Hand-assisted Laparoscopic Donor Nephrectomy and Cytokine Changes.

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.