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Bansal S, Rathi D, Zafar F, Ghosh P, Khera R, Ahlawat R. Renal transplant outcomes in allografts with multiple versus single renal arteries. INDIAN JOURNAL OF TRANSPLANTATION 2023. [DOI: 10.4103/ijot.ijot_95_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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2
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Kumar M, Ram Dhayal I. Observational Study of Early Outcomes in Single-Vessel and Multiple-Vessel Renal Allograft. Cureus 2022; 14:e27579. [PMID: 36059293 PMCID: PMC9428421 DOI: 10.7759/cureus.27579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/05/2022] Open
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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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The effect of single or multiple arteries in the donor kidney on renal transplant surgical outcomes. Ir J Med Sci 2022; 192:929-934. [PMID: 35697967 DOI: 10.1007/s11845-022-03024-8] [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: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND As the number of end-stage renal disease (ESRD) patients is increasing, but there are not enough living donors, it is necessary to broaden the criteria for candidates who can undergo donor nephrectomy. Thanks to surgeons' increasing experience with laparoscopic donor nephrectomy (LND), multiple renal artery grafts, previously considered a relative contraindication to donor nephrectomy, have become candidates for LDN. We aimed to compare the outcomes of donors and recipients with single artery and with multiple arteries in LDN. METHODS A total of 214 patients were included in the study. Patients were divided into two groups according to the number of donor arteries: donors with one artery (group 1) and donors with multiple arteries (group 2). The number of donor arteries, operative time, warm ischemia time (WIT), cold ischemia time (CIT), arterial anastomosis time, venous anastomosis time, the extent of bleeding, and preoperative complications were recorded to evaluate the preoperative data. RESULTS The mean operation time in group 1 was 90.3 ± 11.8 min, while in group 2, it was 102.1 ± 5.5 min (p = 0.000). WIT group 1 was 90.9 ± 4.3 s and group 2 100.6 ± 2.1 s (p = 0.000). Arterial anastomosis time was 12.25 ± 3.8 in group 1 and 22.5 ± 4.5 in group 2 (p = 0.000). No statistically significant difference was found between the two groups in other parameters. CONLUSION Increasing the number of donor arteries in renal transplantation (RT) operations prolonged the operation time on both the donor and recipient sides. Still, it had no negative impact on complications or graft function in the postoperative period.
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Abraham G, Anupama S, Pradeep I, Mathews S, Parthasarathy R, Mathew M, Sundaraja S, Kurien A, Palaniappan N. Clinicopathological correlation of transplant nephrectomies in elusive graft dysfunction - An observational study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_94_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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6
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Giron-Luque F, Baez-Suarez Y, Garcia-Lopez A, Patino-Jaramillo N. Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy. Res Rep Urol 2022; 14:23-31. [PMID: 35118016 PMCID: PMC8801362 DOI: 10.2147/rru.s341028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Vascular multiplicity is the most frequent anatomic variation in kidney donors. Despite concerns about risks, these allografts are increasingly used to overcome the shortage of kidney donors. The safety and clinical outcomes in living kidney donors were evaluated with vascular multiplicity after hand-assisted laparoscopic living donor nephrectomy (HALDN). Patients and Methods Data from all living kidney donors who underwent HALDN from 2008 to 2021 was retrospectively reviewed. Patients were divided into two groups as single (SRV) and multiple renal vessels (MRV), and a comparative analysis was done. The primary outcomes include operating room time (ORT), days of hospital stay, estimated blood loss, complications, conversion, and re-operations. Results MRV were present in 166 out of 612 donors (27.1%). Among those, 10 (1.6%) donors had simultaneous multiple arteries and veins. Additionally, the prevalence of artery and vein multiplicity was 21.8% (n = 134) and 3.5% (n = 22), respectively. Warm ischemia time was significantly different among the two groups but not clinically important. The number of conversions to open technique, the mean ORT, the median blood loss, and days of hospital stay were similar between the SRV and MRV groups, without significant differences. According to the modified Clavien-classification system, no differences were found in the complication rates between the two groups (p = 0.29). Complication rates were 3.3% and 3.6% for the SRV and MRV groups, respectively. Conclusion HALDN is a procedure with safe intraoperative results, even with vascular multiplicity. The presence of multiple renal arteries or veins has no negative impact on the outcome of the donor after living donor nephrectomy.
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Affiliation(s)
| | | | - Andrea Garcia-Lopez
- Research Department, Colombiana de Trasplantes, Bogotá, Colombia
- Correspondence: Andrea Garcia-Lopez Research Department, Colombiana de Trasplantes, Av Carrera 30, No. 47A-74, Bogotá, ColombiaTel +57 300 502 4618 Email
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Kumar A, Panwar P, Bansal D, Maheshwari R, Chaturvedi S, Desai P. Stretching the limits: Finding the standard for achieving single graft artery lumen after left laparoscopic donor nephrectomy – A retrospective cohort study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_95_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Garcia LE, Parra N, Gaynor JJ, Baker L, Guerra G, Ciancio G. Clinical Outcomes Following Single vs. Multiple Vessel Living-Donor Kidney Transplantation: A Retrospective Comparison of 210 Patients. Front Surg 2021; 8:693021. [PMID: 34195224 PMCID: PMC8236516 DOI: 10.3389/fsurg.2021.693021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The use of living-donor kidney allografts with multiple vessels continues to rise in order to increase the donor pool. This requires surgeons to pursue vascular reconstructions more often, which has previously been associated with a higher risk of developing early post-transplant complications. We therefore wanted to investigate the prognostic role of using living-donor renal allografts with a single artery (SA) vs. multiple arteries (MA) at the time of transplant. Methods: We retrospectively analyzed a cohort of 210 consecutive living-donor kidney transplants performed between January, 2008 and March, 2019, and compared the incidence of developing postoperative complications and other clinical outcomes between SA vs. MA recipients. Results: No differences were observed between SA (N = 161) and MA (N = 49) kidneys in terms of the incidence of developing a postoperative (or surgical) complication, a urologic complication, hospital length of stay, delayed graft function, estimated glomerular filtration rate at 3 or 12 mo post-transplant, and graft survival. Conclusions: The use of live-kidney allografts with MA requiring vascular reconstruction shows excellent clinical outcomes and does not increase the risk of developing postoperative complications or other adverse outcomes when compared with SA renal allografts.
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Affiliation(s)
- Leonardo E Garcia
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Natalia Parra
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jeffrey J Gaynor
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.,Departments of Surgery and Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lauren Baker
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Giselle Guerra
- Division of Nephrology, Department of Medicine, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gaetano Ciancio
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.,Departments of Surgery and Urology, University of Miami Miller School of Medicine, Miami, FL, United States
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9
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Fitzpatrick J, Chmelo J, Nambiar A, Fuge O, Page T, Sen G, Soomro N, Rix D, Rogers A, Talbot D, Veeratterapillay R. Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels. Urol Ann 2020; 12:266-270. [PMID: 33100753 PMCID: PMC7546076 DOI: 10.4103/ua.ua_96_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/13/2020] [Indexed: 11/07/2022] Open
Abstract
Introduction: In kidney transplantation, total laparoscopic live donor nephrectomy (TLLDN) in the presence of multiple renal arteries (MRA) is technically challenging and has traditionally been associated with higher complication rates. We report our experience of using MRA grafts procured by TLLDN. Materials and Methods: Patients undergoing TLLDN at our center (2004–2014) was identified from a prospectively maintained database and divided into single renal arteries (SRA) or MRA groups. Recipient perioperative parameters, postoperative complications, and long-term graft survival were analyzed. Results: Of 465 patients, 106 had MRA and 359 had an SRA. There were six vascular complications in the SRA group and two in the MRA group (1.7% vs. 1.8%). There were eight ureteric complications requiring intervention in the SRA group compared to three in the MRA group (4% vs. 3%; P = 0.45). Acute rejection was observed in 12% of the SRA group compared to 9% in the MRA group (P = 0.23). One-, 5- and 10-year graft survivals were 98.2%, 91.3%, and 89.8% in the MRA group versus 98.0%, 90.4%, and 77.5% in the SRA group (log-rank P = 0.13). Conclusion: The use of MRA grafts procured by TLLDN has comparable complication rates to SRA grafts and should not preclude selection for renal transplantation.
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Affiliation(s)
- John Fitzpatrick
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Jakub Chmelo
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Arjun Nambiar
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Oliver Fuge
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Toby Page
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Gourab Sen
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Naeem Soomro
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - David Rix
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Alistair Rogers
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - David Talbot
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
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Baez-Suarez Y, Amaya-Nieto J, Girón-Luque F. Nefrectomía laparoscópica en un programa de donante vivo en la Costa Caribe de Colombia. DUAZARY 2020. [DOI: 10.21676/2389783x.3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La nefrectomía laparoscópica en donante vivo es la mejor opción en el proceso del trasplante para pacientes con enfermedad renal crónica en estadio cuatro y cinco. El objetivo del artículo es describir la experiencia en el programa de donante vivo de riñón entre el 2013 y el 2018 en Colombiana de Trasplantes en la costa Caribe colombiana. Se realizó un estudio descriptivo que incluyó una muestra consecutiva de 55 donantes vivos de riñón operados por Colombiana de Trasplantes, entre enero de 2013 y enero de 2018; se llevó a cabo el análisis estadístico de las variables relevantes. La media de la edad fue de 41 años. El 57,4% de los donantes fueron mujeres. El tiempo de cirugía tuvo una media de 1,9 horas. Ninguno de los pacientes falleció en el seguimiento a los seis meses y el promedio de la estancia hospitalaria posterior a la cirugía fue de dos días. Las variables relevantes y los desenlaces de los pacientes son similares a los de otros grupos de trasplantes, sin embargo, hay características específicas que pueden ayudar a mejorar las estrategias en salud en la costa Caribe colombiana.
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Broudeur L, Karam G, Chelghaf I, De Vergie S, Rigaud J, Perrouin Verbe MA, Branchereau J. Feasibility and safety of laparoscopic living donor nephrectomy in case of right kidney and multiple-renal artery kidney: a systematic review of the literature. World J Urol 2019; 38:919-927. [PMID: 31129713 DOI: 10.1007/s00345-019-02821-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/21/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To access the current status of the security and feasibility of right kidney (RK) and multiple-renal artery (MRA) laparoscopic living donor nephrectomy (LLDN) which are more challenging compared to left kidney (LK) and single renal artery (SRA) because of a shorter renal vein and more complex vascular anatomy. METHODS We did a systematic review of the literature according to the PRISMA recommendations, reporting RK or MRA donor nephrectomy performed with a laparoscopic technique compared to LK or SRA kidney LLDN. The identified and analyzed primary outcomes of interest were operating time (OT), warm ischemia time (WIT), rate of conversion and transfusion, donor length of stay (LOS), delayed graft function (DGF) and rate of graft loss (GL). RESULTS 16 comparative studies (1397 cases) of RK-LLDN and 12 comparative studies including 15 series (993 cases) of MRA-LLDN were selected. For RK-LLDN review, conversion rate was 0.8% and blood transfusion rate 0.2%, only one case of graft venous thrombosis was reported, OT was shorter in four studies and there was no any difference of DGF and GL rate compared to LK-LLDN. For MRA-LLDN review, conversion rate was 1.3% and blood transfusion rate 1.1%, OT and WIT were longer compared to SRA-LLDN, there were more ureteral complications in two studies, and no difference in terms of vascular complications and graft loss rate. CONCLUSION RK-LLDN and MRA-LLDN would be similar to LK-LLDN and SRA-LLDN in terms of feasibility and safety for the donor as well as graft function results for RK-LLDN.
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Affiliation(s)
- L Broudeur
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - G Karam
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - I Chelghaf
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - S De Vergie
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - J Rigaud
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - M A Perrouin Verbe
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France. .,Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France. .,Institut de Transplantation Urologie Néphrologie (ou ITUN), CHU Nantes, Nantes, France.
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12
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Laparoscopic procurement of single versus multiple artery kidney allografts: Meta-analysis of comparative studies. Asian J Surg 2019; 42:61-70. [DOI: 10.1016/j.asjsur.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/24/2018] [Accepted: 06/14/2018] [Indexed: 02/02/2023] Open
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Do Anatomical Anomalies Affect the Results of Living Donor Kidney Transplantation? Transplant Proc 2018; 50:1669-1673. [DOI: 10.1016/j.transproceed.2018.03.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/13/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022]
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Siena G, Campi R, Decaestecker K, Tuğcu V, Sahin S, Alcaraz A, Musquera M, Territo A, Gausa L, Randon C, Stockle M, Janssen M, Fornara P, Mohammed N, Guirado L, Facundo C, Doumerc N, Vignolini G, Breda A, Serni S. Robot-assisted Kidney Transplantation with Regional Hypothermia Using Grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: Results from the European Association of Urology Robotic Urology Section Working Group. Eur Urol Focus 2018; 4:175-184. [DOI: 10.1016/j.euf.2018.07.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/25/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
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Lafranca JA, Spoon EQW, van de Wetering J, IJzermans JNM, Dor FJMF. Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation. PLoS One 2017; 12:e0181846. [PMID: 28732093 PMCID: PMC5521829 DOI: 10.1371/journal.pone.0181846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The transplant community increasingly accepts extended criteria live kidney donors, however, great (geographical) differences are present in policies regarding the acceptance of these donors, and guidelines do not offer clarity. The aim of this survey was to reveal these differences and to get an insight in both centre policies as well as personal beliefs of transplant professionals. METHODS An online survey was sent to 1128 ESOT-members. Questions were included about several extended donor criteria; overweight/obesity, older age, vascular multiplicity, minors as donors and comorbidities; hypertension, impaired fasting glucose, kidney stones, malignancies and renal cysts. Comparisons were made between transplant centres of three regions in Europe and between Europe and other countries worldwide. RESULTS 331 questionnaires were completed by professionals from 55 countries. Significant differences exist between regions in Europe in acceptance of donors with several extended criteria. Median refusal rate for potential live donors is 15%. Furthermore, differences are seen regarding pre-operative work-up, both in specialists who perform screening as in preoperative imaging. CONCLUSIONS Remarkably, 23.4% of transplant professionals sometimes deviate from their centre policy, resulting in more or less comparable personal beliefs regarding extended criteria. Variety is seen, proving the need for a standardized approach in selection, preferably evidence based.
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Affiliation(s)
- Jeffrey A. Lafranca
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emerentia Q. W. Spoon
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, division of Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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Nanmoku K, Kurosawa A, Kubo T, Shinzato T, Shimizu T, Kimura T, Yagisawa T. Selection Criteria for Kidney Laterality in Retroperitoneoscopic Living Donor Nephrectomy and the Usefulness of Pretransplant Intervention. Transplant Proc 2017; 49:924-929. [PMID: 28583560 DOI: 10.1016/j.transproceed.2017.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the selection criteria for kidney laterality and the usefulness of pretransplant intervention in living donor nephrectomy. METHODS We compared conventional and revised criteria. The conventional criteria were that left kidneys were chosen in preference and provided the kidney with the fewest structural abnormalities and lowest functional decline and that most renal arteries remained in the donor. From April 2013, we allowed the use of left kidneys with double renal arteries. Patient characteristics and surgical outcomes were retrospectively compared between right and left retroperitoneoscopic living donor nephrectomies. RESULTS We compared data for 30 right kidney and 222 left kidney nephrectomies. Right kidneys were selected because of multiple renal arteries (n = 18), structural abnormalities (n = 10) of the left kidney, or functional decline (n = 2) of the right kidney. Right retroperitoneoscopic nephrectomies were associated with significantly longer operating times (267 minutes vs 241 minutes), larger blood losses (240 g vs 55 g), and higher open conversion rates (10% vs 0.9%). Pretransplant intervention was necessary for structural abnormalities in right kidneys, but the amended selection criteria resulted in fewer right nephrectomies. Pretransplant intervention was still necessary by ex vivo arterial anastomosis for multiple left renal arteries, which increased the total ischemia time (94 minutes vs 64 minutes); however, post-transplantation renal function was not significantly different. CONCLUSIONS Pretransplant intervention was beneficial both for repairing structural abnormalities and for reducing the difficulties of retroperitoneoscopic living donor nephrectomy.
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Affiliation(s)
- K Nanmoku
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan.
| | - A Kurosawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kubo
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shinzato
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Shimizu
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kimura
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Yagisawa
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
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Perioperative Events and Complications in Minimally Invasive Live Donor Nephrectomy: A Systematic Review and Meta-Analysis. Transplantation 2017; 100:2264-2275. [PMID: 27428715 DOI: 10.1097/tp.0000000000001327] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Nakamura Y, Kihara Y, Iwamoto H, Ozawa Y, Sano T, Tomita K, Yokoyama T, Konno O, Ueno T, Kawachi S. A Novel Assessment of Vascular Regions Using an Intraoperative Near-Infrared Fluorescence. Transplant Proc 2017; 48:710-5. [PMID: 27234719 DOI: 10.1016/j.transproceed.2015.12.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The risk of complications and transplant renal function increases in multiple arterial renal transplantations compared with single arterial renal transplantations. Even when multiple arteries are involved, with the introduction of laparoscopic nephrectomy, I mainly choose the left side kidney. Therefore, the number of renal artery reconstructions is increasing, and simultaneous imaging of arterial rebuilding during the donor nephrectomy is important. MATERIAL Between 2006 and 2015, we performed 132 living donor kidney transplantations at our center and analyzed 32 cases that were diagnosed pre- and intraoperatively. METHOD We compared the single renal artery (SRA) and multiple renal arteries (MRA) groups and analyzed the number of renal arteries, reconstruction methods, donor and recipient ages, sex, total ischemic times, and 1-month serum creatinine values. RESULT In the MRA and SRA groups, the average recipient age was 52.3 and 47.0 years, respectively, while the average donor age was 52.9 and 53.1 years, respectively. In SRA and MRA groups, total ischemic time (TIT) was 96.1 and 143.6 min (P < .01). Serum creatinine level 1 month post-transplantation was 1.54 and 1.25, respectively (P < .001). Here we experienced 12 cases of living renal donor nephrectomy with multiple vessels in which the vascular supply territory was first assessed in April 2013 using an intraoperative near-infrared fluorescence camera system. In addition, regarding TIT, it is possible to shorten surgery by using individual anastomosis and ligation. CONCLUSION By managing multiple donors; arteries by nephrectomy, it is possible to improve kidney transplantation results.
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Affiliation(s)
- Y Nakamura
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
| | - Y Kihara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - H Iwamoto
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Y Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - K Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Yokoyama
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - O Konno
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Ueno
- Division of Acute and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - S Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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Timsit MO, Kleinclauss F, Mamzer Bruneel M, Thuret R. Le donneur vivant de rein. Prog Urol 2016; 26:940-963. [DOI: 10.1016/j.purol.2016.09.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023]
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Tillou X, Timsit MO, Sallusto F, Culty T, Verhoest G, Doerfler A, Thuret R, Kleinclauss F. [Polycystic kidney disease and kidney transplantation]. Prog Urol 2016; 26:993-1000. [PMID: 27665410 DOI: 10.1016/j.purol.2016.08.010] [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: 07/15/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To perform a state of the art about autosomal dominant polykystic kidney disease (ADPKD), management of its urological complications and end stage renal disease treatment modalities. MATERIAL AND METHODS An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH): "autosomal dominant polykystic kidney disease", "complications", "native nephrectomy", "kidney transplantation". Publications obtained were selected based on methodology, language, date of publication (last 10 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 3779 articles. After reading titles and abstracts, 52 were included in the text, based on their relevance. RESULTS ADPKD is the most inherited renal disease, leading to end stage renal disease requiring dialysis or renal transplantation in about 50% of the patients. Many urological complications (gross hematuria, cysts infection, renal pain, lithiasis) of ADPKD required urological management. The pretransplant evaluation will ask the challenging question of native nephrectomy only in case of recurrent kidney complications or large kidney not allowing graft implantation. The optimum timing for native nephrectomy will depend on many factors (dialysis or preemptive transplantation, complication severity, anuria, easy access to transplantation, potential living donor). CONCLUSION Pretransplant management of ADPKD is challenging. A conservative strategy should be promoted to avoid anuria (and its metabolic complications) and to preserve a functioning low urinary tract and quality of life. When native nephrectomy should be performed, surgery remains the gold standard but renal arterial embolization may be a safe option due to its low morbidity.
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Affiliation(s)
- X Tillou
- Service d'urologie et transplantation, CHU Côte de Nacre, 14000 Caen, France
| | - M-O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - F Sallusto
- Département d'urologie et transplantation, CHU de Toulouse, 31400 Toulouse, France
| | - T Culty
- Service d'urologie, CHU d'Angers, 49100 Angers, France
| | - G Verhoest
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - A Doerfler
- Service d'urologie et transplantation, CHU Côte de Nacre, 14000 Caen, France
| | - R Thuret
- Service d'urologie, CHU Lapeyronie, 34000 Montpellier, France; Université de Montpellier, 34000 Montpellier, France
| | - F Kleinclauss
- Service d'urologie et transplantation, CHRU de Besançon, 3, boulevard A.-Fleming, 25000 Besançon, France; Université de Franche-Comté, 25000 Besançon, France; Inserm UMR 1098, 25000 Besançon, France.
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Lim YMJ, Han X, Raman L, Ng TK, Goh THA, Vathsala A, Tiong HY. Outcome of Living Donor Transplant Kidneys With Multiple Arteries. Transplant Proc 2016; 48:848-51. [PMID: 27234750 DOI: 10.1016/j.transproceed.2015.12.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/30/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Living donor transplantation (LDT) using kidneys with multiple arteries (MA) has previously been reported to be associated with increased complications and poorer outcomes in recipients. The objective of this study was to investigate outcomes of LDT with MA at the National University Hospital of Singapore, an institution with modest kidney transplant volumes. METHODS From 2007 to 2014, a total of 109 consecutive living donor kidney transplantations were performed. Of the nephrectomies, 91% were left sided. A total of 19 cases involved MA, of which 7 with small polar vessels (<2 mm) were ligated and 12 were revascularized. Baseline characteristics and outcomes were comparable between donor-recipient pairs with MA and single artery (SA). Both groups had equivalent induction and maintenance immunosuppressive regimens. RESULTS Mean warm ischemia time (minutes) was similar for kidneys with MA and SA (4.3 ± 3.2 vs 3.9 ± 3.2, P = .38). Operative time (minutes) in the recipients was also equivalent (P > .05) for MA and SA (158 ± 39.2 and 145 ± 57.2, respectively). The MA kidney recipients had a lower estimated glomerular filtration rate (eGFR) on postoperative day 5 compared to SA (56.6 ± 24.2 vs 74.1 ± 35.9 mL/min/1.73 m(2), P = .058). However, eGFR at 1 year was the similar for both groups (64.9 ± 16.2 vs 66.4 ± 18.1 mL/min/1.73 m(2), respectively, P = .76). Delayed graft function rates were 5.6% and 6.6% for MA and SA, respectively (P = .9). There were no surgical complications for LDT recipients within the MA group. Patient and graft survival was 100% in the MA group compared with 98% in the SA group (P > .05). CONCLUSIONS With current surgical techniques, LDT with MA can achieve equally good functional outcomes at 1 year as SA kidneys, with minimal surgical complications.
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Affiliation(s)
- Y M J Lim
- Department of Urology, National University Health System, Singapore
| | - X Han
- Department of Urology, National University Health System, Singapore
| | - L Raman
- Department of Urology, National University Health System, Singapore
| | - T K Ng
- Department of Urology, National University Health System, Singapore
| | - T H A Goh
- Department of Urology, National University Health System, Singapore
| | - A Vathsala
- Department of Urology, National University Health System, Singapore
| | - H Y Tiong
- Department of Urology, National University Health System, Singapore.
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Lafranca JA, van Bruggen M, Kimenai HJAN, Tran TCK, Terkivatan T, Betjes MGH, IJzermans JNM, Dor FJMF. Vascular Multiplicity Should Not Be a Contra-Indication for Live Kidney Donation and Transplantation. PLoS One 2016; 11:e0153460. [PMID: 27077904 PMCID: PMC4831799 DOI: 10.1371/journal.pone.0153460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Whether vascular multiplicity should be considered as contraindication and therefore 'extended donor criterion' is still under debate. METHODS Data from all live kidney donors from 2006-2013 (n = 951) was retrospectively reviewed. Vascular anatomy as imaged by MRA, CTA or other modalities was compared with intraoperative findings. Furthermore, the influence of vascular multiplicity on outcome of donors and recipients was studied. RESULTS In 237 out of 951 donors (25%), vascular multiplicity was present. CTA had the highest accuracy levels regarding vascular anatomy assessment. Regarding outcome of donors with vascular multiplicity, warm ischemia time (WIT) and skin-to-skin time were significantly longer if arterial multiplicity (AM) was present (5.1 vs. 4.0 mins and 202 vs. 178 mins). Skin-to-skin time was significantly longer, and complication rates were higher in donors with venous multiplicity (203 vs. 180 mins and 17.2% vs. 8.4%). Outcome of renal transplant recipients showed a significantly increased WIT (30 vs. 26.7 minutes), higher rate of DGF (13.9% vs. 6.9%) and lower rate of BPAR (6.9% vs. 13.9%) in patients receiving a kidney with AM compared to kidneys with singular anatomy. CONCLUSIONS We conclude that vascular multiplicity should not be a contra-indication, since it has little impact on clinical outcome in the donor as well as in renal transplant recipients.
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Affiliation(s)
- Jeffrey A. Lafranca
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark van Bruggen
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hendrikus J. A. N. Kimenai
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thi C. K. Tran
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Türkan Terkivatan
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G. H. Betjes
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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Hiramitsu T, Futamura K, Okada M, Yamamoto T, Tsujita M, Goto N, Narumi S, Watarai Y, Kobayashi T. Impact of Arterial Reconstruction With Recipient's Own Internal Iliac Artery for Multiple Graft Arteries on Living Donor Kidney Transplantation: Strobe Study. Medicine (Baltimore) 2015; 94:e1811. [PMID: 26512578 PMCID: PMC4985392 DOI: 10.1097/md.0000000000001811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to investigate the usefulness of arterial reconstruction using the recipient's own internal iliac artery for multiple kidney graft arteries.The safety and efficacy of various arterial reconstruction methods have been demonstrated. Although some reports have documented arterial reconstruction with the recipient's own internal iliac artery for multiple kidney graft arteries using the interposition method, usefulness of this technique has not yet been investigated compared with other arterial reconstruction methods.Between January 2008 and April 2014, 532 living donor kidney transplants in adult recipients were performed at 1 center. Of these, 389 kidney grafts had a single artery and did not need arterial reconstruction (nonarterial reconstruction group). Among the bench surgery patients, 19 kidney grafts for multiple arteries were performed using the interposition method with the recipient's own internal iliac artery (interposition group). Seventy-nine kidney grafts were performed using conjoined reconstruction (conjoined group) and 15 kidney grafts were performed using end-to-side reconstruction (end-to-side group). Total ischemic time (the period between arterial clamp and blood reperfusion), time to initial urination, perioperative and postoperative estimated glomerular filtration rate (eGFR), and complication rates between the interposition group and other 3 groups were retrospectively investigated. This study was based on the STROBE compliant.Warm ischemic time (the period between arterial clamp and beginning of the cold perfusion) of interposition group was significantly longer than that of nonarterial reconstruction group. Total ischemic time of the interposition group was significantly longer than those of other 3 groups. But time to initial urination, perioperative and postoperative eGFR, and complications were similar to other 3 groups.The interposition method was shown to be a useful standard method for multiple kidney graft arteries of living donor kidney transplantation in carefully selected recipients without calcification of the iliac arteries.
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Affiliation(s)
- Takahisa Hiramitsu
- From the Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital (TH, KF, MO, TY, MT, NG, SN, YW); and Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Aichi, Japan (TK)
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Srivastava A, Prabhakaran S, Sureka SK, Kapoor R, Kumar A, Sharma RK, Prasad N, Ansari MS. The challenges and outcomes of living donor kidney transplantation in pediatric and adolescent age group in a developing country: A critical analysis from a single center of north India. Indian J Urol 2015; 31:33-7. [PMID: 25624573 PMCID: PMC4300569 DOI: 10.4103/0970-1591.145290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Renal transplantation is the treatment of choice for children with end-stage renal disease (ESRD). We evaluated the outcome of renal transplantation in the pediatric and adolescent age groups in the perspective of a developing country as compared with developed nations while highlighting the challenges we have faced in a pediatric transplant programme. Materials and Methods: Seventy live related pediatric and adolescent renal transplantations were reviewed retrospectively. Variables analyzed were etiology of ESRD, pre-transplant renal replacement modality, donor relationship, surgical complications, rejection episodes, immuno-suppression regimens, compliance to immunosuppression, graft survival and overall survival. Results: The cohort consisted of 13 (18%) female and 57 male (82%) recipients. The mean age was 14 ± 1.4 years. The etiology of ESRD was chronic glomerulonephritis (n = 43), chronic interstitial nephritis (n = 26) and Alport's syndrome (n = 1). Fifty-six (80%) children were on hemo-dialysis and 10 (14%) on peritoneal dialysis prior to transplantation. 80.5% and 61% patients were strictly compliant to immunosuppresant medications at 1 and 5 years. The 1, 3 and 5 year graft survival rates were 94.3%, 89.2% and 66.8%, respectively. The overall survival rates were 95.7%, 96.4% and 94.1% for 1, 3 and 5 years, respectively. Conclusions: The spectrum of etiology of ESRD differs in our patients from the west, with chronic glomerulonephritis being the most common etiology. Early graft survival is comparable, but the 5-year graft survival is clearly inferior as compared with developed countries.
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Affiliation(s)
- Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sandeep Prabhakaran
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - R K Sharma
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Retroperitoneoscopic Donor Nephrectomy With Multiple Renal Arteries Does Not Affect Graft Survival and Ureteral Complications. Transplantation 2014; 98:1175-81. [DOI: 10.1097/tp.0000000000000326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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27
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Ahmadi AR, Lafranca JA, Claessens LA, Imamdi RMS, IJzermans JNM, Betjes MGH, Dor FJMF. Shifting paradigms in eligibility criteria for live kidney donation: a systematic review. Kidney Int 2014; 87:31-45. [PMID: 24786706 DOI: 10.1038/ki.2014.118] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/06/2014] [Accepted: 02/20/2014] [Indexed: 12/11/2022]
Abstract
As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, trying to seek and establish the optimal extended criteria. Comprehensive searches were carried out in major databases until November 2013 to search for articles regarding older age, overweight and obesity, hypertension, vascular anomalies/multiplicity, nulliparous women, and minors as donors. Of the 2079 articles found, 152 fell within the scope of the review. Five major guidelines were included and reviewed. Based on the literature search, live kidney donation in older donors (up to 70 years of age) seems to be safe as outcome is comparable to younger donors. Obese donors have comparable outcome to lean donors, in short- and mid-term follow-up. Since little literature is available proving the safety of donation of hypertensive donors, caution is advised. Vascular multiplicity poses no direct danger to the donor and women of childbearing age can be safely included as donors. Although outcome after donation in minors is shown to be comparable to adult donors, they should only be considered if no other options exist. We conclude that the analyzed factors above should not be considered as absolute contraindications for donation.
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Affiliation(s)
- Ali R Ahmadi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeffrey A Lafranca
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura A Claessens
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Raoul M S Imamdi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Chedid MF, Muthu C, Nyberg SL, Lesnick TG, Kremers WK, Prieto M, Heimbach JK, Chow GK, Stegall MD, Dean PG. Living Donor Kidney Transplantation Using Laparoscopically Procured Multiple Renal Artery Kidneys and Right Kidneys. J Am Coll Surg 2013; 217:144-52; discussion 152. [DOI: 10.1016/j.jamcollsurg.2013.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/27/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
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Harraz A, Shokeir A, Soliman S, El-Hefnawy A, Kamal M, Shalaby I, Kamal A, Ghoneim M. Fate of Accessory Renal Arteries in Grafts with Multiple Renal Arteries during Live-Donor Renal Allo-Transplantation. Transplant Proc 2013; 45:1232-6. [DOI: 10.1016/j.transproceed.2013.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cho H, Lee J, Kim J, Kim S, Hwang TK, Hong SH. How Safe and Effective Is Routine Left Hand-Assisted Laparoscopic Donor Nephrectomy With Multiple Renal Arteries? A High-Volume, Single-Center Experience. Transplant Proc 2012. [DOI: 10.1016/j.transproceed.2012.04.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Meyer F, Nichele SA, Adamy A, Santos LS, Machado C. Early outcomes of laparoscopic donor nephrectomy with multiple renal arteries. Int Braz J Urol 2012; 38:496-503. [DOI: 10.1590/s1677-55382012000400009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2011] [Indexed: 11/22/2022] Open
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Laouad I, Bretagnol A, Fabre E, Halimi JM, Al-Najjar A, Boutin JM, Bruyère F, Nivet H, Lebranchu Y, Büchler M. Kidney Transplant with Multiple Renal Artery Grafts from Deceased Donors: Are Long-Term Graft and Patient Survival Compromised? Prog Transplant 2012; 22:102-9. [DOI: 10.7182/pit2012992] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background— Kidneys with multiple arteries are often transplanted. However, the long-term outcome of such kidneys recovered exclusively from deceased donors is not clear. Objective— To determine whether use of renal grafts with multiple arteries affects long-term graft survival and function. Methods— The outcomes of 259 consecutive kidney transplants between 1996 and 2000 were retrospectively reviewed. Patients were divided into 2 groups, multiple renal artery graft recipients (n = 70) and single renal artery graft recipients (n = 189). Short-term complications and long-term outcomes (survival rates, blood pressure after transplant, creatinine clearance, and proteinuria levels at 1, 3, 5, and 7 years after transplant) were compared between the 2 groups. Results— Early vascular complications were more common ( P = .02) in multiple artery graft recipients (18.6%) than in single artery graft recipients (7.9%), mainly because of occlusion of a polar artery in grafts with multiple renal arteries (7.1%). Urologic complications were no more frequent in one group than in the other (5.7% vs 5.3%; P = .89). The 2 groups did not differ significantly ( P = .33) in long-term graft survival, with a median follow-up of 9.05 years (range, 0.1–12.7 years). Mean (SD) for creatinine clearance (59.4 [22.6] vs 55.9 [20.3] mL/min; P = .47), proteinuria (0.77 [2.1] vs 0.4 [0.8] g/24 h; P = .19), and systolic blood pressure (133.6 [14.5] vs 133.7 [17.5] mm Hg; P = .85) did not differ significantly between the 2 groups 7 years after transplant. Conclusions— Kidney transplant with grafts containing multiple renal arteries rather than grafts with a single renal artery does not significantly influence patient and graft outcomes.
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Hung C, Lin Y, Chang S, Chou T, Lee P. Kidney Grafts With Multiple Renal Arteries Is No Longer a Relative Contraindication With Advance in Surgical Techniques of Laparoscopic Donor Nephrectomy. Transplant Proc 2012; 44:36-8. [DOI: 10.1016/j.transproceed.2011.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Rizzari MD, Suszynski TM, Gillingham KJ, Matas AJ, Ibrahim HN. Outcome of living kidney donors left with multiple renal arteries. Clin Transplant 2011; 26:E7-11. [PMID: 22017317 DOI: 10.1111/j.1399-0012.2011.01548.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Individuals with kidneys having ≥ 2 arteries appear to have an increased incidence of hypertension. Whether kidney donors in whom the remaining kidney has ≥ 2 arteries are at increased risk of hypertension is unknown. Therefore, we studied 3685 kidney donors to determine whether donors left with a kidney having ≥ 2 arteries were at increased risk of hypertension, impaired renal function, or death. Cohorts were assigned based on our practice pattern and the anatomy of the donated kidney. Of the 3685 donors, 1211 were estimated to have a remaining kidney with ≥ 2 arteries. Mean follow-up time for the single-artery group was 14.1 (± 11.0) yr and 15.3 (± 11.2) yr for the ≥ 2 artery group. Six-month hospital readmission rate was 1.4% and 1.2%, hypertension was noted in 22.4% and 21.8% and proteinuria in 9.7% and 9.6%, and estimated glomerular filtration rate at last follow-up was 62 (± 28) and 62 (± 16) for single vs. ≥ 2 renal artery groups, respectively. Our data suggest no adverse clinical sequelae nor any decrease in long-term survival for donors left with a kidney having ≥ 2 renal arteries.
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Affiliation(s)
- Michael D Rizzari
- Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, MN 55414, USA
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Veeramani M, Jain V, Ganpule A, Sabnis RB, Desai MR. Donor gonadal vein reconstruction for extension of the transected renal vessels in living renal transplantation. Indian J Urol 2011; 26:314-6. [PMID: 20877621 PMCID: PMC2938567 DOI: 10.4103/0970-1591.65417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Donor gonadal vein is a readily available vascular reconstruction material for vascular reconstruction, for difficult situations, in living related renal transplantation. Vein extension with the gonadal vein has been described as a simple and safe method to elongate renal vein especially in right living donor kidneys. We applied the donor gonadal vein for lacerated accessory renal artery and renal vein reconstruction. Materials and Methods: The donor gonadal vein was used to reconstruct the lacerated accessory renal artery in one patient. The donor gonadal vein was isolated, used as an interposition graft to bridge the gap between transected accessory renal artery and external iliac artery of the recipient. In another patient, gonadal vein was used to reconstruct short right renal vein, which got damaged during retrieval. Results: This technique resulted in a tension-free anastomosis. There were no procedure related complications. The ischemia time remained within acceptable limits and grafts showed excellent outcomes. Conclusions: The use of gonadal vein for renal vascular reconstruction seems to be an acceptable option during living related renal transplantation, lest the need arise, with no increased graft morbidity.
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Affiliation(s)
- Muthu Veeramani
- Department of Urology, Muljibhai Patel Urological Hospital, Dr. V V Desai Road, Nadiad, Gujarat - 387 001, India
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Mishra S, Ganpule A, Muthu V, Sabnis RB, Desai MR. Evaluating graft function in pediatric recipients for living donor renal transplantation: Is laparoscopic donor nephrectomy safe? Indian J Urol 2011; 25:195-8. [PMID: 19672345 PMCID: PMC2710063 DOI: 10.4103/0970-1591.51358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: To evaluate the surgical and functional outcomes of laparoscopic graft procurement in pediatric patients undergoing renal transplantation. Materials and Methods: A retrospective chart review of the cohort records of 54 pediatric living donor renal transplant recipients from 1985 through June 2006 was performed. We compared results of laparoscopic donor nephrectomy (LDN, n = 15) and open donor nephrectomy (ODN, n = 39). Parameters analysed included donor technique and morbidity, operative complications, immediate postoperative renal function, the incidence of early and delayed graft function, and long-term graft survival. Results: The mean age of these recipients was 14.8 years (5-18) in the LDN group and 13.9 years (8-18) in ODN group. Serum creatinine (mg/dl) was 1.5 ± 0.7 vs 1.8 ± 1.3 at day 1 (P = 0.20), 1.0 ± 0.3 vs 1.4 ± 1.3 at day 2 (P = 0.12), 1.1 ± 0.9 vs 1.3 ± 1.0 at day 7 (P = 0.25), 1.2 ± 0.5 vs 1.6 ± 1.8 (P = 0.20) at day 14, 1.1 ± 0.7 vs 1.2 ± 1.4 (P = 0.39) at 1 month in LDN vs ODN groups, respectively. Early graft function was 35.7 vs 46.4% in the respective groups. There were two delayed graft function and one graft nonfunction in ODN group. Over all graft and patient survival at 1 year was 86.67 and 82.22% (P = 0.34) in LDN and ODN groups, respectively. Conclusion: Pediatric recipients of the LDN grafts have outcomes comparable to those of ODN graft recipients. Laparoscopic donor nephrectomy is safe and efficacious for graft procurement for pediatric recipients.
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Affiliation(s)
- Shashikant Mishra
- Department of Urology and Nephrology, Muljibhai Patel Society for Research in Nephrourology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Vascular Constraints in Laparoscopic Renal Allograft: Comparative Analysis of Multiple and Single Renal Arteries in 976 Laparoscopic Donor Nephrectomies. World J Surg 2011; 35:2159-66. [DOI: 10.1007/s00268-011-1168-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tyson MD, Castle EP, Ko EY, Andrews PE, Heilman RL, Mekeel KL, Moss AA, Mulligan DC, Reddy KS. Living Donor Kidney Transplantation With Multiple Renal Arteries in the Laparoscopic Era. Urology 2011; 77:1116-21. [DOI: 10.1016/j.urology.2010.07.503] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/22/2010] [Accepted: 07/31/2010] [Indexed: 10/18/2022]
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Genc V, Karaca AS, Orozakunov E, Cakmak A, Sevim Y, Ustuner E, Oztuna D, Hazinedaroglu SM. Multiple renal arteries challenge in laparoscopic donor nephrectomy: how far can we go? JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80:272-7. [PMID: 22066047 PMCID: PMC3204676 DOI: 10.4174/jkss.2011.80.4.272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/01/2010] [Indexed: 11/30/2022]
Abstract
Purpose Living donor kidneys with multiple arteries are routinely procured laparoscopically. We aim to present our experience with laparoscopic donor nephrectomy (LDN) and to compare the graft function and outcome between cases with single versus multiple arteries. Methods We compared the demographic data, operation time, warm ischemia time, rejection rate, and graft function between LDN kidneys with single artery and those with multiple arteries. Results Seventy-three cases with 1 renal artery (group LDN-1), 8 cases with 2 renal arteries (group LDN-2) and 5 cases with 3 or more renal arteries (group LDN-3) were included in the study. The mean operative time was significantly higher in groups LDN-2 (100.3 ± 9.5 minutes) and LDN-3 (120.6 ± 10.3 minutes) compared to group LDN-1 (75.7 ± 10 minutes, P < 0.001). Similar results were detected with respect to the warm ischemia time. There were no statistically significant differences related to graft function and outcome among these groups. Conclusion Multiple renal arteries present a special challenge in both donor nephrectomy and renal transplantation. However, laparoscopic procurement of a kidney with multiple renal arteries, regardless of the number, is reliable and has no significant impact on the graft outcome.
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Affiliation(s)
- Volkan Genc
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
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Laparoscopic Living-Donor Nephrectomy: Analysis of the Existing Literature. Eur Urol 2010; 58:498-509. [DOI: 10.1016/j.eururo.2010.04.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 04/07/2010] [Indexed: 01/10/2023]
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Modi P. The mini-incision donor nephrectomy is best suited for Indian patients undergoing live donor nephrectomy: against the motion. Indian J Urol 2010; 26:142-4. [PMID: 20535306 PMCID: PMC2878431 DOI: 10.4103/0970-1591.60465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pranjal Modi
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre, Institute of Trans plantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad - 380 016, Gujarat, India
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Ghazanfar A, Tavakoli A, Zaki MR, Pararajasingam R, Campbell T, Parrott NR, Augustine T, Riad HN. The Outcomes of Living Donor Renal Transplants With Multiple Renal Arteries: A Large Cohort Study With a Mean Follow-Up Period of 10 Years. Transplant Proc 2010; 42:1654-8. [PMID: 20620494 DOI: 10.1016/j.transproceed.2009.12.067] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 12/08/2009] [Indexed: 02/05/2023]
Affiliation(s)
- A Ghazanfar
- Department of Transplant Surgery, Central Manchester University Hospitals NHS Foundation Trust Manchester Royal Infirmary, Manchester, England.
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Kuo T, Yip SKH, Ng CF, Ng LG, Cheng CWS. Outcome of Laparoscopic Live Donor Nephrectomy and Impact of Double Renal Arteries: Results From Two Transplant Centres. Asian J Surg 2010; 33:70-5. [DOI: 10.1016/s1015-9584(10)60012-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2010] [Indexed: 10/18/2022] Open
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Laparoscopic procurement of single versus multiple artery kidney allografts: is long-term graft survival affected? Transplantation 2010; 88:1203-7. [PMID: 19935374 DOI: 10.1097/tp.0b013e3181ba343a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Living donor kidneys with multiple arteries (MA) are increasingly procured laparoscopically for transplant. METHODS We compare long-term graft function and survival of kidneys with single arteries (SA) and MA over a 10-year period. RESULTS There were a total of 218 grafts with SA and 60 grafts with MA. The MA group had longer operative and ischemic times than SA group. There was a small increase in ureteral complication (8.3% vs. 2.3% P=0.06) and a significantly higher incidence of rejection (23.3% vs. 10.1%, P=0.01) in MA group than in SA group. Graft function was lower in MA group than SA group. The 5-year graft survival by Kaplan Meier analysis was better in SA group than in MA group (P=0.023). The estimated graft survivals at 1, 3, and 5 year were 94.4%, 90.6%, and 86% for SA group and 89.6%, 83.2%, and 71.8% for MA group. There was a higher percentage of graft loss from chronic allograft nephropathy in MA group than in SA group (16.7% vs. 5.5%, P=0.01). The presence of MA (vs. SA) was an independent risk for acute rejection (OR 3.60, 95% CI 1.59-8.14, P=0.002) and for graft loss (HR 2.31, 95% CI 1.05-5.09, P=0.038). CONCLUSION Laparoscopic procurement of living donor kidneys with SA may be associated with a lower risk of rejection, better function, and superior long-term survival when compared with kidneys with MA.
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Donor complications following laparoscopic compared to hand-assisted living donor nephrectomy: an analysis of the literature. J Transplant 2010; 2010:825689. [PMID: 20130811 PMCID: PMC2814225 DOI: 10.1155/2010/825689] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 11/02/2009] [Indexed: 12/24/2022] Open
Abstract
There are two approaches to laparoscopic donor nephrectomy: standard laparoscopic donor nephrectomy (LDN) and hand-assisted laparoscopic donor nephrectomy (HALDN). In this study we report the operative statistics and donor complications associated with LDN and HALDN from large-center peer-reviewed publications. Methods. We conducted PubMed and Ovid searches to identify LDN and HALDN outcome studies that were published after 2004. Results. There were 37 peer-reviewed studies, each with more than 150 patients. Cumulatively, over 9000 patients were included in this study. LDN donors experienced a higher rate of intraoperative complications than HALDN donors (5.2% versus. 2.0%, P < .001). Investigators did not report a significant difference in the rate of major postoperative complications between the two groups (LDN 0.5% versus HALDN 0.7%, P = .111). However, conversion to open procedures from vascular injury was reported more frequently in LDN procedures (0.8% versus 0.4%, P = .047). Conclusion. At present there is no evidence to support the use of one laparoscopic approach in preference to the other. There are trends in the data suggesting that intraoperative injuries are more common in LDN while minor postoperative complications are more common in HALDN.
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Branchereau J, Rigaud J, Normand G, Muller B, Lepage JY, Giral M, Karam G. Résultats et complications chirurgicales de la néphrectomie donneur vivant : lombotomie vs laparoscopie manuellement assistée. Prog Urol 2009; 19:389-94. [DOI: 10.1016/j.purol.2009.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 01/22/2009] [Accepted: 01/26/2009] [Indexed: 10/21/2022]
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Franceschin M, Capocasale E, Valle DALLA R, Mazzoni M, Busi N, Sianesi M. Living Donor Nephrectomy: Open versus Laparoscopic Technique. Urologia 2009. [DOI: 10.1177/039156030907600105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The living donor nephrectomy has to be safe and effective, allowing a good graft function in the recipient. In the past, donor nephrectomy was performed only by open technique; more recently this nephrectomy has also been performed by laparoscopic technique. The best technique has not been established in literature. The purpose of this study is to report the results of open and laparoscopic nephrectomy in living donors. Materials and Methods From January 1992 to August 2008, 37 living donor nephrectomies were performed. 23 nephrectomies were achieved by laparoscopic procedure (LDN) and 14 by open technique (ODN). The 2 groups were comparable regarding both donor and recipient characteristics. Results All laparoscopic nephrectomies were successfully performed without conversion to open procedure. No donor deaths were reported in either groups. 3 complications (13%) in the LDN group and 1 (7.1%) in the ODN group (p=0.6) were observed. Mean operative time was higher in the LDN group (p<0.036). Mean warm and cold ischemia time, resumption of oral intake and hospital stay were shorter in the LDN group (p<0.04)(p<0.03) (p<0.0001), whereas the return to normal occupational life was similar (p<0.52). We had no significant differences in the surgical complication rates, graft and patient survival. Conclusions Our experience suggests that both procedures can be used safely and efficiently, and assure a good renal function in the recipient. Laparoscopic nephrectomy, although more difficult, provides post-operative advantages. However, laparoscopic procedure must be performed by experienced centres only to prevent serious complications in the donor.
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Affiliation(s)
- M. Franceschin
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - E. Capocasale
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - R. Valle DALLA
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - M.P. Mazzoni
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - N. Busi
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - M. Sianesi
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
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Thomas AJ. Re: Desai MR, Ganpule AP, Gupta R, et al: Outcome of renal transplantation with multiple versus single renal arteries after laparoscopic live donor nephrectomy: a comparative study (Urology 69: 824-827, 2007). Urology 2008; 71:758-9; author reply 459. [PMID: 18387403 DOI: 10.1016/j.urology.2007.11.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Accepted: 11/20/2007] [Indexed: 11/30/2022]
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Desai MR. Reply. Urology 2008. [DOI: 10.1016/j.urology.2007.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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