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Related Experiment Video

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Single Port Donor Nephrectomy
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Hand-assisted Laparoscopic Donor Nephrectomy and Cytokine Changes.

M Field1, A Guy1, A R Ready2

  • 1Department of Renal Transplantation, Queen Elizabeth Medical Centre, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom; MRC Centre for Immune Regulation, School of Immunity and Infection, Medical School, University of Birmingham, Birmingham, United Kingdom.

Transplantation Proceedings
|December 19, 2015
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Summary

Hand-assisted laparoscopic donor nephrectomy (HALDN) showed no significant changes in liver enzymes or kidney injury biomarkers. This minimally invasive approach may reduce systemic inflammation compared to traditional laparoscopic donor nephrectomy.

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Area of Science:

  • Nephrology
  • Minimally Invasive Surgery
  • Transplant Surgery

Background:

  • Laparoscopic living-donor nephrectomy (LDN) can cause systemic effects like transaminitis and increased urinary neutrophil gelatinase-associated lipocalin (NGAL).
  • Hand-assisted laparoscopic donor nephrectomy (HALDN) involves shorter operative times and less pneumoperitoneum, potentially reducing systemic stimulation compared to total laparoscopic LDN.

Purpose of the Study:

  • To investigate the systemic effects of HALDN on liver function and kidney injury biomarkers.
  • To compare the systemic inflammatory response of HALDN with published data on total laparoscopic LDN.

Main Methods:

  • Serial serum and urine samples were collected from 15 patients undergoing HALDN.
  • Analyzed NGAL and kidney injury molecule 1 (KIM-1) preoperatively and 24 hours post-surgery.
  • Assessed liver function tests (alanine aminotransferase) and kidney function (creatinine, eGFR) in 48 live donors.

Main Results:

  • No significant changes in serum or urinary NGAL and KIM-1 levels were observed post-HALDN.
  • Alanine aminotransferase levels decreased significantly at 24 hours post-surgery (P = .004).
  • Creatinine and eGFR showed expected changes, with no significant alterations in liver enzymes at 48 hours.

Conclusions:

  • HALDN did not induce significant changes in liver function tests or kidney injury biomarkers in this cohort.
  • Shorter operative times and intermittent pneumoperitoneum in HALDN may contribute to a reduced systemic inflammatory response.
  • Findings contrast with some published data on LDN, suggesting HALDN may be a less systemically impactful procedure.