Laparoscopic donor nephrectomy for pediatric recipients: outcomes analysis

To present our outcomes of laparoscopic donor nephrectomy for pediatric recipients. Laparoscopic nephrectomy has become the technique of choice for live donor nephrectomy. However, limited data are available regarding the role of this technique for pediatric recipients, who may pose special challenges and considerations, and whose parents need additional information.

Since November 1999, we have performed laparoscopic nephrectomy in more than 300 consecutive patients for live donor transplantation. Of these, 20 cases were identified that involved a recipient younger than 18 years of age. The preoperative, intraoperative, and postoperative data were reviewed to analyze the outcomes of these specific cases. The data were compared with a similar group of pediatric recipients receiving kidneys procured using the traditional open technique.

The mean donor and recipient age was 40 years (range 26 to 52) and 13 years (range 1.7 to 18), respectively, and 19 cases (95%) involved the left kidney. The mean donor and recipient operative time was 3.3 hours (range 2.5 to 5.2) and 3.9 hours (range 2.4 to 5.1), respectively. The warm and anastomotic time averaged 4 minutes (range 2 to 8) and 30 minutes (range 16 to 41), respectively. Nineteen of the grafts functioned immediately, with a mean creatinine at 24 hours of 2.0 mg/dL (range 0.3 to 6.0). At last follow-up (mean 13.6 months), the mean creatinine was 1.1 mg/dL. Ureteral stricture requiring stent placement occurred in 2 patients (10%). No statistically significant differences were noted in operative parameters, complications, or renal function compared with a contemporary cohort of 26 pediatric patients receiving organs obtained by open donor nephrectomy.

Our early experience with laparoscopic donor nephrectomy for pediatric recipients confirmed that the technique provides quality organs with excellent function. The method yields outcomes comparable to those after traditional open donor nephrectomy and does not require modifications for the recipient operation.