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A prospective comparison of simultaneous and sequential live-donor renal transplantation
Richard J Baverstock1, A David C Manson, Li Liu
1Division of Urology, Providence Health Care, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
Background:
Traditionally, we have performed live- donor renal transplantations sequentially with a cold ischemic time (preservation time) of approximately 3 hr. By performing live-donor renal transplantations simultaneously, cold ischemic times can be reduced to 30 min or less. The purpose of this prospective study was to compare clinical outcomes and biologic markers of kidney function between live-donor renal transplantations performed either simultaneously or sequentially.
Methods:
Nine consecutive live-donor renal transplantations were performed in a simultaneous manner by two transplant surgeons. For comparison, 18 consecutive live-donor transplantations were performed sequentially by a single surgeon. Donor and recipient demographic factors, before transplantation, were compared. Posttransplantation comparisons included daily serum creatinine measurements for 5 days, urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG) for 72 hr postoperatively, nuclear glomerular filtration rate (GFR) at 18 hr postoperatively, creatinine clearance at 96 hr postoperatively, and creatinine clearance at 3 and 6 months posttransplantation.
Results:
There were no differences in donor and recipient demographic factors preoperatively between the two groups. With simultaneous and sequential recipients, only the cold ischemic times were significantly different (simultaneous: mean=23.6 min; sequential: mean=191.7 min; P<0.01). After transplantation, no differences were detected in the daily fall of serum creatinine, nuclear GFR at 18 hr, or creatinine clearance at 96 hr, 3 months, or 6 months. In both groups, urinary NAG excretion reached a peak at 1 hr postoperatively and then slowly returned to baseline by 72 hr. There was no difference in the amount of NAG excretion between the two groups.
Conclusions:
Our study found that there is no difference in tubular injury or postoperative GFR in live-donor kidney transplantations performed simultaneously or sequentially. Our findings indicate that a modest prolongation of the cold ischemic time has no detectable influence on posttransplantation renal function for live-donor transplantations.