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Ma C, Shen C, Dong H, Sun C, Wang J, Ding Z, Chen X, Jiao Y, Ren X, Zhou X. The early outcomes of two separate anastomosis procedures in deceased kidney transplantation with double arteries: A retrospective comparative study. Asian J Surg 2024:S1015-9584(24)01428-3. [PMID: 39048426 DOI: 10.1016/j.asjsur.2024.07.058] [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: 09/11/2023] [Revised: 12/12/2023] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Kidneys with double renal arteries are used on a routine basis nowadays, and separate anastomosis in situ is one of the suitable arterial anastomosis procedures. The commonly used methods are parallel end-to-side anastomoses of double arteries to the external iliac artery, and end-to-end anastomosis to the internal iliac artery combined with end-to-side anastomosis to the external iliac artery. No studies have compared the prognoses of the two procedures in deceased kidney transplantation. METHODS We retrospectively analyzed 35 consecutive deceased kidney transplantations with double arterial anastomoses in the urology department of China-Japan Friendship Hospital from January 2018 to April 2021. Group I comprised recipients with double parallel end-to-side anastomoses to the external iliac artery; Group II comprised the others. Their prognoses were then compared. RESULTS There were no significant differences between Group I and II in characteristics of recipients and donors. The mean eGFRs at 1, 3, 6 and 12 months post-transplant in Group I and II were 36.4 vs 54.1 (P = 0.009), 40.4 vs 54.4 (P = 0.02), 40.4 vs 56.9 (P = 0.02) and 39.8 vs 57.9 (P = 0.007) mL/min respectively. There was no difference in early postoperative complications and 1-year survival rates between the two groups (P = 1.00). CONCLUSION Separate anastomosis is a reliable procedure for deceased kidney transplantation with double arteries. Double separate anastomoses to the external and internal iliac arteries have better graft function compared with double parallel anastomoses to the external iliac artery during the first year after transplantation.
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Affiliation(s)
- Changyu Ma
- Department of Urology, China-Japan Friendship Hospital, Beijing, China; Graduate School of Peking Union Medical College, Peking Union Medical College, Beijing, China
| | - Congrong Shen
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Hao Dong
- Department of Urology, China-Japan Friendship Hospital, Beijing, China; China-Japan Friendship Clinical College, Peking University Health Science Center, Beijing, China
| | - Chonghao Sun
- Department of Urology, China-Japan Friendship Hospital, Beijing, China; Graduate School of Peking Union Medical College, Peking Union Medical College, Beijing, China
| | - Jianfeng Wang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Zhenshan Ding
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Xing Chen
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Yangtian Jiao
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaohong Ren
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaofeng Zhou
- Department of Urology, China-Japan Friendship Hospital, Beijing, China; Graduate School of Peking Union Medical College, Peking Union Medical College, Beijing, China; China-Japan Friendship Clinical College, Peking University Health Science Center, Beijing, China.
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The effect of single or multiple arteries in the donor kidney on renal transplant surgical outcomes. Ir J Med Sci 2022; 192:929-934. [PMID: 35697967 DOI: 10.1007/s11845-022-03024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND As the number of end-stage renal disease (ESRD) patients is increasing, but there are not enough living donors, it is necessary to broaden the criteria for candidates who can undergo donor nephrectomy. Thanks to surgeons' increasing experience with laparoscopic donor nephrectomy (LND), multiple renal artery grafts, previously considered a relative contraindication to donor nephrectomy, have become candidates for LDN. We aimed to compare the outcomes of donors and recipients with single artery and with multiple arteries in LDN. METHODS A total of 214 patients were included in the study. Patients were divided into two groups according to the number of donor arteries: donors with one artery (group 1) and donors with multiple arteries (group 2). The number of donor arteries, operative time, warm ischemia time (WIT), cold ischemia time (CIT), arterial anastomosis time, venous anastomosis time, the extent of bleeding, and preoperative complications were recorded to evaluate the preoperative data. RESULTS The mean operation time in group 1 was 90.3 ± 11.8 min, while in group 2, it was 102.1 ± 5.5 min (p = 0.000). WIT group 1 was 90.9 ± 4.3 s and group 2 100.6 ± 2.1 s (p = 0.000). Arterial anastomosis time was 12.25 ± 3.8 in group 1 and 22.5 ± 4.5 in group 2 (p = 0.000). No statistically significant difference was found between the two groups in other parameters. CONLUSION Increasing the number of donor arteries in renal transplantation (RT) operations prolonged the operation time on both the donor and recipient sides. Still, it had no negative impact on complications or graft function in the postoperative period.
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Karayagiz AH, Besli S, Yilmaz G, Ozdemir E, Cakir U, Berber I. Long-term outcomes of left versus right laparoscopic living donor nephrectomy with multiple renal arteries. Eur Surg Res 2022; 63:46-54. [PMID: 35100577 DOI: 10.1159/000522315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of this study is to compare the long-term graft outcomes of left versus right donor nephrectomy with multiple renal arteries, and therefore creating a reference for the expansion of the potential living kidney donor pool. METHODS Laparoscopic live donor nephrectomy cases between May 2010 and October 2020 were included in this retrospective cross-sectional study. The data relating to donor and recipient demographics, surgical and anatomical characteristics, recipient and graft status were retrieved and compared using nonparametric statistical methods and multivariate regression. Analyses were fit for survival factors. RESULTS A total of 1009 recipients were included in this retrospective cross-sectional study with their donors. 16.7% of the donors had been discovered to have more than one renal artery supplying the donated kidney. The acute rejection rate was 12.8%. Death-censored graft survival at post-operative year 5 for single renal artery transplants was 89.6%, 89.5% for left-sided multiple renal arteries, and 88.2% for right-sided ones. CONCLUSIONS Both right donor nephrectomy and left donor nephrectomy are safe procedures with no significant negatively impacted rates for neither survival nor complications of the recipients in the long-term, compared to single renal artery ones.
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Affiliation(s)
- Abdulhak Hamit Karayagiz
- Department of General Surgery, Istanbul Esenyurt Necmi Kadioglu Public Hospital, Istanbul, Turkey
| | - Sevval Besli
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Gulay Yilmaz
- Department of Nephrology, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Ebru Ozdemir
- Department of General Surgery, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Ulkem Cakir
- Department of Nephrology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ibrahim Berber
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
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Zeng J, Jia Z, Lin T, Song T. Machine Retrograde Perfusion of Deceased Donor Kidneys: A Prospective Study. Front Med (Lausanne) 2021; 8:785953. [PMID: 34977090 PMCID: PMC8718700 DOI: 10.3389/fmed.2021.785953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To maximize the utilization of potential kidneys, improving perfusion and preservation techniques is necessary.Methods: We investigated the safety and efficacy of retrograde machine perfusion of kidneys from deceased donors. A total of 30 kidneys were included and all the grafts were preserved in the Kidney Transporter machines. A total of 15 kidneys that received retrograde perfusion (RP) were selected as the RP group (n = 15) and their counterparts received standard antegrade perfusion (AP) as the control group (n = 15).Results: All the recipients were followed up for 6 months. Renal resistance in the RP group remained stable during the perfusion. There was no primary nonfunction. No difference in the incidence of delayed graft function was found in both groups (3 in RP vs. 2 in AP, p = 0.62). The RP group had lower serum creatinine (RP vs. AP, 102.20 vs. 138.67, p = 0.05) and blood urea nitrogen (RP vs. AP, 6.44 vs. 8.71, p = 0.05) than that in the AP group at 6 months. Both the groups had comparable estimated glomerular filtration rate and cystatin C within 6 months.Conclusion: This novel technique may be an effective and safe alternative for kidney preservation.
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Affiliation(s)
- Jun Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - ZiHao Jia
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - TuRun Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: TuRun Song
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5
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Husain SA, King KL, Robbins-Juarez S, Adler JT, McCune KR, Mohan S. Number of Donor Renal Arteries and Early Outcomes after Deceased Donor Kidney Transplantation. KIDNEY360 2021; 2:1819-1826. [PMID: 35373010 PMCID: PMC8785844 DOI: 10.34067/kid.0005152021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
Background Anatomic abnormalities increase the risk of deceased donor kidney discard, but their effect on transplant outcomes is understudied. We sought to determine the effect of multiple donor renal arteries on early outcomes after deceased donor kidney transplantation. Methods For this retrospective cohort study, we identified 1443 kidneys from 832 deceased donors with ≥1 kidney transplanted at our center (2006-2016). We compared the odds of delayed graft function and 90-day graft failure using logistic regression. To reduce potential selection bias, we then repeated the analysis using a paired-kidney cohort, including kidney pairs from 162 donors with one single-artery kidney and one multiartery kidney. Results Of 1443 kidneys included, 319 (22%) had multiple arteries. Multiartery kidneys experienced longer cold ischemia time, but other characteristics were similar between groups. Delayed graft function (50% multiartery versus 45% one artery, P=0.07) and 90-day graft failure (3% versus 3%, P=0.83) were similar between groups before and after adjusting for donor and recipient characteristics. In the paired kidney analysis, cold ischemia time was significantly longer for multiartery kidneys compared with single-artery kidneys from the same donor (33.5 versus 26.1 hours, P<0.001), but delayed graft function and 90-day graft failure were again similar between groups. Conclusions Compared with single-artery deceased donor kidneys, those with multiple renal arteries are harder to place, but experience similar delayed graft function and early graft failure.
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Affiliation(s)
- S Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York.,The Columbia University Renal Epidemiology Group, New York, New York
| | - Kristen L King
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York.,The Columbia University Renal Epidemiology Group, New York, New York
| | - Shelief Robbins-Juarez
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York
| | - Joel T Adler
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, Massachusetts
| | - Kasi R McCune
- Department of Surgery, Kidney and Pancreas Transplant Program, Columbia University College of Physicians & Surgeons, New York, New York
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York.,The Columbia University Renal Epidemiology Group, New York, New York.,Department of Epidemiology, Mailman School of Public Health, New York, New York
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6
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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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7
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O'Kelly F, Lorenzo AJ, Zubi F, De Cotiis K, Farhat WA, Koyle MA. The impact of multiple donor renal arteries on perioperative complications and allograft survival in paediatric renal transplantation. J Pediatr Urol 2021; 17:541.e1-541.e11. [PMID: 33883096 DOI: 10.1016/j.jpurol.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of using allografts with multiple renal arteries in paediatric kidney transplantation has not been clearly established. The aim of this study was to determine whether kidney grafts with multiple arteries pose any adverse effects upon perioperative surgical outcomes, and graft survival up to 12 months post-transplant. OBJECTIVE The objective of this study was to perform a comparative analysis of a minimum of 12-month graft survival and transplant renal function in paediatric renal transplant recipients receiving single versus multiple donor arteries, and to assess perioperative and early post-operative surgical outcomes. STUDY DESIGN A retrospective divisional chart review of 379 transplants performed (2000-2018), of which 90 (23.7%) contained multiple donor arteries. The number of arteries of the graft, donor type, vascular reconstruction technique, occurrence of urological and vascular complications, estimated GFR and graft survival up to 12 months post-transplantation, graft loss and mortality were analysed. Comparisons in baseline characteristics and outcome measures were made between both groups. RESULTS No significant differences were found in age (p = 0.42), BMI (p = 0.39), estimated intraoperative blood loss (p = 0.14), overall (p = 0.63) or warm ischaemic time (p = 0.37). 51.3% patients with multiple donor arteries underwent an ex vivo reconstruction. There were no differences in the site of arterial anastomosis (aorta, external iliac, internal iliac), or anastomotic type (end-side; end-end). Whilst there was a significantly higher post-operative lymphocoele rate in the multiple vessel cohort (p = 0.024), there was no increase in post-transplant urine leaks, rejection episodes, graft loss (1.1% multiple vs 2.1% single), perioperative complications (p = 0.68), or estimated GFR at 1 month (p = 0.9) or at 1 year (p = 0.67). DISCUSSION We demonstrated in this study that there was no significant difference in postoperative complications up to 3 months, eGFR and renal function up to 1 year, and graft survival up to 4 years post transplantation irrespective of allograft type or reconstruction technique. There was however, a higher rate of lymphocoeles in the multiple artery cohort. The results seen here broadly mirror trends seen in adult studies, however, there is little data available from paediatric series. CONCLUSION Our study demonstrates that multiple renal artery allografts - previously been considered to carry a high complication risk - can be safely used for paediatric renal transplantation with equivalent perioperative complications and graft outcomes to single artery allografts.
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Affiliation(s)
- F O'Kelly
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Paediatric Urology, Beacon Hospital, University College, Dublin, Ireland.
| | - A J Lorenzo
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - F Zubi
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - K De Cotiis
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, Neymours/duPont Childrens Hospital, Delaware, USA
| | - W A Farhat
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, American Family Childrens Hospital, Wisconsin, USA
| | - M A Koyle
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
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8
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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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9
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Fitzpatrick J, Chmelo J, Nambiar A, Fuge O, Page T, Sen G, Soomro N, Rix D, Rogers A, Talbot D, Veeratterapillay R. Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels. Urol Ann 2020; 12:266-270. [PMID: 33100753 PMCID: PMC7546076 DOI: 10.4103/ua.ua_96_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/13/2020] [Indexed: 11/07/2022] Open
Abstract
Introduction: In kidney transplantation, total laparoscopic live donor nephrectomy (TLLDN) in the presence of multiple renal arteries (MRA) is technically challenging and has traditionally been associated with higher complication rates. We report our experience of using MRA grafts procured by TLLDN. Materials and Methods: Patients undergoing TLLDN at our center (2004–2014) was identified from a prospectively maintained database and divided into single renal arteries (SRA) or MRA groups. Recipient perioperative parameters, postoperative complications, and long-term graft survival were analyzed. Results: Of 465 patients, 106 had MRA and 359 had an SRA. There were six vascular complications in the SRA group and two in the MRA group (1.7% vs. 1.8%). There were eight ureteric complications requiring intervention in the SRA group compared to three in the MRA group (4% vs. 3%; P = 0.45). Acute rejection was observed in 12% of the SRA group compared to 9% in the MRA group (P = 0.23). One-, 5- and 10-year graft survivals were 98.2%, 91.3%, and 89.8% in the MRA group versus 98.0%, 90.4%, and 77.5% in the SRA group (log-rank P = 0.13). Conclusion: The use of MRA grafts procured by TLLDN has comparable complication rates to SRA grafts and should not preclude selection for renal transplantation.
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Affiliation(s)
- John Fitzpatrick
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Jakub Chmelo
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Arjun Nambiar
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Oliver Fuge
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Toby Page
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Gourab Sen
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Naeem Soomro
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - David Rix
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - Alistair Rogers
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - David Talbot
- Institute of Transplantation, Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
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10
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Sevmis M, Demir ME, Merhametsiz O, Aktas S, Sevmis S, Uyar M. Grafts With Multiple Renal Arteries in Kidney Transplantation. Transplant Proc 2020; 53:933-940. [PMID: 32950261 DOI: 10.1016/j.transproceed.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/21/2020] [Accepted: 07/11/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Renal grafts with multiple renal arteries (MRA) are a compelling issue in surgery of kidney transplantation. Transplantations using "grafts with MRA" have conflicting results. Here, we present our experiences on the issue. METHOD This is a single-center, observational, descriptive study. One hundred ninety-nine patients with end-stage renal disease received a kidney graft from their living- or deceased-related donors in our center between July 2016 and May 2017. We included all recipients to the study. Patients were divided into the following 2 groups: Group 1, recipients who received a renal graft with single renal artery, and Group 2, recipients who received a renal graft with MRA. Groups were compared for estimated glomerular filtration rates (months 1-3 and 12), delayed graft function, and graft survival. Data were analyzed by using SPSS for Windows version 15. RESULTS One hundred ninety-five recipients with all documented data were analyzed. Graft function was compared between 2 groups in months 1, 3, and 12 and found both to have similar outcomes. MRA has been indicated to have no impact on delayed graft function, higher risk for vascular injury, and biopsy-proven acute tubular necrosis. Also, anastomosis sides have been found to have no importance on graft function in recipients with MRA (P > .05 between all sides). CONCLUSION Our study indicates grafts with MRA and grafts with a single renal artery have comparable results in the first post-transplant year.
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Affiliation(s)
- Murat Sevmis
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Mehmet Emin Demir
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey.
| | - Ozgur Merhametsiz
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey
| | - Sema Aktas
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Sinasi Sevmis
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of General Surgery and Organ Transplantation, Istanbul, Turkey
| | - Murathan Uyar
- Yeni Yuzyil University, School of Medicine, Private Gaziosmanpasa Hospital, Department of Nephrology and Organ Transplantation, Istanbul, Turkey
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11
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Robotic Assisted Living Donor Nephrectomies: A Safe Alternative to Laparoscopic Technique for Kidney Transplant Donation. Ann Surg 2020; 275:591-595. [PMID: 32657945 DOI: 10.1097/sla.0000000000004247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review outcomes after laparoscopic, robotic-assisted living donor nephrectomy (RLDN) in the first, and largest series reported to date. SUMMARY OF BACKGROUND DATA Introduction of minimal invasive, laparoscopic donor nephrectomy has increased live kidney donation, paving the way for further innovation to expand the donor pool with RLDN. METHODS Retrospective chart review of 1084 consecutive RLDNs performed between 2000 and 2017. Patient demographics, surgical data, and complications were collected. RESULTS Six patients underwent conversion to open procedures between 2002 and 2005, whereas the remainder were successfully completed robotically. Median donor age was 35.7 (17.4) years, with a median BMI of 28.6 (7.7) kg/m. Nephrectomies were preferentially performed on the left side (95.2%). Multiple renal arteries were present in 24.1%. Median operative time was 159 (54) minutes, warm ischemia time 180 (90) seconds, estimated blood loss 50 (32) mL, and length of stay 3 (1) days. The median follow-up was 15 (28) months. Complications were reported in 216 patients (19.9%), of which 176 patients (81.5%) were minor (Clavien-Dindo class I and II). Duration of surgery, warm ischemia time, operative blood loss, conversion, and complication rates were not associated with increase in body mass index. CONCLUSION RLDN is a safe technique and offers a reasonable alternative to conventional laparoscopic surgery, in particular in donors with higher body mass index and multiple arteries. It offers transplant surgeons a platform to develop skills in robotic-assisted surgery needed in the more advanced setting of minimal invasive recipient operations.
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12
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Broudeur L, Karam G, Chelghaf I, De Vergie S, Rigaud J, Perrouin Verbe MA, Branchereau J. Feasibility and safety of laparoscopic living donor nephrectomy in case of right kidney and multiple-renal artery kidney: a systematic review of the literature. World J Urol 2019; 38:919-927. [PMID: 31129713 DOI: 10.1007/s00345-019-02821-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/21/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To access the current status of the security and feasibility of right kidney (RK) and multiple-renal artery (MRA) laparoscopic living donor nephrectomy (LLDN) which are more challenging compared to left kidney (LK) and single renal artery (SRA) because of a shorter renal vein and more complex vascular anatomy. METHODS We did a systematic review of the literature according to the PRISMA recommendations, reporting RK or MRA donor nephrectomy performed with a laparoscopic technique compared to LK or SRA kidney LLDN. The identified and analyzed primary outcomes of interest were operating time (OT), warm ischemia time (WIT), rate of conversion and transfusion, donor length of stay (LOS), delayed graft function (DGF) and rate of graft loss (GL). RESULTS 16 comparative studies (1397 cases) of RK-LLDN and 12 comparative studies including 15 series (993 cases) of MRA-LLDN were selected. For RK-LLDN review, conversion rate was 0.8% and blood transfusion rate 0.2%, only one case of graft venous thrombosis was reported, OT was shorter in four studies and there was no any difference of DGF and GL rate compared to LK-LLDN. For MRA-LLDN review, conversion rate was 1.3% and blood transfusion rate 1.1%, OT and WIT were longer compared to SRA-LLDN, there were more ureteral complications in two studies, and no difference in terms of vascular complications and graft loss rate. CONCLUSION RK-LLDN and MRA-LLDN would be similar to LK-LLDN and SRA-LLDN in terms of feasibility and safety for the donor as well as graft function results for RK-LLDN.
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Affiliation(s)
- L Broudeur
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - G Karam
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - I Chelghaf
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - S De Vergie
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - J Rigaud
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - M A Perrouin Verbe
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France. .,Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France. .,Institut de Transplantation Urologie Néphrologie (ou ITUN), CHU Nantes, Nantes, France.
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13
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Iwami D, Hotta K, Sasaki H, Hirose T, Higuchi H, Takada Y, Iwahara N, Shinohara N. A 2-mm Cutoff Value Is Reasonable and Feasible for Vascular Reconstruction in a Kidney Allograft With Multiple Arteries. Transplant Proc 2019; 51:1317-1320. [PMID: 31027827 DOI: 10.1016/j.transproceed.2019.01.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple renal arteries are found in approximately 20% of living donor kidneys. We have been using an accessory artery cutoff diameter of 2 mm on preoperative computed tomography angiography to determine whether to sacrifice or reconstruct the artery. In this study, we assessed the validity and feasibility of this cutoff value. METHODS Living related kidney recipients from 2005 to 2013 were enrolled in this retrospective study. The diameter of the accessory artery and adverse events were evaluated. The lost parenchymal volume (%) due to vascular obstruction or branch ligation was calculated by computed tomography volumetry. RESULTS Among 128 kidney transplants, 30 donor kidneys had multiple arteries. Accessory arteries were reconstructed in 18 cases and intentionally ligated in 12 cases (mean diameter of accessory arteries, 3.10 [SD, 0.75] mm and 1.81 [SD, 0.28] mm, respectively). The mean estimated glomerular filtration rate at 1 or 12 months after transplant was not significantly different between the groups. Among reconstructed cases, 14 cases (77.8%) had good patency in the reconstructed arteries whereas the other 4 had vascular complications. The percentage of lost parenchymal volume due to ligation or occlusion of the reconstructed artery (calculated in 16 cases) was predictable with the following formula: lost volume (%) = 9.09 × diameter (mm) - 10.5 (P= .03, rs= 0.533 by Spearman rank correlation coefficient). This formula indicated that ligation of a 2-mm accessory artery leads to 7.68% loss of the renal parenchyma. CONCLUSIONS Reconstruction using a cutoff diameter of 2 mm is worth attempting in terms of the success rate and graft function. Sacrifice of a 2-mm accessory artery leads to parenchymal loss of <8%.
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Affiliation(s)
- Daiki Iwami
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Kiyohiko Hotta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hajime Sasaki
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hirose
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Haruka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Takada
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoya Iwahara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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14
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Laparoscopic procurement of single versus multiple artery kidney allografts: Meta-analysis of comparative studies. Asian J Surg 2019; 42:61-70. [DOI: 10.1016/j.asjsur.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/24/2018] [Accepted: 06/14/2018] [Indexed: 02/02/2023] Open
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15
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Silvinato A, Bernardo WM, Santos LS. Living donor nephrectomy. Rev Assoc Med Bras (1992) 2018; 64:1061-1068. [PMID: 30569978 DOI: 10.1590/1806-9282.64.12.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. CONCLUSIONS The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
| | - Antonio Silvinato
- Author and member of the Guidelines Program of the Brazilian Medical Association, São Paulo, Brasil
| | - Wanderley M Bernardo
- Lecturer Professor of School of Medicine of USP; São Paulo, SP, Brasil.,Coordinator of the Brazilian Medical Association Guidelines Program, São Paulo, SP, Brasil
| | - Luis Sérgio Santos
- Reviewer and member of the Guidelines Program of the Brazilian Medical Association, São Paulo, Brasil
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16
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Yamanaga S, Rosario A, Fernandez D, Kobayashi T, Tavakol M, Stock PG, Kang SM. Inferior long-term graft survival after end-to-side reconstruction for two renal arteries in living donor renal transplantation. PLoS One 2018; 13:e0199629. [PMID: 29995911 PMCID: PMC6040747 DOI: 10.1371/journal.pone.0199629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/11/2018] [Indexed: 12/26/2022] Open
Abstract
Living donor kidneys with two arteries can be revascularized using various techniques depending on anatomy. We hypothesized that the revascularization technique could impact long-term outcomes. We retrospectively analyzed 1714 living donor renal transplants at our institution between 1999 and 2015. Three hundred and eleven kidneys had dual arteries, and these were categorized into 5 groups; end-to-side (n = 18), inferior epigastric artery (n = 21), direct anastomosis (n = 65), side-to-side (n = 126) and ligated (n = 81). We then compared the outcomes with that of a control group (single artery, n = 1403) using Kaplan-Meier and Cox regression analyses. Cox regression was adjusted by age, sex and race/ethnicity of donor and recipient, side of kidney, transplant period and recipient surgeon. Compared to the control group, the end-to-side group had increased all-cause graft loss (10 years: 77.2% vs 24.5%, adjusted hazard ratio [aHR] 3.02, 95% confidence interval [CI] 1.30–7.03, p = 0.010) and death-censored graft loss (10 years: 82.0% vs 55.9%, aHR 4.17, 95% CI 1.63–10.68, p = 0.003), whereas the other groups did not. Our study shows that 10-year overall survival and death-censored graft survival were significantly worse for end-to-side arterial reconstruction than for other techniques. Alternative techniques to the end-to-side method should be used for accessory arteries that require revascularization.
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Affiliation(s)
- Shigeyoshi Yamanaga
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Angel Rosario
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Danny Fernandez
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mehdi Tavakol
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Peter G. Stock
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Sang-Mo Kang
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
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17
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Do Anatomical Anomalies Affect the Results of Living Donor Kidney Transplantation? Transplant Proc 2018; 50:1669-1673. [DOI: 10.1016/j.transproceed.2018.03.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/13/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022]
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18
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Ng ZQ, Musk G, Rea A, He B. Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy. Surg Endosc 2017; 32:2793-2799. [PMID: 29218666 DOI: 10.1007/s00464-017-5981-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Laparoscopic donor nephrectomy has become the standard of care due to multiple benefits. Currently, there are various techniques employed with two different approaches: transperitoneal (TLDN) or retroperitoneoscopic (RLDN) approach. There is a lack of data to determine which technique is superior, although the RLDN offers an anatomical advantage by avoidance of manipulation of the intraperitoneal organs. The aims of this study were to explore the merits of RLDN to TLDN and assess the learning curve of transition from TLDN to RLDN. METHODS From January 2010 to February 2017, 106 live donor nephrectomies were performed: 56 by TLDN and 50 by RLDN. Data on patient demographics, perioperative parameters, analgesic consumption, pain scores, and kidney graft function were collected and analysed. Data were compared with a Student's t test or Mann-Whitney test. A CUSUM analysis was performed to investigate the learning curve. RESULTS All live donor nephrectomies were successful with no conversion to open surgery. There was no blood transfusion, readmission, or mortality. No postoperative complications were graded over Clavien II. Kidney function was comparable in both groups. The follow-up period ranged from 3 to 78 months. CONCLUSION Retroperitoneoscopic live donor nephrectomy is a safe approach with comparable results to TLDN. RLDN has an anatomical advantage as it avoids manipulating the intraperitoneal organs and retains a virgin abdomen and hence translates to a lower perioperative complication risk.
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Affiliation(s)
- Zi Qin Ng
- WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia. .,WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Gabrielle Musk
- Animal Care Services, University of Western Australia, Perth, WA, Australia
| | - Alethea Rea
- Centre for Applied Statistics, University of Western Australia, Perth, WA, Australia
| | - Bulang He
- WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia. .,School of Surgery, University of Western Australia, Perth, WA, Australia. .,WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
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19
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Serrano OK, Bangdiwala AS, Vock DM, Berglund D, Dunn TB, Finger EB, Pruett TL, Matas AJ, Kandaswamy R. Defining the Tipping Point in Surgical Performance for Laparoscopic Donor Nephrectomy Among Transplant Surgery Fellows: A Risk-Adjusted Cumulative Summation Learning Curve Analysis. Am J Transplant 2017; 17:1868-1878. [PMID: 28029219 DOI: 10.1111/ajt.14187] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/20/2016] [Indexed: 01/25/2023]
Abstract
The United Network for Organ Sharing recommends that fellowship-trained surgeons participate in 15 laparoscopic donor nephrectomy (LDN) procedures to be considered proficient. The American Society of Transplant Surgeons (ASTS) mandates 12 LDNs during an abdominal transplant surgery fellowship. We performed a retrospective intraoperative case analysis to create a risk-adjusted cumulative summation (RACUSUM) model to assess the learning curve of novice transplant surgery fellows (TSFs). Between January 2000 and December 2014, 30 novice TSFs participated in the organ procurement rotation of our ASTS-approved abdominal transplant surgery fellowship. Measures of surgical performance included intraoperative time, estimated blood loss, and incidence of intraoperative complications. The performance of senior TSFs was used to benchmark novice TSF performance. Scores were tabulated in a learning curve model, adjusting for case complexity and prior TSF case volume. Rates of adverse surgical events were significantly higher for novice TSFs than for senior TSFs. In univariable analysis, multiple renal arteries, high BMI, prior abdominal surgery, male donor, and nephrolithiasis were correlated with higher incidence of adverse surgical events. Based on the RACUSUM model, high intraoperative time is mitigated after 28 procedures, incidence of intraoperative complications tends to diminish after 24 procedures, and improvement in estimated blood loss did not remain consistent. TSFs exhibit a tipping point in LDN performance by 24-28 cases and proficiency by 35-38 cases.
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Affiliation(s)
- O K Serrano
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - A S Bangdiwala
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - D M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - D Berglund
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - T B Dunn
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - E B Finger
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - T L Pruett
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - A J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - R Kandaswamy
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
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20
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Cintorino D, Pagano D, Bonsignore P, di Francesco F, Li Petri S, Ricotta C, Gruttadauria S. Evolution of Technique in Laparoscopic Donor Nephrectomy: A Single Center Experience. J Laparoendosc Adv Surg Tech A 2017; 27:666-668. [DOI: 10.1089/lap.2017.0140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Davide Cintorino
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS–ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Duilio Pagano
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS–ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Pasquale Bonsignore
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS–ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Fabrizio di Francesco
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS–ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Sergio Li Petri
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS–ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Calogero Ricotta
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS–ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS–ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
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21
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Nakamura Y, Kihara Y, Iwamoto H, Ozawa Y, Sano T, Tomita K, Yokoyama T, Konno O, Ueno T, Kawachi S. A Novel Assessment of Vascular Regions Using an Intraoperative Near-Infrared Fluorescence. Transplant Proc 2017; 48:710-5. [PMID: 27234719 DOI: 10.1016/j.transproceed.2015.12.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The risk of complications and transplant renal function increases in multiple arterial renal transplantations compared with single arterial renal transplantations. Even when multiple arteries are involved, with the introduction of laparoscopic nephrectomy, I mainly choose the left side kidney. Therefore, the number of renal artery reconstructions is increasing, and simultaneous imaging of arterial rebuilding during the donor nephrectomy is important. MATERIAL Between 2006 and 2015, we performed 132 living donor kidney transplantations at our center and analyzed 32 cases that were diagnosed pre- and intraoperatively. METHOD We compared the single renal artery (SRA) and multiple renal arteries (MRA) groups and analyzed the number of renal arteries, reconstruction methods, donor and recipient ages, sex, total ischemic times, and 1-month serum creatinine values. RESULT In the MRA and SRA groups, the average recipient age was 52.3 and 47.0 years, respectively, while the average donor age was 52.9 and 53.1 years, respectively. In SRA and MRA groups, total ischemic time (TIT) was 96.1 and 143.6 min (P < .01). Serum creatinine level 1 month post-transplantation was 1.54 and 1.25, respectively (P < .001). Here we experienced 12 cases of living renal donor nephrectomy with multiple vessels in which the vascular supply territory was first assessed in April 2013 using an intraoperative near-infrared fluorescence camera system. In addition, regarding TIT, it is possible to shorten surgery by using individual anastomosis and ligation. CONCLUSION By managing multiple donors; arteries by nephrectomy, it is possible to improve kidney transplantation results.
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Affiliation(s)
- Y Nakamura
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
| | - Y Kihara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - H Iwamoto
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Y Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - K Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Yokoyama
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - O Konno
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - T Ueno
- Division of Acute and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - S Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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22
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23
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Lafranca JA, van Bruggen M, Kimenai HJAN, Tran TCK, Terkivatan T, Betjes MGH, IJzermans JNM, Dor FJMF. Vascular Multiplicity Should Not Be a Contra-Indication for Live Kidney Donation and Transplantation. PLoS One 2016; 11:e0153460. [PMID: 27077904 PMCID: PMC4831799 DOI: 10.1371/journal.pone.0153460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Whether vascular multiplicity should be considered as contraindication and therefore 'extended donor criterion' is still under debate. METHODS Data from all live kidney donors from 2006-2013 (n = 951) was retrospectively reviewed. Vascular anatomy as imaged by MRA, CTA or other modalities was compared with intraoperative findings. Furthermore, the influence of vascular multiplicity on outcome of donors and recipients was studied. RESULTS In 237 out of 951 donors (25%), vascular multiplicity was present. CTA had the highest accuracy levels regarding vascular anatomy assessment. Regarding outcome of donors with vascular multiplicity, warm ischemia time (WIT) and skin-to-skin time were significantly longer if arterial multiplicity (AM) was present (5.1 vs. 4.0 mins and 202 vs. 178 mins). Skin-to-skin time was significantly longer, and complication rates were higher in donors with venous multiplicity (203 vs. 180 mins and 17.2% vs. 8.4%). Outcome of renal transplant recipients showed a significantly increased WIT (30 vs. 26.7 minutes), higher rate of DGF (13.9% vs. 6.9%) and lower rate of BPAR (6.9% vs. 13.9%) in patients receiving a kidney with AM compared to kidneys with singular anatomy. CONCLUSIONS We conclude that vascular multiplicity should not be a contra-indication, since it has little impact on clinical outcome in the donor as well as in renal transplant recipients.
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Affiliation(s)
- Jeffrey A. Lafranca
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark van Bruggen
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hendrikus J. A. N. Kimenai
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Thi C. K. Tran
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Türkan Terkivatan
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G. H. Betjes
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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24
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25
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Song G, Jeong IG, Kim YH, Han DJ, Kim CS, Ahn H, Ahn TY, Hong B. Kidney Laterality and the Safety of Hand-assisted Live Donor Nephrectomy: Review of 1000 Consecutive Cases at a Single Center. Urology 2015; 85:1360-6. [DOI: 10.1016/j.urology.2014.12.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 12/05/2014] [Accepted: 12/12/2014] [Indexed: 10/23/2022]
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26
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Laparoscopic living donor nephrectomy: making optimal use of donors without doing harm. Transplantation 2014; 98:1144. [PMID: 25050470 DOI: 10.1097/tp.0000000000000324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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27
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Ahmadi AR, Lafranca JA, Claessens LA, Imamdi RMS, IJzermans JNM, Betjes MGH, Dor FJMF. Shifting paradigms in eligibility criteria for live kidney donation: a systematic review. Kidney Int 2014; 87:31-45. [PMID: 24786706 DOI: 10.1038/ki.2014.118] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/06/2014] [Accepted: 02/20/2014] [Indexed: 12/11/2022]
Abstract
As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, trying to seek and establish the optimal extended criteria. Comprehensive searches were carried out in major databases until November 2013 to search for articles regarding older age, overweight and obesity, hypertension, vascular anomalies/multiplicity, nulliparous women, and minors as donors. Of the 2079 articles found, 152 fell within the scope of the review. Five major guidelines were included and reviewed. Based on the literature search, live kidney donation in older donors (up to 70 years of age) seems to be safe as outcome is comparable to younger donors. Obese donors have comparable outcome to lean donors, in short- and mid-term follow-up. Since little literature is available proving the safety of donation of hypertensive donors, caution is advised. Vascular multiplicity poses no direct danger to the donor and women of childbearing age can be safely included as donors. Although outcome after donation in minors is shown to be comparable to adult donors, they should only be considered if no other options exist. We conclude that the analyzed factors above should not be considered as absolute contraindications for donation.
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Affiliation(s)
- Ali R Ahmadi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeffrey A Lafranca
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura A Claessens
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Raoul M S Imamdi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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