Long-term graft function in a randomized clinical trial comparing laparoscopic versus open donor nephrectomy.

Area of Science:

• Nephrology
• Transplant Surgery
• Minimally Invasive Surgery

Background:

• Laparoscopic donor nephrectomy (LDN) has become increasingly common, but long-term graft outcomes compared to open donor nephrectomy (ODN) require continued evaluation.
• Previous studies have raised concerns regarding potential impacts of longer warm ischemia times in LDN on graft function.

Purpose of the Study:

• To compare long-term graft survival and patient survival rates between kidney transplant recipients who received kidneys from LDN versus ODN donors.
• To assess the impact of surgical approach on delayed graft function and overall graft outcome.

Main Methods:

• A retrospective study comparing 100 LDN cases with 100 ODN cases performed between 2001 and 2003.
• Mean recipient follow-up of 6.6 years, exceeding that of prior randomized trials.
• Comparison of patient and graft survival, delayed graft function, and impact of warm ischemia time.

Main Results:

• No significant difference in 5-year graft survival between LDN and ODN groups (89.5% vs. 84.3%, P = .96).
• No significant difference in delayed graft function between the two groups (8 vs. 11 patients, P = .135).
• Longer warm ischemia time in LDN (8.7 min vs. 1.8 min) did not adversely affect long-term graft outcomes.

Conclusions:

• Laparoscopic donor nephrectomy provides equivalent long-term graft outcomes to open donor nephrectomy.
• The study validates the safety and efficacy of LDN for kidney donation, addressing earlier concerns about graft function.