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Early graft function in kidney transplantation: comparison between laparoscopic donor nephrectomy and open donor
L S Percegona1, A T Bignelli, A Adamy
1Transplant Unit Hospital Santa Casa de Misericórdia de Curitiba, Curitiba, Paraná, Brazil. l.percegona@pucpr.br
Transplantation Proceedings
|May 6, 2008
Summary
Laparoscopic donor nephrectomy (LN) has longer warm ischemic times (WIT) than open nephrectomy (ON), but early kidney graft function in recipients remains comparable between the two surgical approaches.
Area of Science:
- Nephrology
- Surgical Innovation
- Transplantation
Background:
- Laparoscopic donor nephrectomy (LN) offers benefits like reduced postoperative pain and faster recovery for living kidney donors.
- However, concerns exist regarding potential delayed graft kidney function in recipients due to prolonged warm ischemic time (WIT) and pneumoperitoneum effects.
- Comparing early outcomes of LN versus open nephrectomy (ON) is crucial for donor and recipient management.
Purpose of the Study:
- To compare the early function of grafted kidneys in recipients following laparoscopic donor nephrectomy (LN) versus open nephrectomy (ON).
- To evaluate and compare surgical complications in kidney recipients after both LN and ON procedures.
Main Methods:
- A comparative analysis of 109 kidney recipients from living donors was conducted, with 60 undergoing LN and 49 undergoing ON.
- Key metrics assessed included immediate post-operative diuresis, glomerular filtration rate (GFR) at day 5 (using the MDRD formula), and surgical complication rates.
- Warm ischemic time (WIT) was recorded and compared between the LN and ON groups.
Main Results:
- While WIT was significantly longer in the LN group (1.4-11 minutes) compared to the ON group (1-4 minutes), P < .05, early graft function did not differ.
- Immediate diuresis was observed in 95% of LN recipients and 87% of ON recipients, with comparable GFR at day 5 between groups (LN: 4.85-99.45 mL/min/1.73 m², ON: 4.75-101.1 mL/min/1.73 m²).
- Surgical complications included renal artery stenosis (5% in LN, 8.16% in ON) and urinary leakage (5% in LN).
Conclusions:
- Despite a longer warm ischemic time (WIT) in laparoscopic donor nephrectomy (LN) compared to open nephrectomy (ON), early kidney graft function in recipients is not adversely affected.
- LN and ON demonstrate comparable early graft function and similar complication profiles, suggesting LN is a viable alternative for kidney donation.
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