; 12:e12075. [PMID: 33489493 PMCID: PMC7805520 DOI: 10.7759/cureus.12075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Solid organ transplants have been impacted significantly during the COVID-19 pandemic in the United States. Limited data exist regarding changes in living donor kidney transplants. The aim of this study was to describe national trends in kidney transplantation during COVID-19. This descriptive cross-sectional study used publicly available data from the United Network for Organ Sharing (UNOS) and the National Kidney Registry (NKR). Plots of national waitlist inactivations, waitlist additions, deceased donor transplants and living donor transplants were created. An Auto Regressive Integrated Moving Average (ARIMA) model with interrupted time series analysis adjusting for first-order autocorrelation was used to evaluate for significant changes in outcome trends every four-week period during the COVID-19 era between March 15 and August 1, 2020. A statistical significance of 0.05 (𝛼) was established for analysis. Changes in kidney transplant volumes during the COVID-19 outbreak were registered. Density mapping and linear regression with interrupted time series analysis were used to characterize changes over time nationwide. Kidney transplants were affected significantly in recent months due to COVID-19. Deceased donor and living donor kidney transplant trends are described in this paper in addition to operative recommendations.
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Affiliation(s)
- Stephen J Bordes
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | | | - Wesley West-Ortiz
- Transplant, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | | | | | | | | | - Samer Ebaid
- Transplant, Cleveland Clinic Florida, Weston, USA
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Vu L, Nghia N, Thanh D, Giang T, Nga V, Bui L, Chu D. Laparoscopic living donor right nephrectomy: Assessment of outcome and association of BMI to length of right renal vein. Actas Urol Esp 2019; 43:536-542. [PMID: 31405530 DOI: 10.1016/j.acuro.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/27/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
AIMS The aim of this study was to describe outcomes of laparoscopic living donor right nephrectomy (LLDRN) and study factors affecting the length of right renal vein from the donors. MATERIAL AND METHODS This study was conducted in 60 donors (48 males and 12 females) from January 2016 to December 2017. We performed a retrospective review of consecutive patients who underwent transperitoneal right laparoscopic living donor nephrectomy at our unit. RESULTS LLDRN was successfully performed in all subjects by the same surgeons. Among 60 cases, 47 donors had single renal artery and vein, 2 cases had one artery and 2 veins, and 5 donors had 2 arteries and one vein, and the rest had 2-3 arteries with 1-3 veins. Operative time was 142.60±33.73min. Warm ischemic time was 2.64±0.76min. The mean hospital stay was 6.69±0.63 days. The median length of right renal vein was 1.92±0.41cm. All transplanted kidneys showed immediate function. No graft losses were recorded. Almost no gender differences were found in study variables except BMI and warm ischemic time, that was higher BMI but shorter warm ischemic time in female versus male donors. Further analysis showed a negative correlation between BMI and right renal vein (r=-0.282, P<0.05), but a positive correlation between operative time and estimate blood loss (r=0.37, P<0.01). CONCLUSIONS LLDRN is a feasible safe procedure, less traumatic approach, and provides good outcomes kidney for recipients. Notably, in the study group the higher BMI was associated with resulting more difficult LLDRN and kidney transplantation.
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Choi SW, Kim KS, Kim S, Choi YS, Bae WJ, Hong SH, Lee JY, Kim SW, Hwang TK, Cho HJ. Hand-assisted and pure laparoscopic living donor nephrectomy: a matched-cohort comparison over 10 yr at a single institute. Clin Transplant 2014; 28:1287-93. [DOI: 10.1111/ctr.12462] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Sae Woong Choi
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Kang Sup Kim
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Seol Kim
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Yong Sun Choi
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Woong Jin Bae
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Sung-Hoo Hong
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Ji Youl Lee
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Sae Woong Kim
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Tae-Kon Hwang
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Hyuk Jin Cho
- Department of Urology; College of Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
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Monn MF, Gramm AR, Bahler CD, Yang DY, Sundaram CP. Economic and Utilization Analysis of Robot-Assisted Versus Laparoscopic Live Donor Nephrectomy. J Endourol 2014; 28:780-3. [DOI: 10.1089/end.2014.0014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- M. Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alec R. Gramm
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Clinton D. Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - David Y. Yang
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chandru P. Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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Liu XS, Narins HW, Maley WR, Frank AM, Lallas CD. Robotic-assistance does not enhance standard laparoscopic technique for right-sided donor nephrectomy. JSLS 2013; 16:202-7. [PMID: 23477166 PMCID: PMC3481222 DOI: 10.4293/108680812x13427982376068] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Robotic-assistance did not improve outcomes associated with laparoscopic donor nephrectomy in this study. Objective: To examine donor and recipient outcomes after right-sided robotic-assisted laparoscopic donor nephrectomy (RALDN) compared with standard laparoscopic donor nephrectomy (LDN) and to determine whether robotic-assistance enhances LDN. Materials & Methods: From December 2005 to January 2011, 25 patients underwent right-sided LDN or RALDN. An IRB-approved retrospective review was performed of both donor and recipient medical charts. Primary endpoints included both intraoperative and postoperative outcomes. Results: Twenty right-sided LDNs and 5 RALDNs were performed during the study period. Neither estimated blood loss (76.4mL vs. 30mL, P=.07) nor operative time (231 min vs. 218 min, P=.61) were significantly different between either group (LDN vs. RALDN). Warm ischemia time for LDN was 2.6 min vs. 3.8 min for RALDN (P=.44). Donor postoperative serum estimated glomerular filtration rates (eGFR) were similar (53 vs. 59.6mL/min/1.73m2, LDN vs. RALDN, P=.26). For the recipient patients, posttransplant eGFR were similar at 6 months (53.4 vs. 59.8mL/min/1.73m2, LDN vs. RALDN, P=.53). Conclusion: In this study, robotic-assistance did not improve outcomes associated with LDN. Larger prospective studies are needed to confirm any perceived benefit of RALDN.
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Affiliation(s)
- Xiaolong S Liu
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
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Cho HJ, Choi YS, Bae WJ, Bae JH, Hong SH, Lee JY, Kim SW, Hwang TK, Cho YH. Another option for laparoscopic living donor nephrectomy: a single center experience comparing two-port versus hand-assisted technique. J Endourol 2013; 27:587-91. [PMID: 23228097 DOI: 10.1089/end.2012.0577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of two-port laparoscopic donor nephrectomy (TPLDN) vs hand-assisted laparoscopic donor nephrectomy (HALDN). PATIENTS AND METHODS Between November 2010 and March 2012, 100 kidney donors scheduled for left nephrectomy were alternatively assigned to HALDN or TPLDN in a 1:1 fashion. All procedures were performed by the same laparoscopic surgeon. Demographic data and intraoperative and early postoperative data were collected prospectively and analyzed. RESULTS There was no difference in the operating time (133±12 vs 142±17 min, P=0.07), blood loss (55±46 vs 58±52 mL, P=0.84), complication rate (10% vs 12%, P=0.74), and length of hospital stay (3.8±0.8 vs 4.1±2.8 days, P=0.5) between the HALDN and TPLDN groups. The warm ischemia time was longer in the TPLDN group (2.2±0.7 vs 3.5±0.9 min, P<0.001). No statistically significant differences were found in the analgesic requirement and the visual analog pain scores. There was a trend toward quicker return to 100% recovery in the TPLDN group (60±46 vs 39±15 days, P=0.05). The TPLDN group had a significantly smaller surgical incision (8.2±0.6 vs 5.5±0.4 cm, P<0.001) and higher scar satisfaction score (7.8±1.5 vs 8.6±1.3, P=0.02) than the HALDN group. No differences were found in the recipient serum creatinine values or in the incidence of delayed graft function. CONCLUSIONS In comparing TPLDN and HALDN, there was no significant difference in a majority of the operative and postoperative parameters. TPLDN might be associated with smaller surgical incision, improved cosmetic satisfaction, and equivalent recipient graft function.
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Affiliation(s)
- Hyuk Jin Cho
- Department of Urology, College of Medicine, Catholic University of Korea, Seoul, Korea
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Cooper M, Kramer A, Nogueira JM, Phelan M. Recipient outcomes of dual and multiple renal arteries following 1000 consecutive laparoscopic donor nephrectomies at a single institution. Clin Transplant 2013; 27:261-6. [DOI: 10.1111/ctr.12062] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Matthew Cooper
- Division of Transplantation; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Andrew Kramer
- Division of Urology; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Joseph M. Nogueira
- Division of Nephrology; Department of Medicine; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Michael Phelan
- Division of Urology; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
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Saito M, Tsuchiya N, Narita S, Kumazawa T, Maita S, Numakura K, Obara T, Tsuruta H, Inoue T, Horikawa Y, Satoh S, Habuchi T. Comparison of the Clinical Outcome and Systemic Inflammatory Marker Levels Between Retroperitoneal and Transperitoneal Laparoscopic Donor Nephrectomy. J Endourol 2012; 26:1038-43. [DOI: 10.1089/end.2012.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Teruaki Kumazawa
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinya Maita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takashi Obara
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Tsuruta
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takamitsu Inoue
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yohei Horikawa
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeru Satoh
- Division of Renal Replacement Therapeutic Science, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
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Sharma PK, Vijay MK, Pandey PK, Goel A, Bera MK. Comparison of transperitoneal laparoscopic approach and retroperitoneoscopic-assisted open approach for right-sided donor nephrectomies: A single institution experience. INDIAN JOURNAL OF TRANSPLANTATION 2011. [DOI: 10.1016/s2212-0017(11)60036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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10
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Canes D, Berger A, Aron M, Brandina R, Goldfarb DA, Shoskes D, Desai MM, Gill IS. Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 2009; 57:95-101. [PMID: 19664877 DOI: 10.1016/j.eururo.2009.07.023] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 07/17/2009] [Indexed: 01/13/2023]
Abstract
BACKGROUND Laparo-endoscopic single site (LESS) surgery is a recent development in minimally invasive surgery. Presented herein is the initial comparison of LESS donor nephrectomy (LESS-DN) and standard laparoscopic living donor nephrectomy (LLDN). OBJECTIVE To determine whether LESS-DN provides any measurable benefit over LLDN during the perioperative period and subsequent convalescence. DESIGN, SETTING, AND PARTICIPANTS Between November 2007 and November 2008, 18 consecutive patients underwent LESS-DN (17 left DN, 1 right DN). A contemporary matched-pair cohort of 17 patients undergoing standard LLDN was selected for retrospective comparison. INTERVENTIONS LESS-DN was performed through an intraumbilical novel multichannel port. The kidney was extracted through a slightly extended umbilical incision. MEASUREMENTS All data were prospectively accrued in an institutional review board-approved database. Convalescence data included visual analog pain scores and questionnaires containing patient-reported time to recovery end points. RESULTS AND LIMITATIONS One right-sided donor was converted to standard laparoscopy and excluded from analysis. Baseline demographics, operating time, blood loss, and hospital stay were comparable between groups. Compared to LLDN, patients undergoing LESS-DN had similar in-hospital analgesic requirements and mean visual analog scores at discharge. After discharge, patient-reported convalescence was faster in the LESS-DN group, including days on oral pain medication (20 vs 6; p=0.01), days off work (46 vs 18; p=0.0009), and days to 100% physical recovery (83 vs 29; p=0.03). Mean warm ischemia time was longer in the LESS-DN group (3 vs 6.1 min; p<0.0001); however, allograft function was immediate and comparable between groups. One allograft in the LESS-DN group thrombosed postoperatively. Regardless of laparoscopic approach, patients' global satisfaction with kidney donation and willingness to recommend their procedure to others were favorable and equivalent between groups. CONCLUSIONS This retrospective matched-pair comparison between LESS-DN and LLDN suggests that the single-port approach may be associated with quicker convalescence. In this initial series, LESS-DN had longer ischemia time, yet early allograft outcomes were comparable.
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Affiliation(s)
- David Canes
- Department of Urology, Lahey Clinic, Burlington, MA, USA
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11
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Feifer A, Anidjar M. [Laparoscopic nephrectomy in a living donor]. ANNALES D'UROLOGIE 2007; 41:158-172. [PMID: 18260606 DOI: 10.1016/j.anuro.2007.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Kidney transplantation is the therapeutic option of choice for patients with end-stage renal disease. With the advent of safer harvesting techniques and immunosuppression, both donor and recipient outcomes have markedly improved in recent years. Kidney donation from Living donors remains the single most important factor responsible for improving patient and graft survival. The laparoscopic donor nephrectomy has revolutionized renal transplantation, allowing expansion of the donor pool by diminishing surgical morbidity while maintaining equivalent recipient outcome. This technique is now becoming the gold-standard harvesting procedure in transplant centres worldwide, despite its technical challenge and ongoing procedural maturation, especially early in the learning curve. Previous contraindications to laparoscopic donor nephrectomy are no longer absolute. In the following analysis, the procedural aspects of the laparoscopic donor nephrectomy are detailed including pre-operative assessment, operative technique and a review of the current literature delineating aspects of both donor and recipient morbidity and mortality compared with open harvesting techniques.
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Affiliation(s)
- A Feifer
- McGill University Health Center, Royal Victoria Hospital, Department of urology, S6.88 Pine Avenue West, Montréal, Québec, Canada
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12
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Srivastava A, Gupta N, Kumar A, Kapoor R, Dubey D. Transperitoneal laparoscopic live donor nephrectomy: Current status. Indian J Urol 2007; 23:294-8. [PMID: 19718333 PMCID: PMC2721609 DOI: 10.4103/0970-1591.33727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Renal transplantation is the treatment of choice for a suitable patient with end stage renal disease. Unfortunately, the supply of donor organs is greatly exceeded by demand. In many countries the use of kidneys from living donors has been widely adopted as a partial solution. Traditionally donor nephrectomy has been performed via a open flank incision however with some morbidity like pain and a loin scar. Currently, the donor nephrectomy is increasingly being performed laparoscopically with the objective of reducing the morbidity. It is also hoped that this will lead to increasing acceptance of living donation. The first minimally invasive living donor nephrectomy was carried out in 1995 at the Johns Hopkins Medical Center and since then many centers have undertaken laparoscopic living donor nephrectomy. The laparoscopic approach substantially reduces the donor morbidity and wound related problems associated with open nephrectomy. The laparoscopic techniques thus have the potential to increase the number of living kidney donors. The present article attempts to review the safety and efficacy of transperitoneal laparoscopic donor nephrectomy.
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Affiliation(s)
- A Srivastava
- Department of Urology and Renal Transplantation, SGPGIMS, Lucknow, India
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Buresley S, Samhan M, Al-Mousawi M. Kuwait Experience in Laparoscopic Donor Nephrectomy: First 80 Cases. Transplant Proc 2007; 39:813-5. [PMID: 17524819 DOI: 10.1016/j.transproceed.2007.03.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Laparoscopic donor nephrectomy (LDN) has been adopted rapidly as it offers less postoperative pain, early recovery, and better cosmetic results compared with the open approach. This prospective study investigated the results of the first 80 LDN performed between May 2005 and May 2006, with regard to donor morbidity and effect on graft function. PATIENTS AND METHODS LDN was attempted in 80 donors by one surgical team. Donors included 68 men and 12 women, ages 22 to 53 years, with body mass indices of 17.9 to 42.4. According to computed tomographic angiography, left nephrectomy was planned in 75 donors and right nephrectomy in 5. RESULTS LDN was completed successfully in 74 (92.5%) and converted to open in 6 (7.5%) secondary to technical difficulties and operative bleeding. The mean operating time for LDN was 186.16 minutes (range, 95-260 minutes). Mean warm ischemia time (WIT) was 5.7 minutes (range 2-16 minutes). Mean hospital stay was 5.28 days (range, 3-14 days). Two donors (2.5%) were reexplored for postoperative bleeding. Renal function in all donors was satisfactory within 3 months of surgery. Immediate diuresis occurred in 76 (95%) recipients. Acute cellular rejection was diagnosed in 1 recipient. No association was observed between WIT, graft function, development of acute tubular necrosis (ATN), or rejection. Plasma creatinine normalization was clearly associated with donor age. CONCLUSIONS LDN was found to be a safe procedure with low postoperative morbidity and short recovery time for donors. It can potentially increase the donor pool.
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Affiliation(s)
- S Buresley
- Hamed Al-Essa Organ Transplantation Centre, Safat, Kuwait.
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14
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Lam JS, Breda A, Schulam PG. Is laparoscopic donor nephrectomy the new standard? ACTA ACUST UNITED AC 2007; 4:186-7. [PMID: 17342098 DOI: 10.1038/ncpuro0755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 02/02/2007] [Indexed: 11/09/2022]
Affiliation(s)
- John S Lam
- Division of Endourology and the Department of Urology, Center for Advanced Surgical and Interventional Technology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
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Rettkowski O, Hamza A, Markau S, Osten B, Fornara P. Ten Years of Laparoscopic Living Donor Nephrectomy: Retrospect and Prospect From the Nephrologist’s Point of View. Transplant Proc 2007; 39:30-3. [PMID: 17275469 DOI: 10.1016/j.transproceed.2006.10.220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Indexed: 11/20/2022]
Abstract
The laparoscopic living kidney donor nephrectomy introduced in 1995 has become an accepted method of kidney harvest for transplantation. The method has proven its usefulness as well as its superiority compared to open donor nephrectomy. Based on the results of a decade, an overview from a nephrologist's point of view is presented here in; a view that is known to be quite different from (and sometimes contrary to) the surgeon's approach. While urologists and surgeons focus more on the technique and complication rates, the nephrologist tends to estimate the new procedure with regard to his dialysis patients' outcomes (ie, whether it will result in an increased number of kidney transplantations in the long term). The latter aspect has to be the benchmark in the estimation of the effects of this procedure; it is the ultimate goal of every surgery in kidney transplantation. The 10-year results are more than encouraging, but nevertheless it will take at least one more decade for a valid evaluation.
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Affiliation(s)
- O Rettkowski
- Martin-Luther-University Halle-Wittenberg, Department of Urology and Kidney Transplantation, Halle, Germany.
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16
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Sabharwal A, Kumar A. Laparoscopic Donor Nephrectomy. APOLLO MEDICINE 2006. [DOI: 10.1016/s0976-0016(11)60223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Diner EK, Radolinski B, Murdock JD, Ghasemian SR. Right laparoscopic donor nephrectomy: The Washington Hospital Center experience. Urology 2006; 68:1175-7. [PMID: 17169641 DOI: 10.1016/j.urology.2006.08.1076] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 05/16/2006] [Accepted: 08/17/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To review 167 consecutive laparoscopic living donor nephrectomies performed at the Washington Hospital Center to determine whether the side of extraction, right versus left, affects the operative outcomes. METHODS From January 2003 to June 2005, 167 consecutive patients (127 left and 40 right) underwent laparoscopic living donor nephrectomy. The right-sided and left-sided procedures were compared in the following categories: operative time, warm ischemia time, length of stay, and complications. RESULTS The mean operative time for a right donor nephrectomy was 220 minutes versus 228 minutes for a left. The mean estimated blood loss was 115 mL for right donor nephrectomy versus 106 mL for the left. The corresponding mean warm ischemia times were 5.32 minutes and 4.91 minutes. The median length of stay was 3 days in both groups. Five minor and three major complications occurred, including 2 patients with recognized bowel injuries and 1 patient who required reoperation for a bladder injury. CONCLUSIONS Historically, laparoscopic living donor nephrectomy has been performed solely on the left side because of the increased length of the left renal vein. However, in our experience, the operative parameters and postoperative results were equivalent in the right and left laparoscopic donor nephrectomy groups. Therefore, we recommend removal of the more appropriate kidney, regardless of side.
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Affiliation(s)
- Eric K Diner
- Department of Urology, Washington Hospital Center, Washington, DC 20010, USA.
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Qazi HAR, Manikandan R, Philip J, Cornford PA, Parsons KF. Laparoscopic urology practice in the uk: current trends and future prospects. BJU Int 2006; 98:492-4. [PMID: 16925742 DOI: 10.1111/j.1464-410x.2006.06289.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hasan A R Qazi
- Department of Urology, The Royal Liverpool University Hospital, Liverpool, UK
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Sinha T, Varma PP, Srivastava A, Karan SC, Sandhu AS, Sethi GS, Khanna R, Talwar R, Narang V. A Comparative Study of Laparoscopic with Conventional Open Donor Nephrectomy in Renal Transplantation. Med J Armed Forces India 2006; 62:236-8. [PMID: 27365685 DOI: 10.1016/s0377-1237(06)80009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 10/06/2005] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Laparoscopic donor nephrectomy (LDN) has been gaining popularity among kidney donors. There have been concerns about the safety and efficacy of the procedure as compared to open donor nephrectomy (ODN). We compare our results on LDN with ODN. METHODS We retrospectively analysed our data of LDN and ODN. Duration of surgery, blood loss, period of hospitalisation, per oral intake and analgesic requirements. RESULT 22 LDNs were done, the operation time ranged from 220-300 minutes, and blood loss from 100-150ml. In the first 10 laparoscopic operations four cases required conversion to open surgical dissection. Only one case was converted to open surgery in the subsequent 12 laparoscopic cases. Oral intake was started on the first postoperative day. Analgesic requirement in laparoscopy cases was less. Patients were mobilised on the first day after surgery. Patients were discharged by seventh day. There was no significant difference in the functioning of the graft after revascularisation in the recipient. CONCLUSION Laparoscopic donor nephrectomy is a safe and effective technique of donor nephrectomy.
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Affiliation(s)
- T Sinha
- Senior Advisor and Head of Dept, Delhi Cantt
| | - P P Varma
- Senior Advisor (Medicine and Nephrology) Army Hospital (R&R), Delhi Cantt
| | - A Srivastava
- Graded Specialist (Surgery), Army Hosp (R&R), Delhi Cantt
| | - S C Karan
- Senior Advisor (Surgery and Urology), AH(R&R), Delhi Cantt
| | - A S Sandhu
- Classified Specialist (Surgery and Urology), AH (R&R), Delhi Cantt
| | - G S Sethi
- Classified Specialist (Surgery and Urology), AH (R&R), Delhi Cantt
| | - R Khanna
- Classified Specialist (Surg), CH (SC) Pune
| | - R Talwar
- Classified Specialist (Surg), CH (SC) Pune
| | - V Narang
- Resident (Urology), AH (R&R), Delhi Cantt
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yoo KY, Hong SH, Hwang TK. Donor Nephrectomy: Comparison of Open, Hand-assisted and Laparoscopic Donor Nephrectomy. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.12.1309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ki Young Yoo
- Department of Urology, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, The Catholic University of Korea, Seoul, Korea
| | - Tae-Kon Hwang
- Department of Urology, The Catholic University of Korea, Seoul, Korea
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Gupta N, Raina P, Kumar A. Laparoscopic donor nephrectomy. J Minim Access Surg 2005; 1:155-64. [PMID: 21206658 PMCID: PMC3004117 DOI: 10.4103/0972-9941.19262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Accepted: 12/12/2005] [Indexed: 11/22/2022] Open
Abstract
Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN), by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.
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Affiliation(s)
- Nitin Gupta
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pamposh Raina
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Kumar
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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