Flank donor nephrectomy: efficacy in the donor and recipient

Area of Science:

• Nephrology
• Transplant Surgery
• Urology

Background:

• Live donor kidney transplantation is a critical treatment for end-stage renal disease.
• Surgical approaches for live donor nephrectomy aim to optimize donor safety and graft quality.
• The extraperitoneal flank approach is one such technique evaluated for its efficacy.

Purpose of the Study:

• To evaluate the safety and outcomes of live donor nephrectomy using an extraperitoneal flank approach.
• To assess early graft function and complications in recipients following this surgical technique.

Main Methods:

• A retrospective review of 115 live donor nephrectomies performed via an extraperitoneal flank approach with rib resection since August 1983.
• Analysis of donor hospital stay, morbidity, and recipient early graft function (urinary output, serum creatinine).
• Documentation of complications such as acute tubular necrosis, urinary fistula, and graft loss due to technical issues.

Main Results:

• The extraperitoneal flank approach resulted in a short overall hospital stay and negligible morbidity for donors.
• Excellent early graft function was observed, with a mean urinary output of 6,442 cc in the first 20 hours and a mean nadir serum creatinine of 1.57 mg/dL.
• Complications were infrequent, with acute tubular necrosis or urinary fistula in 2.6% of kidneys and only 0.8% graft loss due to technical complications.

Conclusions:

• The extraperitoneal flank approach for live donor nephrectomy is a safe procedure for the donor.
• This technique yields a structurally and functionally sound allograft for the recipient.
• The study supports the use of the extraperitoneal flank approach in live donor kidney transplantation.