Transperitoneal, hand-assisted laparoscopic donor nephrectomy: surveillance of renal function by immune monitoring

The history of living donor nephrectomy has undergone several development phases with respect to medical, immunologic, and operative aspects. Due to the shortage of postmortem organ donations and the rising number of patients with terminal renal insufficiency who are awaiting kidney transplantation, living kidney donation has become increasingly important during recent years.

From December 2004 to May 2005, we performed hand-assisted laparoscopic donor nephrectomies on 15 female and 9 male patients of median age 37 years. Our immunosuppressive regimen included tacrolimus, mycophenolate mofetil, methylprednisolone, and a monoclonal antibody.

The median operative time was 138 minutes (113-180 minutes), and the median warm ischemia time was 87 seconds (63-150 seconds); results comparable to those of open donor nephrectomy. The hospitalization periods of the donors were between 5 and 7 days. The renal function and acute-phase parameters showed a transient increase during and after the operation. Most of the patients reached baseline levels by postoperative day 3 or 4.

Together with the clinical data, these findings confirmed the efficacy and minimal invasiveness of laparoscopic donor nephrectomy. It is thus possible that in the future this operative method will become the procedure of choice.