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Ram P, Das MK, Mandal S, Nayak P, Tripathy S. A Novel Technique for Hand-Assisted Laparoscopy in Difficult Nephrectomies-Is One Hand Better Than Two? A Single-Centre, Single-Surgeon Series. Indian J Surg Oncol 2024; 15:349-354. [PMID: 38741644 PMCID: PMC11088573 DOI: 10.1007/s13193-024-01922-0] [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: 12/14/2023] [Accepted: 03/05/2024] [Indexed: 05/16/2024] Open
Abstract
Laparoscopic radical nephrectomy is the standard of care for T1 renal tumors and nowadays being used for T2 or higher tumors, resulting in higher the conversion rates. To bridge this gap, the hand-assisted laparoscopy (HAL) method was introduced. Even now, in the robotic era, this HAL approach continues to find importance in urology, especially in the most challenging cases, albeit, with a relatively low usage rate due to the cost involved and availability of hand port devices. Here, we report a case series using a novel modification of the HAL nephrectomy (HALN) technique when open conversion is needed. From a prospective database, we retrospectively analyzed the data of Six patients who underwent HALN at the All India Institute of Medical Sciences between January 2019 and December 2022. Indications for surgery included both malignant and benign renal disease. Four surgeries were performed on the right side while two were performed on the left. Five patients underwent a HALN for renal cell carcinoma (RCC) and 1 for a benign non-functioning kidney. In our series, all the cases with RCC had were T2a or higher. Our case series shows that HALN is technically safe, effective, and a great adjunct to conventional laparoscopy. The ingenious use of a surgical glove as a hand port is an easy-to-make-and- use device in such challenging surgeries.
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Affiliation(s)
- Prasanna Ram
- Department of Urology & Renal Transplant, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneshwar, Odisha 751019 India
| | - Manoj K. Das
- Department of Urology & Renal Transplant, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneshwar, Odisha 751019 India
| | - Swarnendu Mandal
- Department of Urology & Renal Transplant, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneshwar, Odisha 751019 India
| | - Prasant Nayak
- Department of Urology & Renal Transplant, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneshwar, Odisha 751019 India
| | - Sambit Tripathy
- Department of Urology & Renal Transplant, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneshwar, Odisha 751019 India
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Zacharis A, Reimold P, Aksoy C, Jung J, Martin T, Eisenmenger N, Thoduka SG, Groeben C, Huber J, Flegar L. Trends in kidney transplantation and living donor nephrectomy in Germany: a total population analysis from 2006 to 2021. World J Urol 2024; 42:24. [PMID: 38198066 PMCID: PMC10781803 DOI: 10.1007/s00345-023-04737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/13/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE To analyze recent trends of surgical access routes, length of hospital stay (LOS), and mortality in kidney transplantation (KT) and living donor nephrectomy (LDN) in Germany. MATERIALS AND METHODS We studied the nationwide German hospital billing database and the German hospital quality reports from 2006 to 2021. RESULTS There were a total of 35.898 KTs. In total, 9044 (25%) were living donor transplantations, while 26.854 (75%) were transplantations after donation after brain death (DBD). The share of open LDN decreased from 82% in 2006 to 22% in 2020 (- 4%/year; p < 0.001). The share of laparoscopic LDN increased from 18% in 2006 to 70% in 2020 (+ 3%/year; p < 0.001). The share of robotic LDN increased from 0% in 2006 to 8% in 2020 (+ 0.6%/year; p < 0.001). Robotic-assisted KT increased from 5 cases in 2016 to 13 procedures in 2019 (p = 0.2). LOS was shorter after living donor KT, i.e., 18 ± 12.1 days versus 21 ± 19.6 days for DBD renal transplantation (p < 0.001). Moreover, LOS differed for open versus laparoscopic versus robotic LDN (9 ± 3.1 vs. 8 ± 2.9 vs. 6 ± 2.6; p = 0.031). The overall in-hospital mortality was 0.16% (n = 5) after LDN, 0.47% (n = 42) after living donor KT and 1.8% (n = 475) after DBD KT. CONCLUSIONS There is an increasing trend toward minimal-invasive LDN in recent years. Overall, in-hospital mortality was low after KT. However, 5 deceased healthy donors after LKD caution that the risks of this procedure should also be taken very seriously.
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Affiliation(s)
- Aristeidis Zacharis
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Philipp Reimold
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Cem Aksoy
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Jonas Jung
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Thomas Martin
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | | | - Smita George Thoduka
- Department of Nuclear Medicine, Philipps University of Marburg, Marburg, Germany
| | - Christer Groeben
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany.
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3
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Ruch B, Tsering D, Bhati C, Kumar D, Saeed M, Lee SD, Khan A, Imai D, Bruno D, Levy M, Cotterell A, Sharma A. Right versus left fully robotic live donor nephrectomy and open kidney transplantation: Does the laterality of the donor kidney really matter? Asian J Urol 2023; 10:453-460. [PMID: 38024427 PMCID: PMC10659977 DOI: 10.1016/j.ajur.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robotic-assisted live donor nephrectomy (LDN) is being gradually adopted across transplant centers. The left donor kidney is preferred over right due to anatomical factors and ease of procurement. We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys. Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed. Results Out of 196 robotic LDN (49 [right] vs. 147 [left]), 10 (5.1%) donors had intra-operative events (6.1% [right] vs. 4.8% [left], p=0.71). None of the LDN required conversion to open surgery. The operative times were comparable for the two groups. Nausea (13.3%) was the most common post-operative complication. There was no mortality in either LDN group. Herein, we report our outcomes on 156 recipients (39 right and 117 left allografts) excluding robotic implants, exports, and pediatric recipients. There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival (100.0% vs. 98.1%, p=0.45) or graft survival (93.9% vs. 97.1%, p=0.11), or delayed graft function (7.7% vs. 5.1%, p=0.55). Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes. Right LDN was not associated with higher incidence of complications compared to left LDN. Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.
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Affiliation(s)
- Brianna Ruch
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Deki Tsering
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chandra Bhati
- Division of Transplant Surgery, University of Maryland, Baltimore, MD, USA
| | - Dhiren Kumar
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Muhammad Saeed
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Seung Duk Lee
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Aamir Khan
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Daisuke Imai
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - David Bruno
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Marlon Levy
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian Cotterell
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amit Sharma
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
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4
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Burgan CM, Summerlin D, Lockhart ME. Renal Transplantation: Pretransplant Workup, Surgical Techniques, and Surgical Anatomy. Radiol Clin North Am 2023; 61:797-808. [PMID: 37495288 DOI: 10.1016/j.rcl.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
End-stage renal disease continues to grow worldwide, and renal transplantation remains the primary and most effective treatment to handle this burden. Living-donor transplantation is the ideal mechanism for transplant recipients to have a successful allograft but carries both medical and surgical risks. Cadaveric kidneys have their own risks and can have a high rate of success as well. Multimodality imaging is crucial and has improved greatly during the last 20 years. Finally, a robust understanding of current surgical techniques can facilitate better postoperative imaging when early complications are a consideration.
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Affiliation(s)
- Constantine M Burgan
- Department of Radiology, University of Alabama-Birmingham, 625 19th Street South JT N316, Birmingham, AL 35233, USA.
| | - David Summerlin
- Department of Radiology, University of Alabama-Birmingham, 625 19th Street South JT N370A, Birmingham, AL 35233, USA
| | - Mark E Lockhart
- Department of Radiology, University of Alabama-Birmingham, 619 19th Street South JTN 344, Birmingham, AL 35233, USA
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Zaman M, Ryncarz R, Chen A, Yildirim S, Iskhagi S, Saidi R, Bratslavsky G, Shahbazov R. Chylous Ascites After Robot-Assisted Laparoscopic Donor Nephrectomy: Is Early Surgical Intervention Necessary? EXP CLIN TRANSPLANT 2023; 21:397-407. [PMID: 37334687 DOI: 10.6002/ect.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
OBJECTIVES Chylous ascites is a rare complication that may occur after living donor nephrectomy. The continuous loss of lymphatics, which carries a high risk of morbidity, may ensue in possible immunodeficiency and protein-calorie malnutrition. Here, we presented patients who developed chylous ascites after robotassisted living donor nephrectomy and reviewed the current literature of therapeutic strategies for chylous ascites. MATERIALS AND METHODS We reviewed the medical records of 424 laparoscopic living donor nephrectomies performed at a single transplant center; among these, we studied the records of 3 patients who developed chylous ascites following robot-assisted living donor nephrectomy. RESULTS Among 438 living donor nephrectomies, 359 (81.9%) were laparoscopic and 77 (18.1%) were by robotic assistance. In the 3 cases highlighted in our study, patient 1 did not respond to conservative therapy, which consisted of diet optimization, total parenteral nutrition, and octreotide (somatostatin). Patient 1 subsequently underwent robotic-assisted laparoscopy with suture ligation and clipping of leaking lymphatic vessels, allowing the chylous ascites to subside. Patient 2 similarly did not respond to conservative treatment and developed ascites. Despite initial improvement after wound interrogation and drainage, patient 2 had continued symptoms, resulting in diagnostic laparoscopy and repair of leaky channels leading to the cisterna chyli. Patient 3 developed chylous ascites 4 weeks postoperatively and received ultrasonographic-guided paracentesis by interventional radiology, with results showing an aspirate consistent with chyle. The patient's diet was optimized, allowing for initial improvement and eventual return to normal diet. CONCLUSIONS Our case series and literature review demonstrate the importance of early surgical intervention after failed conservative management for resolution of chylous ascites in patients after robotassisted donor laparoscopic nephrectomy.
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Affiliation(s)
- Muizz Zaman
- From the Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York; the Choate Rosemary Hall, Wallingford, Connecticut
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Kim I, Maggiore U, Knight SR, Rana Magar R, Pengel LHM, Dor FJMF. Pre-emptive living donor kidney transplantation: A public health justification to change the default. Front Public Health 2023; 11:1124453. [PMID: 37006536 PMCID: PMC10063978 DOI: 10.3389/fpubh.2023.1124453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Affiliation(s)
- Isaac Kim
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, Unità Operativa Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
| | - Simon R. Knight
- Sir Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Reshma Rana Magar
- Sir Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Liset H. M. Pengel
- Sir Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- *Correspondence: Frank J. M. F. Dor
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Bailey PK, Caskey FJ, MacNeill S, Ashford R, Pryce L, Kayler L, Ben-Shlomo Y. Investigating strategies to improve AccesS to Kidney transplantation (the ASK trial): a protocol for a feasibility randomised controlled trial with parallel process evaluation. Pilot Feasibility Stud 2023; 9:13. [PMID: 36670510 PMCID: PMC9854094 DOI: 10.1186/s40814-023-01241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The UK's living-donor kidney transplant (LDKT) activity falls behind that of many other countries internationally, with less than 20% of those eligible receiving a LDKT each year. Certain individuals with kidney disease in the UK appear to be particularly disadvantaged in accessing a LDKT; the most socioeconomically deprived people with kidney disease are 60% less likely to receive a LDKT than the least deprived. Improving equity in living-donor kidney transplantation has been highlighted as an international research priority. METHODS This feasibility trial was designed to determine the feasibility of delivery and acceptability of a multicomponent intervention designed to improve access to living-donor kidney transplantation. The intervention comprises three main components: (i) a meeting between a home educator and the transplant candidate for a dedicated discussion about living-donor kidney transplantation, living kidney donation and potential donors; (ii) a standardized letter from a healthcare professional to a candidate's potential donors and (iii) a home-based education and family engagement session including two home educators, the transplant candidate and their family. The primary objectives are to establish the feasibility (i) of delivering the developed intervention in existing care pathways and (ii) of undertaking a randomised controlled trial of the intervention. A mixed-methods parallel process evaluation will investigate the acceptability, implementation and mechanisms of impact of the intervention. The trial is based at two UK hospitals: a transplanting hospital and a non-transplanting referral hospital. Individuals are eligible if they are ≥ 18 years old, are active on the kidney transplant waiting list or have been referred for transplant listing and do not have a potential living-donor undergoing surgical assessment. Randomisation will be undertaken with concealed allocation. Participants will be randomly allocated 1:1 to (i) the intervention or (ii) usual care, stratified by site to ensure a balance in terms of local differences. Minimisation will be used to ensure balance in sex, age group and socioeconomic strata, with probability weighting of 0.8 in order to reduce predictability. The primary outcomes are recruitment (% of those eligible and invited who consent to randomisation) and retention (% of participants completing follow-up). DISCUSSION Findings will inform the design of a future fully powered, randomised controlled trial to formally evaluate the effectiveness of the intervention at improving equitable access to living-donor kidney transplantation. TRIAL REGISTRATION ISRCTN Registry ISRCTN10989132 Applied 30/10/20.
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Affiliation(s)
- Pippa K. Bailey
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK ,grid.416201.00000 0004 0417 1173Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Fergus J. Caskey
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK ,grid.416201.00000 0004 0417 1173Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Stephanie MacNeill
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK
| | - Rachel Ashford
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK
| | - Lindsay Pryce
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK
| | - Liise Kayler
- grid.414557.60000 0000 9161 9095Erie County Medical Center, Buffalo, NY 14215 USA
| | - Yoav Ben-Shlomo
- grid.5337.20000 0004 1936 7603Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, BS8 2PS UK
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8
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Benavides X, Rogers RT, Tan EK, Merzkani MA, Thirunavukkarasu S, Yigitbilek F, Smith BH, Rule AD, Kukla A, Chow GK, Heimbach JK, Taner T, Dean PG, Prieto M, Stegall MD. Complications After Hand-Assisted Laparoscopic Living Donor Nephrectomy. Mayo Clin Proc 2022; 97:894-904. [PMID: 35483987 DOI: 10.1016/j.mayocp.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To study the complications of hand-assisted laparoscopic living donor nephrectomy (HALLDN) with an emphasis on complications occurring early after hospital discharge up to 120 days after surgery. PATIENTS AND METHODS We retrospectively categorized complications using the Clavien-Dindo classification in 3002 HALLDNs performed at 1 center from January 1, 2000, through December 31, 2019. In addition to overall summaries, modeling was used to identify correlates of complications before and after living donation. RESULTS Of these donors, 87% were White, 59% were female, the mean age was 45 years (range, 18-77 years), 30.3% had a body mass index of at least 30, and 36.3% had previous abdominopelvic surgery. There were no deaths related to the surgery. The incidence of major complications (intraoperative complications plus Clavien-Dindo grade ≥III postoperatively) was 2.5% (n=74). The overall complication rate was 12.4% (n=371), including 15 intraoperative, 76 postoperative before discharge, and 280 after discharge to 120 days. Reoperation was required in 1.8% of patients (n=54), and all but 1 of these were incision-related problems. Seventy-six percent of all complications occurred after discharge, including 85% of the reoperations. For major complications, no risk factor was found. Risk factors for any complication included paramedian incision (hazard ratio [HR], 2.54; 95% CI, 1.49 to 4.34; P<.001); a history of abdominopelvic surgery (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), male sex (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), non-White race (HR, 1.40; 95% CI, 1.05 to 1.88; P=.02), and early era of the experience. CONCLUSION Most major complications of HALLDN occur after discharge, suggesting that close follow-up is warranted and that the current literature may underestimate the true incidence.
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Affiliation(s)
- Xiomara Benavides
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Richard T Rogers
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Ek Khoon Tan
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Massini A Merzkani
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Furkan Yigitbilek
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Byron H Smith
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Aleksandra Kukla
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Julie K Heimbach
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Timucin Taner
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Patrick G Dean
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mikel Prieto
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Division of Transplantation Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
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9
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Mamode N, Van Assche K, Burnapp L, Courtney A, van Dellen D, Houthoff M, Maple H, Moorlock G, Dor FJMF, Lennerling A. Donor Autonomy and Self-Sacrifice in Living Organ Donation: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View. Transpl Int 2022; 35:10131. [PMID: 35387400 PMCID: PMC8979023 DOI: 10.3389/ti.2022.10131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
Clinical teams understandably wish to minimise risks to living kidney donors undergoing surgery, but are often faced with uncertainty about the extent of risk, or donors who wish to proceed despite those risks. Here we explore how these difficult decisions may be approached and consider the conflicts between autonomy and paternalism, the place of self-sacrifice and consideration of risks and benefits. Donor autonomy should be considered as in the context of the depth and strength of feeling, understanding risk and competing influences. Discussion of risks could be improved by using absolute risk, supra-regional MDMs and including the risks to the clinical team as well as the donor. The psychological effects on the donor of poor outcomes for the untransplanted recipient should also be taken into account. There is a lack of detailed data on the risks to the donor who has significant co-morbidities.
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Affiliation(s)
- Nizam Mamode
- Department of Transplantation, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
- *Correspondence: Nizam Mamode,
| | - Kristof Van Assche
- Research Group Personal Rights and Property Rights, University of Antwerp, Antwerp, Belgium
| | - Lisa Burnapp
- Department of Transplantation, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Aisling Courtney
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, United Kingdom
| | - David van Dellen
- Department of Renal and Pancreas Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mireille Houthoff
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Hannah Maple
- Department of Transplantation, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Windisch OL, Matter M, Pascual M, Sun P, Benamran D, Bühler L, Iselin CE. Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation. J Robot Surg 2022; 16:1471-1481. [PMID: 35254601 PMCID: PMC9606056 DOI: 10.1007/s11701-022-01393-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
Abstract
Robot-assisted donor nephrectomy (RDN) is increasingly used due to its advantages such as its precision and reduced learning curve when compared to laparoscopic techniques. Concerns remain among surgeons regarding possible longer warm ischemia time. This study aimed to compare patients undergoing robotic living donor nephrectomy to the more frequently used hand-assisted laparoscopic nephrectomy (HLDN) technique, focusing on warm ischemia time, total operative time, learning curve, hospital length of stay, donor renal function and post-operative complications. Retrospective study comparing RDN to HLDN in a collaborative transplant network. 176 patients were included, 72 in RDN and 104 in HLDN. Left-sided nephrectomy was favored in RDN (82% vs 52%, p < 0.01). Operative time was longer in RDN (287 vs 160 min; p < 0.01), while warm ischemia time was similar (221 vs 213 secs, p = 0.446). The hospital stay was shorter in RDN (3.9 vs 5.7 days, p < 0.01).Concerning renal function, a slightpersistent increase of 7% of the creatinine ratio was observed in the RDN compared to the HLDN group (1.56 vs 1.44 at 1-month checkup, p < 0.01). The results show that RDN appears safe and efficient in comparison to the gold-standard HLDN technique. Warm ischemia time was similar for both techniques, whereas RDN operative time was longer. Patients undergoing RDN had a shorter hospital stay, this being possibly mitigated by differences in center release criteria. Donor renal function needs to be assessed on a longer-term basis for both techniques.
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Affiliation(s)
- Olivier Laurent Windisch
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland. .,Division of Urologic Surgery, Geneva University Hospital, Genève, Switzerland.
| | - Maurice Matter
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Department of Visceral Surgery, Lausanne University Hospital, and University of Lausanne, Lausannne, Switzerland
| | - Manuel Pascual
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Transplantation Center, Lausanne University Hospital, and University of Lausanne, Lausannne, Switzerland
| | - Pamela Sun
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Division of Urologic Surgery, Geneva University Hospital, Genève, Switzerland
| | - Daniel Benamran
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Division of Urologic Surgery, Geneva University Hospital, Genève, Switzerland
| | - Leo Bühler
- Section of Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Christophe Emmanuel Iselin
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Division of Urologic Surgery, Geneva University Hospital, Genève, Switzerland
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11
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Spoon EQW, Kortram K, Ismail SY, Nieboer D, d’Ancona FCH, Christiaans MHL, Dam RE, Hofker HS, Hoksbergen AWJ, van der Pant KA, Toorop RJ, van de Wetering J, Ijzermans JNM, Dor FJMF. Living Kidney Donor Knowledge of Provided Information and Informed Consent: The PRINCE Study. J Clin Med 2022; 11:jcm11030698. [PMID: 35160147 PMCID: PMC8837079 DOI: 10.3390/jcm11030698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Informed consent for living kidney donation is paramount, as donors are healthy individuals undergoing surgery for the benefit of others. The informed consent process for living kidney donors is heterogenous, and the question concerns how well they are actually informed. Knowledge assessments, before and after donor education, can form the basis for a standardized informed consent procedure for live kidney donation. Methods: In this prospective, a multicenter national cohort study conducted in all eight kidney transplant centers in The Netherlands, we assessed the current status of the informed consent practice for live donor nephrectomy. All of the potential living kidney donors in the participating centers were invited to participate. They completed a pop quiz during their first outpatient appointment (Cohort A). Living kidney donors completed the same pop quiz upon admission for donor nephrectomy (Cohort B). Results: In total, 656 pop quizzes were completed (417 in Cohort A, and 239 in Cohort B). The average donor knowledge score was 7.0/25.0 (±3.9, range 0–18) in Cohort A, and 10.5/25.0 (±2.8, range 0–17.5) in Cohort B. Cohort B scored significantly higher on overall knowledge, preparedness, and the individual item scores (p < 0.0001), except for the long-term complications (p = 0.91). Conclusions: Donor knowledge generally improves during the live donor workup, but it is still quite disappointing. Long-term complications, especially, deserve more attention during living kidney donor education.
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Affiliation(s)
- Emerentia Q. W. Spoon
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Kirsten Kortram
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Sohal Y. Ismail
- Erasmus MC University Medical Centre, Department of Psychiatry, 3015 GD Rotterdam, The Netherlands;
| | - Daan Nieboer
- Erasmus MC University Medical Centre, Department of Public Health, 3015 GD Rotterdam, The Netherlands;
| | - Frank C. H. d’Ancona
- Radboud University Medical Centre, Department of Urology, 6525 GA Nijmegen, The Netherlands;
| | - Maarten H. L. Christiaans
- Maastricht University Medical Centre, Department of Internal Medicine, 6229 HX Maastricht, The Netherlands;
| | - Ruth E. Dam
- Leiden University Medical Centre, Department of Nephrology, 2333 ZA Leiden, The Netherlands;
| | - Hendrik Sijbrand Hofker
- University Medical Centre Groningen, Department of Surgery, 9713 GZ Groningen, The Netherlands;
| | | | - Karlijn Ami van der Pant
- Amsterdam University Medical Centre, Renal Transplant Unit, Department of Internal Medicine, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam University Medical Centre, Renal Transplant Unit, Department of Nephrology, 1105 AZ Amsterdam, The Netherlands
| | - Raechel J. Toorop
- Utrecht University Medical Centre, Department of Surgery, 3584 CX Utrecht, The Netherlands;
| | | | - Jan N. M. Ijzermans
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
| | - Frank J. M. F. Dor
- Erasmus MC University Medical Centre, Department of Surgery, 3015 GD Rotterdam, The Netherlands; (E.Q.W.S.); (K.K.); (J.N.M.I.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
- Correspondence:
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12
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Bailey PK, Lyons H, Caskey FJ, Ben-Shlomo Y, Al-Talib M, Babu A, Selman LE. Expectations of a new opt-out system of consent for deceased organ donation in England: A qualitative interview study. Health Expect 2021; 25:607-616. [PMID: 34951093 PMCID: PMC8957744 DOI: 10.1111/hex.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction In 2020 England moved to an opt‐out deceased donation law. We aimed to investigate the views of a mixed stakeholder group comprising people with kidney disease, family members and healthcare practitioners towards the change in legislation. We investigated the expected impacts of the new legislation on deceased‐donor and living‐donor transplantation, and views on media campaigns regarding the law change. Methods We undertook in‐depth qualitative interviews with people with kidney disease (n = 13), their family members (n = 4) and healthcare practitioners (n = 15). Purposive sampling was used to ensure diversity for patients and healthcare practitioners. Family members were recruited through snowball sampling and posters. Interviews were audio‐recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Results Three themes with six subthemes were identified: (i) Expectations of impact (Hopeful patients; Cautious healthcare professionals), (ii) Living‐donor transplantation (Divergent views; Unchanged clinical recommendations), (iii) Media campaigns (Single message; Highlighting recipient benefits). Patients expected the law change would result in more deceased‐donor transplant opportunities. Conclusions Clinicians should ensure patients and families are aware of the current evidence regarding the impact of opt‐out consent: expectations of an increased likelihood of receiving a deceased‐donor transplant are not currently supported by the evidence. This may help to prevent a decline in living‐donor transplantation seen in other countries with similar legislation. Media campaigns should include a focus on the impact of organ receipt. Patient or Public Contribution Two patient representatives from the Kidney Disease Health Integration Team, Primrose Granville and Soumeya Bouacida, contributed to the content and design of the study documents.
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Affiliation(s)
- Pippa K Bailey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Hannah Lyons
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Leeds School of Medicine, University of Leeds, Leeds, UK
| | - Fergus J Caskey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mohammed Al-Talib
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Adarsh Babu
- Department of Renal Medicine, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Lucy E Selman
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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13
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Akin E, Altintoprak F, Firat N, Dheir H, Bas E, Demirci T, Kamburoglu B, Celebi F. Is Laparoscopic Technique Suitable for Initial Experience in Live Donor Nephrectomy? Results of The First 51 Cases. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Farrow JM, Vasquez R, Zappia JL, Sundaram AC, Sharfuddin AA, Powelson JA, Goggins WC, Sundaram CP. Procedure: Laparoscopic Donor Nephrectomy. J Endourol 2021; 35:S75-S82. [PMID: 34499549 DOI: 10.1089/end.2021.0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Minimally invasive approaches for laparoscopic donor nephrectomy are necessary to limit surgical morbidity, and technical challenges differ from those encountered during other laparoscopic renal surgeries. Presented here is a step-by-step guide for laparoscopic donor nephrectomy-focusing on pure laparoscopic and hand-assisted techniques. Both straight laparoscopic and hand-assisted nephrectomies were performed in healthy donors who met transplantation criteria in terms of global health and psychologic well-being. Patient positioning, trocar placement, surgical steps, incision closure, and postoperative care are reviewed. Standard equipment used to complete this procedure is itemized. This guide outlines indications, preoperative preparation, and procedural steps for laparoscopic donor nephrectomy. The techniques and the evolution thereof represent our experience since 2002 for 510 cases. The attached videos demonstrate a high-volume surgeon's typical approach while factoring in anatomical variation. In both cases, the donor nephrectomies were without incident and the patient's postoperative courses were without complication. A basic framework for donor nephrectomy is presented highlighting surgical steps we believe to be essential for graft preservation and ultimately effective transplantation. Although no two cases are the same, systematic approaches will allow for timely case completion, fewer complications, and better donor/recipient outcomes.
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Affiliation(s)
- Jason M Farrow
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Ruben Vasquez
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Jason L Zappia
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amitha C Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Asif A Sharfuddin
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John A Powelson
- Department of Surgery, Division of Transplantation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William C Goggins
- Department of Surgery, Division of Transplantation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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Bhatia K, Columb M, Wadsworth R, Macnab W, Jepegnanam C, Campbell T, Van Dellen D. Effect of rectus sheath block vs. spinal anaesthesia on time-to-readiness for hospital discharge after trans-peritoneal hand-assisted laparoscopic live donor nephrectomy: A randomised trial. Eur J Anaesthesiol 2021; 38:374-382. [PMID: 33009185 DOI: 10.1097/eja.0000000000001337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of spinal anaesthesia in patients having a transperitoneal hand-assisted laparoscopic donor nephrectomy in an enhanced recovery setting has never been investigated. OBJECTIVE We explored whether substituting a rectus sheath block (RSB) with spinal anaesthesia, as an adjunct to a general anaesthetic technique, influenced time-to-readiness for discharge in patients undergoing hand-assisted laparoscopic donor nephrectomy. DESIGN Prospective randomised open blinded end-point (PROBE) study with two parallel groups. SETTING Tertiary University Hospital. PATIENTS Ninety-seven patients undergoing a trans-peritoneal hand-assisted laparoscopic donor nephrectomy. INTERVENTION Patients (n=52) were randomly assigned to receive a general anaesthetic and a surgical RSB with 2 mg kg-1 of levobupivacaine at the time of surgical closure or a spinal anaesthetic with hyperbaric bupivacaine 12.5 mg and diamorphine 0.5 mg (n=45) before general anaesthesia. PRIMARY OUTCOME The primary outcome was the time-to-readiness for discharge following surgery. RESULTS Median [IQR] times-to-readiness for discharge were 75 [56 to 83] and 79 [67 to 101] h for RSB and spinal anaesthesia and there was no significant difference in times-to-readiness for discharge (median difference 4 (95% CI, 0 to 20h; P = 0.07)). There were no significant differences in pain scores at rest (P = 0.91) or on movement (P = 0.66). Median 24-h oxycodone consumptions were similar (P = 0.80). Nausea and vomiting scores were similar (P = 0.57) and urinary retention occurred in one vs. four patients with RSB and spinal anaesthesia, respectively (P = 0.077). CONCLUSION Substitution of RSB with spinal anaesthesia using 12.5 mg hyperbaric bupivacaine and 0.5 mg diamorphine, together with a general anaesthetic failed to confer any benefit on time-to-discharge readiness following transperitoneal hand-assisted laparoscopic donor nephrectomy. RSB provided similar analgesia in the immediate postoperative period with a low frequency of side-effects in this cohort. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT02700217.
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Affiliation(s)
- Kailash Bhatia
- From the Department of Anaesthesia, Manchester Royal Infirmary (KB, RW, WM, CJ), Department of Anaesthesia and Intensive Care, Wythenshawe Hospital (MC) and Department of Transplant Surgery, Manchester Royal Infirmary, Manchester University Hospital NHS Foundation Trust, Manchester, UK (TC, DVD)
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16
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Glatz T, Brinkmann S, Bausch D. [Robot-assisted Living Donor Nephrectomy - Technical Aspects and Initial Evidence]. Zentralbl Chir 2021; 146:400-406. [PMID: 33782928 DOI: 10.1055/a-1346-0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Minimally invasive donor nephrectomy has become the standard procedure in most transplant centres over the past two decades and has contributed to a reduction in postoperative morbidity for the donor. Robot-assisted technology is an alternative to conventional (hand-assisted) laparoscopic technology and will find increasing use in the future. In this review article, we address technical aspects of robotic-assisted donor nephrectomy, in accordance with our own experience and will provide an overview of the currently available literature. Robot-assisted living kidney donation is a safe procedure with a very low postoperative complication rate. The procedure offers advantages over the open surgical technique with respect to the reduction in the postoperative need for analgesia and the duration of hospital stay, with longer operating times and warm ischemia times, but without a measurable effect on transplant function. The postoperative outcome parameters are comparable to those of the laparoscopic technique, indicating a further acceleration of postoperative convalescence. The advantages of robot-assisted technology, due to the better exposure options, are most relevant in patients with a high BMI and multiple renal arteries, as well as in right-sided nephrectomies in which a longer transplant artery can be obtained. Robot-assisted living kidney donation will play a major role in the future of transplant surgery and is a serious alternative to conventional laparoscopic technology.
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Affiliation(s)
- Torben Glatz
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Sebastian Brinkmann
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Dirk Bausch
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
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17
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The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience. J Clin Med 2021; 10:jcm10061195. [PMID: 33809339 PMCID: PMC8001196 DOI: 10.3390/jcm10061195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 01/11/2023] Open
Abstract
Since its introduction in 1995, laparoscopic nephrectomy has emerged as the preferred surgical approach for living donor nephrectomy. Given the ubiquity of the surgical procedure and the need for favorable outcomes, as it is an elective operation on otherwise healthy individuals, it is imperative to ensure appropriate preoperative risk stratification and anticipate intraoperative challenges. The aim of the present study was to compare peri-and postoperative outcomes of living kidney donors (LD), who had undergone laparoscopic nephrectomy (LDN), with a control group of those who had undergone open nephrectomy (ODN). Health-related quality of life (QoL) was also assessed using the validated SF-36 questionnaire. Data from 252 LD from a single transplant center from March 2015 to December 2020 were analyzed retrospectively. In total, 117 donors in the LDN and 135 in the ODN groups were assessed. Demographics, type of transplantation, BMI, duration of surgery, length of hospital stay, peri- and postoperative complications, renal function at discharge and QoL were recorded and compared between the two groups using Stata 13.0 software. There was no difference in baseline characteristics, nor in the prevalence of peri-and postoperative complications, with a total complication rate of 16% (mostly minor, Clavien–Dindo grade II) in both groups, while a different pattern of surgical complications was noticed between them. Duration of surgery was significantly longer in the ODN group (median 240 min vs. 160 min in LDN, p < 0.01), warm ischemia time was longer in the LDN group (median 6 min vs.2 min in ODN, p < 0.01) and length of hospital stay shorter in the LDN group (median 3 days vs. 7 days in ODN). Conversion rate from laparoscopic to open surgery was 2.5%. There was a drop in estimated glomerular filtration rate (eGFR) at discharge of 36 mL/min in the LDN and 32 mL/min in the ODN groups, respectively (p = 0.03). No death, readmission or reoperation were recorded. There was a significant difference in favor of LDN group for each one of the eight items of the questionnaire (SF1–SF8). As for the two summary scores, while the total physical component summary (PCS) score was comparable between the two groups (57.87 in the LDN group and 57.07 in the ODN group), the mental component summary (MCS) score was significantly higher (62.14 vs. 45.22, p < 0.001) in the LDN group. This study provides evidence that minimally invasive surgery can be performed safely, with very good short-term outcomes, providing several benefits for the living kidney donor, thereby contributing to expanding the living donor pool, which is essential, especially in countries with deceased-donor organ shortage.
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18
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Akin EB, Soykan Barlas I, Dayangac M. Hand-assisted retroperitoneoscopic donor nephrectomy offers more liberal use of right kidneys: lessons learned from 565 cases - a retrospective single-center study. Transpl Int 2021; 34:445-454. [PMID: 33340167 DOI: 10.1111/tri.13806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/08/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023]
Abstract
The introduction of laparoscopic donor nephrectomy caused a shift toward' left donor nephrectomy. Some centers report a significantly low rate of endoscopic right donor nephrectomy. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP-DN) was introduced as a novel surgical technique, which aims to avoid intra-abdominal complications. It was also reported to provide technical advantages for right-sided DN. In this retrospective single-center study, we evaluated the impact of HARP-DN technique on utilization of right-sided DNs. After the implementation of HARP-DN on February 2009, a total of 565 DNs were performed until December 2015. The introduction of HARP-DN technique resulted in an immediate increase in the utilization of right kidneys from 6.1% to an average of 19.6% annually. The donors 'outcome was similar to the left-sided and right-sided DN groups, excluding the increased incidence of incisional hernias in left kidney donors. None of the donors developed intra-abdominal complications. In conclusion, the implementation of HARP technique significantly increased the use of right-sided DNs, which enables a more liberal use of donors in LDKT.
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Affiliation(s)
- Emin Baris Akin
- Department of General Surgery, Division of Transplantation, Demiroglu Bilim University, Istanbul, Turkey
| | - Ilhami Soykan Barlas
- Department of General Surgery, Division of Transplantation, Demiroglu Bilim University, Istanbul, Turkey
| | - Murat Dayangac
- Center for Organ Transplantation, Medipol University, Istanbul, Turkey
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19
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Xie L, O'Leary M, Jefferson FA, Karani R, Limfueco L, Parkhomenko E, Sung JM, Patel RM, Ichii H, Dafoe D, Clayman RV, Landman J. Interactive Virtual Reality Renal Models as an Educational and Preoperative Planning Tool for Laparoscopic Donor Nephrectomy. Urology 2021; 153:192-198. [PMID: 33556447 DOI: 10.1016/j.urology.2020.12.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy of interactive virtual reality (iVR) in providing a three-dimensional (3D) experience with the donor's anatomy for surgeons and patients, we present a retrospective, case-controlled study assessing the impact of iVR renal models prior to LDN on both surgical outcomes and patients' understanding of the procedure. MATERIALS AND METHODS Twenty patients undergoing LDN were prospectively recruited; their contrast-enhanced CT scans were transformed into iVR models. An iVR platform allowed the surgeons to rotate and deconstruct the renal anatomy; patients could also view their anatomy as the procedure was explained to them. Questionnaires assessed surgeons' understanding of renal anatomy after CT alone and after CT+iVR. Surgeons also commented on whether iVR impacted their preoperative plan. Patients assessed their anatomical understanding and anxiety level before and after iVR. Surgical outcomes for the iVR cohort were compared to a retrospectively matched, non-iVR cohort of LDN patients. RESULTS Surgeons altered their preoperative plan in 18 of 20 LDNs after viewing iVR models. Patients reported better understanding of their anatomy (5/5) and noted decreased preoperative anxiety (5/5) after viewing iVR. When compared to the non-iVR group, the iVR group had a 25% reduction in median operative time (P < .001). In terms of surgical outcomes, patients in the iVR group had a 40% lower median relative change in postoperative creatinine (P < .001). CONCLUSION Preoperative viewing of iVR models altered the operative approach, decreased the operative time, and improved donor patient outcomes. iVR models also reduced patients' preoperative anxiety.
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Affiliation(s)
- Lillian Xie
- Department of Urology, University of California, Irvine, Orange CA.
| | - Mitchell O'Leary
- Department of Urology, University of California, Irvine, Orange CA
| | | | - Rajiv Karani
- Department of Urology, University of California, Irvine, Orange CA
| | - Luke Limfueco
- Department of Urology, University of California, Irvine, Orange CA
| | | | - John M Sung
- Department of Urology, University of California, Irvine, Orange CA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange CA
| | - Hirohito Ichii
- Department of Surgery, University of California, Irvine, Orange CA
| | - Donald Dafoe
- Department of Surgery, University of California, Irvine, Orange CA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange CA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange CA.
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20
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Vincenzi P, Gonzalez J, Guerra G, Gaynor JJ, Alvarez A, Ciancio G. Complex Surgical Reconstruction of Upper Pole Artery in Living-Donor Kidney Transplantation. Ann Transplant 2021; 26:e926850. [PMID: 33446626 PMCID: PMC7814512 DOI: 10.12659/aot.926850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The use of allografts with multiple renal arteries has increased in the era of laparoscopic donor nephrectomy. Although several studies recommend reconstructing lower pole arteries (LPAs) to reduce risk of urologic complications, it is common opinion to ligate upper pole arteries (UPAs) with a diameter less than 2 mm because of increased risk of thrombosis related to their reconstruction. This retrospective study evaluates the feasibility and safety of reconstructing thin UPAs during living-donor kidney transplantation, with the goal of maintaining the integrity of the graft and assuring its maximal function. Material/Methods Data from 922 living-donor kidney transplants performed between 2009 and 2019 were reviewed. Six cases with UPAs were identified (0.65%). The study endpoints were incidence of allograft vascular and urologic complications, slow graft function, delayed graft function, graft failure, and graft and patient survival. Results The UPAs had a mean diameter of 1.8±0.28 mm. Methods of reconstruction included: interposition graft (n=2), end-to-side anastomosis inside the renal hilum to a branch of the main renal artery (n=3), and side-to-side anastomosis with the main renal artery (n=1). Additional reconstruction of LPAs (n=2) and main renal arteries (n=2) was performed. During a median (range) follow-up of 14.5 (9–49) months no complications were observed. Conclusions Ex vivo reconstruction of UPAs with a diameter less than 2 mm is worth attempting, particularly in the setting of living-donor kidney transplantation.
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Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Javier Gonzalez
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Giselle Guerra
- University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Department of Medicine, Division of Nephrology, Miami Transplant Institute, Miami, FL, USA
| | - Jeffrey J Gaynor
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Angel Alvarez
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery, Miami Transplant Institute, Miami, FL, USA.,University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA.,Department of Urology, Miami Transplant Institute, Miami, FL, USA
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21
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One size does not fit all: understanding individual living kidney donor risk. Pediatr Nephrol 2021; 36:259-269. [PMID: 31897715 PMCID: PMC7815560 DOI: 10.1007/s00467-019-04456-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 01/06/2023]
Abstract
Living donor kidney transplantation is the optimal treatment for end-stage kidney disease (ESKD) but confers a risk upon the donor, both in the short term and many years after donation. While perioperative mortality is low and longevity does not appear to be adversely affected, there are small increases in the risk of other important morbidities. The overall risk of ESKD among donors is low but appears to be three- to five-fold higher than among healthy non-donors, and this relative risk is even higher among donors of African ancestry. For these individuals, apolipoprotein L1 genotyping may be helpful. Kidney donors also have an increased risk of developing hypertension post-donation and a modestly increased risk of developing gout. Living kidney donation also increases the risk of gestational hypertension and preeclampsia while not affecting other important pregnancy outcomes. As our understanding of donor risk grows, it is important to counsel prospective donors according to their individual risk and so obtain better informed donor consent. As knowledge advances, it is also important that all clinicians who manage kidney transplant candidates have an up to date understanding of donor risk to inform shared decision making.
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22
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Favi E, Iesari S, Catarsini N, Sivaprakasam R, Cucinotta E, Manzia T, Puliatti C, Cacciola R. Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with trans-peritoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy. Clin Transplant 2020; 34:e14113. [PMID: 33051895 DOI: 10.1111/ctr.14113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 01/06/2023]
Abstract
The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016. Donor and recipient outcomes were compared between TP-HALDN (n = 235) and RP-HALDN (n = 82). Conversion to open nephrectomy (0.4% vs 0%; P = 1.000), intra-operative complications (1.7% vs 1.2%; P = 1.000), and 1-year overall post-operative complications (11.9% vs 17.1%; P = .258) rates were similar in TP-HALDN and RP-HALDN. Overall surgical site infections were higher in RP-HALDN (6.1% vs 1.7%; P = .053), whereas incisional hernias were only recorded following TP-HALDN (3.4% vs 0%; P = .118). The duration of the procedure was 11-minute shorter for TP-HALDN than RP-HALDN (P < .001) but extraction time was equivalent (2, IQR 1.5-2.5 minutes; P = 1.000). RT following TP-HALDN and RP-HALDN showed comparable one-year death-censored allograft survival (97% vs 98.8%; P = .685), primary non-function (0.4% vs 0%; P = .290), delayed graft function (1.3% vs 4.9%; P = .077), and urological complications (2.6% vs 4.9%; P = .290) rates. In our series, donor and recipient outcomes were not substantially affected by the approach used for donor nephrectomy. TP-HALDN and RP-HALDN were both safe and effective.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Samuele Iesari
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Nivia Catarsini
- General Surgery, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Rajesh Sivaprakasam
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Eugenio Cucinotta
- General Surgery, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Tommaso Manzia
- HPB Surgery and Transplantation, Fondazione PTV, Rome, Italy
| | | | - Roberto Cacciola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,HPB Surgery and Transplantation, Fondazione PTV, Rome, Italy
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23
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Ceuppens S, Kimenai HJAN, Klop KWJ, Zuidema WC, Betjes MGH, Weimar W, IJzermans JNM, Dor FJMF, Minnee RC. Unspecified live kidney donation by urological patients. World J Transplant 2020; 10:215-222. [PMID: 32850289 PMCID: PMC7416359 DOI: 10.5500/wjt.v10.i8.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Individuals with benign kidney disorders undergoing nephrectomy have three possibilities: Autotransplantation, with a certain risk of complications, but without a clear benefit; discarding the kidney; or living kidney donation.
AIM To investigate whether patients with benign kidney disorders and a medical indication for nephrectomy are suitable as unspecified live kidney donors.
METHODS We searched all clinical data from 1994-2019 for unspecified donors and their transplant recipients (n = 160). Nine of these 160 donors had pre-existing kidney disorders necessitating nephrectomy and had decided to donate their kidney anonymously after discussing the possibility of kidney donation. We studied the clinical course of these nine donating patients and their transplant recipients.
RESULTS Seven of nine donating patients indicated unbearable loin pain as the main complaint, one donating patient refused ureterocutaneostomy and one had two aneurysms of the renal artery. Postoperatively, seven donating patients described absence of pain and one a significant reduction after the nephrectomy. The average 1-year creatinine level in the donating patients was 88 µmol/L and after a median of 6.9 years the average creatinine level was 86.6 µmol/L. In the transplant recipients, one major complication occurred which led to death and in one transplant recipient graft function failed to normalize at first but has been stable for nine years now. Currently, all transplant recipients are off dialysis.
CONCLUSION Our data show that patients undergoing nephrectomy as part of treatment in selected kidney disorders can function as live kidney donors.
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Affiliation(s)
- Sebastiaan Ceuppens
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam 3015GD, Netherlands
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam 3015GD, Netherlands
| | - Karel W J Klop
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam 3015GD, Netherlands
| | - Willij C Zuidema
- Department of Internal Medicine, Nephrology and Kidney Transplant Unit, Rotterdam 3000CA, Netherlands
| | - Michiel G H Betjes
- Department of Internal Medicine, Nephrology and Kidney Transplant Unit, Rotterdam 3000CA, Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Nephrology and Kidney Transplant Unit, Rotterdam 3000CA, Netherlands
| | - Jan N M IJzermans
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam 3015GD, Netherlands
| | - Frank J M F Dor
- Imperial College Renal and Transplant Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom
| | - Robert C Minnee
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam 3015GD, Netherlands
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24
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Melkonian V, Nguyen MTJP. Managing the Obese Living Kidney Donor. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00279-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Robot-Assisted versus Laparoscopic Donor Nephrectomy: A Comparison of 250 Cases. J Clin Med 2020; 9:jcm9061610. [PMID: 32466503 PMCID: PMC7355615 DOI: 10.3390/jcm9061610] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
Living kidney donation is the best treatment for end-stage renal disease, however, the best surgical approach for minimally-invasive donor nephrectomy (DN) is still a matter of debate. This bi-centric study aimed to retrospectively compare perioperative outcomes and postoperative kidney function after 257 transperitoneal DNs including 52 robot-assisted (RDN) and 205 laparoscopic DNs (LDN). As primary outcomes, the intraoperative (operating time, warm ischemia time (WIT), major complications) and postoperative (length of stay, complications) results were compared. As secondary outcomes, postoperative kidney and graft function were analyzed including delayed graft function (DGF) rates, and the impact of the surgical approach was assessed. Overall, the type of minimally-invasive donor nephrectomy (RDN vs. LDN) did not affect primary outcomes, especially not operating time and WIT; and major complication and DGF rates were low in both groups. A history of smoking and preoperative kidney function, but not the surgical approach, were predictive for postoperative serum creatinine of the donor and recipient. To conclude, RDN and LDN have equivalent perioperative results in experienced centers. For this reason, not the surgical approach, but rather the graft- (preoperative kidney function) and patient-specific (history of smoking) aspects impacted postoperative kidney function.
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26
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Bellini MI, Wilson RS, Veitch P, Brown T, Courtney A, Maxwell AP, D'Andrea V, McDaid J. Hyperamylasemia Post Living Donor Nephrectomy Does Not Relate to Pain. Cureus 2020; 12:e8217. [PMID: 32582478 PMCID: PMC7306643 DOI: 10.7759/cureus.8217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The aetiology of pain after laparoscopic donor nephrectomy remains unclear. Given the proximity of the left kidney to the tail of the pancreas, we aimed to assess whether mobilisation and retrieval of the left kidney might inflame the pancreas, leading to pain and hyperamylasaemia in the post-operative period. Patient and methods In the present study, 16 consecutive live kidney donors were analysed in the same three months period. Amylase levels were measured on days 1 and 2. For each 24-hour period post-operatively analgesia consumption was recorded, as well as pain scores at rest on a visual analogue scale (VAS). Results Three out of 16 donors presented hyperamylasemia. A multiple regression analysis found levobupivacaine dose, propofol dose, transversus abdominis plane block and day 1 amylase did not significantly predict pain scores. Interestingly, body mass index significantly correlated with increased pain scores (p = 0.041). Also, increasing CO2 insufflation pressure and use of local anaesthetic infusion catheters predicted a decreased deep pain score (p = 0.036 and p = 0.037). Conclusion There was no correlation of amylase levels and pain scores. Pancreatitis is a rare complication of nephrectomy and no overt cases were seen in the case of donor nephrectomy.
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Affiliation(s)
| | - Rebekah S Wilson
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Peter Veitch
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Tim Brown
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Aisling Courtney
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | | | | | - James McDaid
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
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27
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Pinar U, Pettenati C, Hurel S, Pietak M, Dariane C, Audenet F, Legendre C, Rozenberg A, Méjean A, Timsit MO. Persistent orchialgia after laparoscopic living-donor nephrectomy: an underestimated complication requiring information adjustment. World J Urol 2020; 39:621-627. [PMID: 32363451 DOI: 10.1007/s00345-020-03228-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/24/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Laparoscopic living-donor nephrectomy (LLDN) is the gold-standard procedure for kidney procurement. Ipsilateral orchialgia has barely been described. Some authors reported that ligation of gonadal vein (GV) above iliac vessel bifurcation could prevent orchialgia. We aimed to assess incidence and duration of orchialgia after LLDN in male donors despite distal ligation of GV. METHODS Patients who underwent LLDN from 2014 to 2017 were included. Standard procedure consisted in distal ligation of GV, close to the renal vein confluence and proximal ureteral ligation. Patients' demographics, per-operative data, and post-operative consultation reports were retrospectively reviewed. Orchialgia and scrotal symptoms were assessed through a non-validated questionnaire by phone interview. RESULTS Sixty-nine donors were included. Orchialgia incidence and testicular swelling were 31.9% (n = 22) and 15.9% (n = 11), respectively. Median symptom duration was 15.5 months. Orchialgia led to medical consultation in 41.7% (n = 10) of cases. All patients declared having been informed, prior to donation, about possible residual pain but not specifically orchialgia. CONCLUSION Orchialgia after LLDN affects more than 30% of donors, despite distal ligation of GV and led less than 50% of them to medical consultation, suggesting a large underestimation in clinical practice. Emphasis should be put on this complication during pre-donation information.
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Affiliation(s)
- Ugo Pinar
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France. .,Université de Paris, APHP Centre, Paris, France.
| | - Caroline Pettenati
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Sophie Hurel
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Michel Pietak
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Charles Dariane
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - François Audenet
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Christophe Legendre
- Université de Paris, APHP Centre, Paris, France.,Department of Nephrology and Renal Transplantation, Hôpital Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015, Paris, France
| | - Alain Rozenberg
- Université de Paris, APHP Centre, Paris, France.,Department of Anaesthesiology, Hôpital Necker-Enfants malades, AP-HP, 149 rue de Sèvres, 75015, Paris, France
| | - Arnaud Méjean
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology and Renal Transplantation, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Université de Paris, APHP Centre, Paris, France
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Mercimek MN, Ozden E, Yakupoglu YK. Strategies to Perform Pure Retroperitoneoscopic Donor Nephrectomy: A Single-Center Cohort Study. J Laparoendosc Adv Surg Tech A 2020; 30:531-537. [PMID: 32208049 DOI: 10.1089/lap.2019.0785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Considering the increase in a number of vascular complications, right laparoscopic donor nephrectomy is less preferred due to achieving not only shorter renal vein but also longer renal artery. However, recent studies have indicated that the side of the surgery would not affect the outcomes. Aim: The aim of this study is to evaluate the outcomes and strategies to increase the safety of pure retroperitoneoscopic donor nephrectomy (RDN). Methods: We analyzed the prospectively collected medical records of 158 kidney donors who underwent RDN from January 2010 to August 2018. The patients were divided into two groups based on their side of surgery. Right- and left-sided RDNs were compared in terms of demographics, intraoperative, and postoperative data, including the development of incisional hernia (IH). The outcomes of the recipients were also evaluated. Results: Right RDN was performed in 40 (25.3%) and left RDN was performed in 118 (74.7%) donors. Operation time (P = .593), warm ischemia time (P = .271), blood loss (P = .787), and length of hospital stay (P = .908) were statistically similar in right and left RDN groups. Intraoperative and postoperative complications were statistically showed no difference between right and left RDNs. No IH was observed in any group. One-year and five-year patient survival and graft survival rates were 100% versus 97% (P = .299) and 100% versus 95% (P = .126) on both sides, respectively. Conclusion: Right RDN is an effective and safe method as on the left side. RDN has an additional advantage in the absence of IH. Experience with other retroperitoneoscopic urological interventions may have had a positive effect on the outcomes of pure RDN.
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Affiliation(s)
| | - Ender Ozden
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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29
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Long-term Surgical Outcome and Risk Factors in Living Kidney Donors. Transplant Proc 2020; 52:722-730. [PMID: 32143866 DOI: 10.1016/j.transproceed.2019.12.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/25/2019] [Accepted: 12/15/2019] [Indexed: 11/21/2022]
Abstract
CONTEXT Studies on the surgical outcome in living kidney donors mainly report perioperative complications with short follow-up. OBJECTIVE The objectives of this study are to evaluate the long-term surgical outcome in living kidney donors and to identify donors with an increased risk for a complicated postoperative course. BASIC PROCEDURES A prospectively collected database of 496 living kidney donors at the Department of General, Visceral, and Transplantation Surgery of the Ruprecht Karls University Heidelberg was retrospectively analyzed in a retrospective, observational single-center study. RESULTS The median follow-up time was 37 months. The perioperative severe complication (Clavien-Dindo IIIb) rate was 2.8%, the early postoperative (PO) severe complication rate (1-3 months post operation) was 0.7%, and the late PO severe complication rate (> 3 months post operation) was 8.4%. In multivariate analyses, male sex was associated with higher overall perioperative complication rate (odds ratio [OR], 1.930; P = .005) as well as higher rate of late PO complications (OR, 2.243; P = .014). An increased body mass index was associated with a higher late and severe (Clavien-Dindo ≥ IIIb) PO complication rate (OR, 1.107; P = .009 and OR, 1.105; P = .008, respectively). CONCLUSIONS AND RELEVANCE Long-term surgery-associated severe complications occur in 8.4% of kidney donors. Older age is associated with an increased operative time, greater intraoperative blood loss, and longer PO hospital stay. Male donors and donors with an increased body mass index have a higher risk for a complicated PO course after kidney donation. Within a shared decision-making process before living kidney donation, special awareness should be brought to these facts.
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Behbehani S, Suarez-Salvador E, Buras M, Magtibay P, Magrina J. Mortality Rates in Benign Laparoscopic and Robotic Gynecologic Surgery: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:603-612.e1. [DOI: 10.1016/j.jmig.2019.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/27/2019] [Accepted: 10/08/2019] [Indexed: 11/17/2022]
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Brunotte M, Rademacher S, Weber J, Sucher E, Lederer A, Hau HM, Stolzenburg JU, Seehofer D, Sucher R. Robotic assisted nephrectomy for living kidney donation (RANLD) with use of multiple locking clips or ligatures for renal vascular closure. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:305. [PMID: 32355749 PMCID: PMC7186662 DOI: 10.21037/atm.2020.02.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Robotic assisted nephrectomy for living donation (RANLD) is a rapid emerging surgical technique competing for supremacy with totally laparoscopic and laparoscopic hand assisted techniques. Opinions about the safety of specific techniques of vascular closure in minimally invasive living kidney donation are heterogeneous and may be different for laparoscopic and robotic assisted surgical techniques. Methods We retrospectively analyzed perioperative and short-term outcomes of our first (n=40) RANLD performed with the da Vinci Si surgical platform. Vascular closure of renal vessels was performed by either double clipping or a combination of clips and non-transfixing suture ligatures. Results RANLD almost quintupled in our center for the observed time period. A total of n=21 (52.5%) left and n=19 (47.5%) right kidneys were procured. Renal vessel sealing with two locking clips was performed in 18 cases (45%) Both, clips and non-transfixing ligatures were used in 22 cases (55%). Mean donor age was 53.075±11.68 years (range, 28–70). The average total operative time was 150.75±27.30 min. Right donor nephrectomy (139±22 min) was performed significantly faster than left (160.95±27.93 min, P=0.01). Warm ischemia time was similar for both vascular sealing techniques and did not differ between left and right nephrectomies. No conversion was necessary. Clavien-Dindo Grade ≤IIIb complications occurred in (n=5) 12.5%. Grade IV and V complications did not develop. In particular no hemorrhage occurred using multiple locking clips or suture ligatures for renal vascular closure. Mortality was 0%. Thirteen kidneys (32.5%) were transplanted across the AB0 barrier. Conclusions RANLD is an emerging minimally invasive surgical technique which facilitates excellent perioperative and short-term outcomes also when using multiple locking clips or suture ligatures for renal vascular closure.
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Affiliation(s)
- Maximilian Brunotte
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Justine Weber
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Gastroenterology, Division of Hepatology, University Hospital of Leipzig, Leipzig, Germany
| | - Andri Lederer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | | | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
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Prophylaxis of Wound Infections-antibiotics in Renal Donation (POWAR): A UK Multicentre Double Blind Placebo Controlled Randomised Trial. Ann Surg 2019; 272:65-71. [PMID: 31714309 DOI: 10.1097/sla.0000000000003666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative infection after hand-assisted laparoscopic donor nephrectomy (HALDN) confers significant morbidity to a healthy patient group. Current UK guidelines cite a lack of evidence for routine antibiotic prophylaxis. This trial assessed if a single preoperative antibiotic dose could reduce post HALDN infections. METHODS Eligible donors were randomly and blindly allocated to preoperative single-dose intravenous co-amoxiclav or saline. The primary composite endpoint was clinical evidence of any postoperative infection at 30 days, including surgical site infection (SSI), urinary tract infection (UTI), and lower respiratory tract infection (LRTI). FINDINGS In all, 293 participants underwent HALDN (148 antibiotic arm and 145 placebo arm). Among them, 99% (291/293) completed follow-up. The total infection rate was 40.7% (59/145) in the placebo group and 23% (34 of 148) in the antibiotic group (P = 0.001). Superficial SSIs were 20.7% (30/145 patients) in the placebo group versus 10.1% (15/148 patients) in the antibiotic group (P = 0.012). LRTIs were 9% (13/145) in the placebo group and 3.4% (5/148) in the antibiotic group (P = 0.046). UTIs were 4.1% (6/145) in the placebo group and 3.4% (5/148) in the antibiotic group (P = 0.72).Antibiotic prophylaxis conferred a 17.7% (95% confidence interval 7.2%-28.1%), absolute risk reduction in developing postoperative infection, with 6 donors requiring treatment to prevent 1 infection. INTERPRETATION Single-dose preoperative antibiotic prophylaxis dramatically reduces post-HALDN infection rates, mainly impacting SSIs and LRTIs.
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Prudhomme T, Roumiguié M, Benoit T, Lesourd M, Beauval JB, Doumerc N, Sallusto F, Soulié M, Kamar N, Gamé X. Laparoscopy for living donor left nephrectomy: Comparison of three-dimensional and two-dimensional vision. Clin Transplant 2019; 33:e13745. [PMID: 31665808 DOI: 10.1111/ctr.13745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/29/2019] [Accepted: 10/21/2019] [Indexed: 12/01/2022]
Abstract
The main objective of this preliminary study was to evaluate the feasibility and safety of 3-D laparoscopic living donor left nephrectomy (LDLN). The secondary objective was to compare intraoperative and postoperative outcomes between 3-D and 2-D laparoscopic LDLN. All patients who underwent a laparoscopic LDLN from January 2015 to April 2018 in a university center were included. All surgeries were performed by three experienced surgeons. Seventy three patients were included the following: 16 underwent a 3-D laparoscopic LDLN (3-D group), and 57 underwent a 2-D laparoscopic LDLN (2-D group). Operative time and warm ischemia time (WIT) were significantly lower in the 3-D group (operative time: 80.9 ± 10.2 vs 114.1 ± 32.3 minutes in the 3-D and 2-D groups, P = .0002) (WIT: 1.7 ± 0.6 vs 2.3 ± 0.9 minutes in the 3-D and 2-D groups, P = .02). No conversion to open surgery occurred in both groups. Length of hospital stay was significantly shorter in the 3-D group. No major postoperative complications (Clavien ≥ III) occurred. One-year postoperative GFR was similar to 3-D and 2-D groups. Our preliminary study demonstrates that 3-D laparoscopic LDLN is a feasible and safe surgical procedure. Intraoperative and postoperative outcomes were similar in both 2-D and 3-D vision systems, but 3-D vision systems allow reduction in WIT and operative time.
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Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Thibaut Benoit
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Marine Lesourd
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | | | - Nicolas Doumerc
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Federico Sallusto
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Michel Soulié
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital, Toulouse, France
| | - Xavier Gamé
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
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Tokaç M, Eren E, Özçelik Ü, Şahin T, Dinçkan A. Renal Hilus Ligation With Single Stapler in Laparoscopic Donor Nephrectomy. Transplant Proc 2019; 51:2225-2227. [DOI: 10.1016/j.transproceed.2019.02.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/25/2019] [Accepted: 02/03/2019] [Indexed: 11/30/2022]
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Cheng SD, Li WQ, Mu L, Ding GP, Zhang B, Shen C, Ying ZW, Yang KL, Hao H, Li XS, Zhou LQ. [Application of totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis in upper urinary tract urothelial carcinomas treatment]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:758-763. [PMID: 31420636 DOI: 10.19723/j.issn.1671-167x.2019.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis in the treatment of upper urinary tract urothelial carcinoma (UTUC), and to review the experience of renal autotransplantation for UTUC treatment. METHODS One case of applying the totally extraperitoneal renal autotransplantation with boari flap-pelvis anastomosis to the UTUC treatment was reported, and related literature was reviewed. The patient was a sixty-four-year old man who received right radical nephroureterectomy for right ureteral carcinoma 1 year before and diagnosed as left ureteral carcinoma(G2, high grade) this time. In order to preserve his renal function and avoid the shortness of common kidney-sparing surgery, a totally extraperitoneal procedure, including retroperitoneoscopic nephrectomy, ureterectomy, renal autotransplantation and Boari flap-pelvis anastomosis, was performed to the patient. RESULTS The operation was completed successfully without perioperative complications. The renal function recovered to preoperative level within 1 week. No deterioration of renal function during the follow-up and no tumor recurrence was observed under cystoscopy at the 3-month postoperative consult. CONCLUSION The totally extraperitoneal renal autotransplantation with Boari flap-pelvis anastomosis is a feasible and effective treatment for UTUC. The innovative procedure has several advantages compared to the former ones. The extraperitoneal procedure results in significantly less pain, shorter hospital stay, decreased overall time to recovery and lower bowel complications risk without warm ischemia time extension. Meanwhile, the Boari flap-pelvis anastomosis simplifies the follow -up protocols and creates an easy route for cystoscopy and topical therapy. From the systematic clinical analysis, as well as the related literature review, it's been concluded that the renal autotransplantation can be a reasonable option for the patients who have UTUC in solitary kidney or have bilateral UTUC. This type of treatment possesses advantages of preservation of renal function and total resection of malignant lesions. But long-term data and large cohort study on renal function or tumor recurrence are still absent which will be necessary to confirm the advantages of this approach.
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Affiliation(s)
- S D Cheng
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - W Q Li
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University/Yichang Central People's Hospital, Yichang 443003, Hubei, China
| | - L Mu
- Central Operating Room, Peking University First Hospital, Beijing 100034, China
| | - G P Ding
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - B Zhang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - C Shen
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - Z W Ying
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - K L Yang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - H Hao
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - X S Li
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
| | - L Q Zhou
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
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Abstract
PURPOSE OF REVIEW The safety of living donor nephrectomy is essential to the continued success, growth, and sustainability of the clinical practice of living donor kidney transplantation. This review summarizes recent advances in our understanding of the perioperative and long-term risks faced by living kidney donors. RECENT FINDINGS Although adverse perioperative complications are extremely rare, donors particularly men, Black, or obese, frequently experience minor complications that result in delayed return to normal duties at home and work. Similarly, although long-term complications such as end-stage renal disease (ESRD) are rare, recent studies suggest a relative increase in risk of ESRD that is attributable to donation. Several risk calculators have been developed to help donors and their care providers quantify the baseline and postdonation risk of ESRD based on demographic and health characteristics. Thresholds of risk may help define what is an acceptable level of risk to the donor and the transplant center. SUMMARY Individualized risk calculators now allow care providers and potential donors to objectively and transparently participate in shared decision-making about the safety of living kidney donation.
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Affiliation(s)
- Luckmini Liyanage
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Abimerki Muzaale
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Macey Henderson
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA
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McCormick F, Held PJ, Chertow GM, Peters TG, Roberts JP. Removing Disincentives to Kidney Donation: A Quantitative Analysis. J Am Soc Nephrol 2019; 30:1349-1357. [PMID: 31345987 DOI: 10.1681/asn.2019030242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Philip J Held
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Thomas G Peters
- Department of Surgery, University of Florida, Jacksonville, Florida; and
| | - John P Roberts
- Department of Surgery, University of California, San Francisco, San Francisco, California
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Donor and Recipient Outcomes following Robotic-Assisted Laparoscopic Living Donor Nephrectomy: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1729138. [PMID: 31143770 PMCID: PMC6501265 DOI: 10.1155/2019/1729138] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/14/2019] [Indexed: 01/30/2023]
Abstract
Aims We aimed to summarize available lines of evidence about intraoperative and postoperative donor outcomes following robotic-assisted laparoscopic donor nephrectomy (RALDN) as well as outcomes of graft and recipients. Methods A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in May 2018. The following search terms were combined: nephrectomy, robotic, and living donor. We included full papers that met the following criteria: original research; English language; human studies; enrolling patients undergoing RALDN. Results Eighteen studies involving 910 patients were included in the final analysis. Mean overall operative and warm ischemia times ranged from 139 to 306 minutes and from 1.5 to 5.8 minutes, respectively. Mean estimated blood loss varied from 30 to 146 mL and the incidence of intraoperative complications ranged from 0% to 6.7%. Conversion rate varied from 0% to 5%. The mean hospital length of stay varied from 1 to 5.8 days and incidence of early postoperative complications varied from 0% to 15.7%. No donor mortality was observed. The incidence of delayed graft function was reported in 7 cases. The one- and 10-year graft loss rates were 1% and 22%, respectively. Conclusions Based on preliminary data, RALDN appears as a safe and effective procedure.
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Noguchi H, Kakuta Y, Okumi M, Omoto K, Okabe Y, Ishida H, Nakamura M, Tanabe K. Pure versus hand-assisted retroperitoneoscopic live donor nephrectomy: a retrospective cohort study of 1508 transplants from two centers. Surg Endosc 2019; 33:4038-4047. [PMID: 30888499 DOI: 10.1007/s00464-019-06697-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/06/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although minimally invasive procedures have been established as the standard for a donor nephrectomy, there are many different surgical techniques described in the literature. The aim of this study is to compare the outcomes of kidney transplant procedures using the pure retroperitoneoscopic donor nephrectomy (PRDN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARDN) techniques. METHODS A retrospective study involving 1508 transplant procedures was conducted; 874 were PRDN procedures; and 634 were HARDN. We reviewed the outcomes of the PRDN and HARDN groups, which were performed at two different centers over an identical time period. RESULTS Donors in the PRDN group had a longer operation time (P < 0.0001), reduced estimated blood loss (P < 0.0001), less open conversion (P = 0.0002), lower postoperative serum C-reactive protein levels (P < 0.0001), and a shorter postoperative hospital stay (P < 0.0001) than the HARDN group. Recipients in the PRDN group had lower serum creatinine levels at postoperative day 1-6 and the decreased incidence of slow graft function (P = 0.0017) than the HARDN group. The HARDN procedure was an independent risk factor for the incidence of acute rejection (P = 0.0211) and graft loss (P = 0.0193). CONCLUSIONS Our study suggests that the PRDN procedure is less invasive for donors as it results in reduced blood loss, lower postoperative serum CRP levels, and a shorter postoperative stay than the HARDN procedure. Additionally, PRDN provides a better outcome for recipients as it lowers the incidence of acute rejection and improves graft survival compared to HARDN.
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Affiliation(s)
- Hiroshi Noguchi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichi Kakuta
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
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Informative for Decision Making? The Spectrum and Consistency of Outcomes After Living Kidney Donation Reported in Trials and Observational Studies. Transplantation 2019; 103:284-290. [DOI: 10.1097/tp.0000000000002489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures. J Anesth 2019; 33:148-154. [DOI: 10.1007/s00540-018-02605-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
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Hirose T, Hotta K, Iwami D, Harada H, Morita K, Tanabe T, Sasaki H, Fukuzawa N, Seki T, Shinohara N. Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopic Living Donor Nephrectomy. J Endourol 2018; 32:1120-1124. [DOI: 10.1089/end.2018.0669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takayuki Hirose
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Daiki Iwami
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Harada
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hajime Sasaki
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuyuki Fukuzawa
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Toshimori Seki
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Shockcor NM, Sultan S, Alvarez-Casas J, Brazio PS, Phelan M, LaMattina JC, Barth RN. Minimally invasive donor nephrectomy: current state of the art. Langenbecks Arch Surg 2018; 403:681-691. [DOI: 10.1007/s00423-018-1700-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 01/09/2023]
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Chauhan N, Kenwar DB, Singh N, Singh S, Sharma A, Kapoor K, Kumar S. Retroperitoneal Single Port Versus Transperitoneal Multiport Donor Nephrectomy: A Prospective Randomized Control Trial. J Endourol 2018; 32:496-501. [DOI: 10.1089/end.2017.0829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Neelam Chauhan
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Benjamin Kenwar
- Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navdeep Singh
- Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarbpreet Singh
- Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kunal Kapoor
- Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Kumar
- Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Jędrzejko K, Kieszek R, Dor FJMF, Kwapisz M, Nita M, Bieniasz M, Czerwińska M, Kwiatkowski A. Does Low Birthweight Have an Impact on Living Kidney Donor Outcomes? Transplant Proc 2018; 50:1710-1714. [PMID: 30056887 DOI: 10.1016/j.transproceed.2018.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Because nearly 30,000 people worldwide become living kidney donors each year, donor safety is of the utmost importance. Recent studies have shown that living kidney donation is associated with an increased relative risk for end-stage renal disease (ESRD). It is essential to determine which donors will be more likely to develop ESRD. One of the risk factors for ESRD in living kidney donors is hypertension and, because there are studies demonstrating that low birthweight is a risk factor for developing hypertension in adult life, we hypothesized that donors with low birthweight may be at higher risk of developing renal disease after donation. METHODS Seventy-three living kidney donors were examined. Donors were divided into 2 cohorts: a group with low birthweight and group with normal birthweight. We checked whether the donor birthweight has an impact on the outcome of donor renal function and on the development of hypertension. RESULTS Hypertension was observed statistically more frequent in the group with low birthweight (P = .003). CONCLUSION Glomerular filtration rate before kidney donation was found to be lower in the low-birthweight group.
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Affiliation(s)
- K Jędrzejko
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Kieszek
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - F J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College, London, UK
| | - M Kwapisz
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Nita
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Bieniasz
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Czerwińska
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - A Kwiatkowski
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
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Merkx R, Muselaers C, d'Ancona F, Warlé M, van der Jagt M, Kusters A, Poyck P, Schulte R, Langenhuijsen J. Effectiveness of Heated Sterile Water vs ResoClear ® for Prevention of Laparoscopic Lens Fogging in a Randomized Comparative Trial. J Endourol 2018; 32:54-58. [PMID: 29186976 DOI: 10.1089/end.2017.0683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Laparoscopic surgery may be complicated by visual disturbances, including lens fogging. Several techniques have been developed to prevent laparoscopic lens fogging (LLF). We aim to compare the effectiveness of two commonly available techniques in prevention of LLF: heated sterile water in a thermos flask and ResoClear® impregnation wipes. MATERIALS AND METHODS In this single-center prospective randomized study, 50 patients underwent an elective laparoscopic donor nephrectomy and were allocated to either heated sterile water or ResoClear® impregnation wipes as the antifogging method. The primary outcome was the number of fogging events during the first 30 minutes of the operation, whereas secondary outcomes were operating time, number of cleaning events because of other causes, cost differences, and assessment of predicting factors for fogging events. RESULTS In 50 patients, the outcomes were analyzed. The number of fogging events was significantly lower when using heated sterile water (median = 0, interquartile range [IQR]: 0-0) compared to ResoClear® (median 1.0, IQR: 0.5-3.0), p < 0.001. There were no significant differences in operating time, number of cleaning events because of other causes, and costs. No predictors of fogging events were found. CONCLUSION The use of heated sterile water leads to significantly less fogging events than the use of ResoClear® impregnation wipes, resulting in an improved continuity of the surgery without differences in operating time and costs.
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Affiliation(s)
- Robin Merkx
- 1 Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | | | - Frank d'Ancona
- 1 Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | - Michiel Warlé
- 2 Department of Vascular Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | - Anneke Kusters
- 1 Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | - Paul Poyck
- 2 Department of Vascular Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Ronald Schulte
- 3 Department of Operation Rooms, Radboudumc, Nijmegen, The Netherlands
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Hosseini K, Omorou AY, Hubert J, Ngueyon Sime W, Ladrière M, Guillemin F. Nephrectomy Complication Is a Risk Factor of Clinically Meaningful Decrease in Health Utility among Living Kidney Donors. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1376-1382. [PMID: 29241897 DOI: 10.1016/j.jval.2017.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/25/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the clinically relevant change in health state utility (HSU) in living kidney donors and whether this change value is constant across measures and clinical conditions and is useful for health economics studies. We aimed to 1) measure the change in the HSU score for living kidney donors from before donation to 3 months after donation and 2) estimate the minimal important decrease (MIDe) in the HSU score for living kidney donors and its associated clinical factors. METHODS Data from a prospective multicenter observational study measuring quality of life of kidney donors by the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L) and the six-dimensional health state short form (SF-6D) before donation and at 3 months after donation provided HSU scores. Two methods were used to derive the MIDe: the anchor-based method and the distribution-based (standard error of measurement) method. Logistic regression was used to identify clinical factors associated with the MIDe after donation. RESULTS In total, 228 and 216 donors completed the EQ-5D-3L and the SF-6D, respectively. Mean HSU scores were 0.932 and 0.823 before donation and 0.895 and 0.764 at 3 months after donation. HSU scores were significantly decreased at 3 months, and 18.5% of donors rated their global health as "somewhat worse." By the EQ-5D-3L and the SF-6D, the MIDe was estimated at -0.113 and -0.116 with the anchor-based method and -0.075 and -0.077 with the distribution-based method. Risk of decreased HSU score was significantly associated with clinical complications but only marginally with surgical technique. CONCLUSIONS A short-term clinically relevant decrease in HSU was significantly associated with clinical complications in kidney donors. Preventing perioperative complications is of prime importance in kidney donation.
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Affiliation(s)
- Kossar Hosseini
- INSERM, CIC-1433 Clinical Epidemiology, CHRU Nancy, France; University of Lorraine, University Paris Descartes, EA 4360 Apemac, Nancy, France
| | - Abdou Y Omorou
- INSERM, CIC-1433 Clinical Epidemiology, CHRU Nancy, France; University of Lorraine, University Paris Descartes, EA 4360 Apemac, Nancy, France.
| | | | | | | | - Francis Guillemin
- INSERM, CIC-1433 Clinical Epidemiology, CHRU Nancy, France; University of Lorraine, University Paris Descartes, EA 4360 Apemac, Nancy, France
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Garbens A, Wallis CJD, Bjarnason G, Kulkarni GS, Nathens AB, Nam RK, Satkunasivam R. Platelet to white blood cell ratio predicts 30-day postoperative infectious complications in patients undergoing radical nephrectomy for renal malignancy. Can Urol Assoc J 2017; 11:E414-E420. [PMID: 29072562 DOI: 10.5489/cuaj.4478] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION We sought to examine the relationship between preoperative platelet to white blood cell ratio (PLT/WBC), a hematological marker of the systemic inflammatory response, and postoperative infectious complications following radical nephrectomy for localized renal cell carcinoma. METHODS We performed a retrospective cohort study of patients treated with radical nephrectomy for localized kidney cancer between January 1, 2005 and December 31, 2014 (n=6235) using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Univariate and multivariate analyses were used to assess the association between PLT/WBC ratio and 30-day infectious complications, including surgical site infection, urinary tract infection (UTI), pneumonia, and sepsis. Secondarily, we examined major complications and bleeding requiring transfusion. RESULTS A lower PLT/WBC ratio was associated with an increased risk of sepsis, pneumonia, and UTI rates (p<0.05 for all). Furthermore, there was a significant trend of decreasing rates of sepsis and pneumonia with increasing PLT/WBC ratio across quintiles (p<0.05 for all). On multivariate analysis, patients with the lowest PLT/WBC ratios (Quintile 1) had a two-fold risk of having a postoperative infectious complication compared to patients in the highest quintile (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.42-2.86; p<0.0001). Patients in Quintile 5 had a higher risk of requiring blood transfusion than those in Quintiles 2-4 (p<0.05 for all). CONCLUSIONS The PLT/WBC ratio represents a widely available and novel index to predict risk of infectious and bleeding complications in patients undergoing radical nephrectomy. External validation is required and the biological underpinning of this phenomenon requires further study.
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Affiliation(s)
- Alaina Garbens
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Georg Bjarnason
- Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Princess Margaret Hospital and University Health Network, University of Toronto, ON, Canada
| | - Avery B Nathens
- Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Robert K Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Raj Satkunasivam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
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Lanot A, Bouvier N, Chatelet V, Lecouf A, Tillou X, Hurault de Ligny B. [Outcome of living kidney donors for transplantation]. Nephrol Ther 2017; 13:448-459. [PMID: 29031488 DOI: 10.1016/j.nephro.2017.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 01/10/2023]
Abstract
Nowadays, several treatments exist to treat terminal chronic renal failure. Best results for the recipients are obtained with kidney transplantation concerning mortality and quality of life. Transplantation is also the cheaper option for society. Living kidney donation raises the issue of the becoming of the donor, an absolutely healthy subject who gets to a surgical procedure. The becoming of living kidney donors has been compared with the one of controls subjects in several studies. The evaluations focused on the complications of nephrectomy in the short and long-term: kidney failure, hypertension, proteinuria, possibility of pregnancy, quality of life, and mortality. The first results did not show any risk linked to kidney donation, compared to general population. However, since 2013, kidney donors were found at higher risk for kidney failure and even for mortality, compared with controls selected like donor candidates. The risk of kidney donation is nevertheless acceptable and minimal, on the condition of rigorous selection of candidates and regular follow-up.
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Affiliation(s)
- Antoine Lanot
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Normandie université, Unicaen, UFR de médecine, 2 rue des rochambelles, 14032 Caen cedex, France.
| | - Nicolas Bouvier
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Normandie université, Unicaen, UFR de médecine, 2 rue des rochambelles, 14032 Caen cedex, France
| | - Valérie Chatelet
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - Angélique Lecouf
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - Xavier Tillou
- Normandie université, Unicaen, UFR de médecine, 2 rue des rochambelles, 14032 Caen cedex, France; Service d'urologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - Bruno Hurault de Ligny
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Normandie université, Unicaen, UFR de médecine, 2 rue des rochambelles, 14032 Caen cedex, France
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Unger LW, Feka J, Sabler P, Rasoul-Rockenschaub S, Györi G, Hofmann M, Schwarz C, Soliman T, Böhmig G, Kainz A, Salat A, Berlakovich GA. High BMI and male sex as risk factor for increased short-term renal impairment in living kidney donors - Retrospective analysis of 289 consecutive cases. Int J Surg 2017; 46:172-177. [PMID: 28912105 DOI: 10.1016/j.ijsu.2017.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidney transplantation represents the treatment of choice for end-stage renal disease (ESRD). However, nephrectomy bears certain short- as well as long-term risks for the healthy, voluntary donor. As obesity is increasing and is a known risk factor for surgical complications, we wanted to assess the impact of BMI on perioperative complication rates and renal function. MATERIALS AND METHODS We retrospectively assessed patients undergoing living donor kidney nephrectomy at our institution. We identified 289 donors that underwent unilateral nephrectomy between January 2006 and December 2015. Donors were categorized according to their BMI (BMI <25 kg/m2, BMI ≥25/<30 kg/m2, BMI ≥30 kg/m2). Where indicated, analysis of variance (ANOVA) was used to compare groups, a stepwise linear regression model was used to assess impact of BMI on the change of eGFR. RESULTS 126 donors (43.6%) had a BMI <25 while 120 (41.5%) had a BMI ≥25/<30 and 43 (14.9%) were obese with a BMI ≥30. BMI had no statistically significant influence on the percentage of laparoscopic approach (86.5% vs. 83.3% vs. 88.4%, p = 0.6564), on conversion rates (0% vs. 2.0% vs. 2.6%, p = 0.2879) or postoperative complication rates defined as Clavien Dindo ≥ II (8.7% vs. 13.3% vs. 14.0%, respectively; p = 0.4474). Notably, there were no Grade III or higher complications in any group. There was no difference in pre-operative kidney function, postoperative surgical site infection or systemic infection. BMI and male sex had a statistically significant influence on short-term decline of eGFR. CONCLUSION Obese donors do not suffer from an increased risk of intraoperative or perioperative complication rates. However, male sex and high BMI are associated with a more pronounced short-term decline in renal function. The impact of BMI on long-term consequences for kidney donors needs to be defined in larger prospective cohorts.
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Affiliation(s)
- Lukas W Unger
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Joy Feka
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Philipp Sabler
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Susanne Rasoul-Rockenschaub
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Georg Györi
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Hofmann
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Christoph Schwarz
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Soliman
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Georg Böhmig
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alexander Kainz
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Andreas Salat
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Gabriela A Berlakovich
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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