Extending anatomic barriers to right laparoscopic live donor nephrectomy.

Area of Science:

• Nephrology
• Transplant Surgery
• Minimally Invasive Surgery

Background:

• Right-sided laparoscopic live donor nephrectomy is increasingly utilized for donors with complex left-sided anatomy.
• Complex right renal artery anatomy, such as retrocaval bifurcation, presents unique surgical challenges.

Purpose of the Study:

• To evaluate the outcomes of right-sided laparoscopic live donor nephrectomy in cases with complex renal artery anatomy.
• To compare graft function, warm ischemia times, and donor/recipient complications between simple and complex right-sided laparoscopic live donor nephrectomy.

Main Methods:

• Retrospective review of 59 laparoscopic live donor nephrectomy procedures (2001-2010).
• Group 1: Simple right-sided cases (n=48).
• Group 2: Complex right-sided cases with retrocaval artery bifurcation (n=11).
• Analysis of warm ischemia, graft function (eGFR, serum creatinine), and complications.

Main Results:

• No significant differences in donor/recipient demographics or warm ischemia times between groups.
• Graft function (eGFR, serum creatinine) at 1 week, 3, and 6 months showed no significant differences.
• No delayed graft function or vascular thrombosis reported; cumulative conversion rate was 3.3%.

Conclusions:

• Complex renal artery anatomy in right-sided donation is not a contraindication for laparoscopic live donor nephrectomy.
• Procured kidneys from complex cases exhibit excellent function comparable to those from simple cases.
• The described techniques facilitate procurement of well-functioning kidneys, even with multiple arterial vessels.