Laparoscopic donor nephrectomy for pediatric recipient

To present our outcome of laparoscopic donor nephrectomy for pediatric recipients, who may pose special challenges.

Since March 2003, we performed more than 400 laparoscopic donor nephrectomies for 39 pediatric recipients (age less than 17 years of age). The preoperative, intraoperative, and postoperative data were reviewed to analyze the outcomes of these cases. We used the left kidney in 26 and the right kidney in 13 cases. Seven cases had double renal arteries, which were reconstructed on the bench.

The mean donor and recipient ages were 31 +/- 5 years and 13 +/- 4 years, respectively. The mean donor operative time was 2.1 hours (range 1.2 to 3.2). The warm ischemia time averaged 3 +/- 0.6 minutes. In 27 cases, we used the common iliac artery and common iliac vein for vascular anastomosis. In 12 cases, the anastomosis was performed to the aorta and vena cava. Seven patients had prior augmentation cystoplasty, and the ureter was anastomosed to the pouch directly. All grafts functioned immediately, with a mean creatinine at 24 hours of 1.5 +/- 0.3 mg/dL. At last follow-up (mean 13.6 months), the mean creatinine was 0.9 mg/dL. One patient lost the graft due to severe rejection that was resistant to antithymocyte globulin.

Laparoscopic donor nephrectomy for pediatric recipients is safe and provides quality organs with excellent function. Outcome is comparable to those after open donor nephrectomy.