Systemic immunologic and inflammatory response after transperitoneal versus retroperitoneal laparoscopic donor...

Area of Science:

• Nephrology
• Surgical Innovation
• Transplantation Immunology

Background:

• Laparoscopic donor nephrectomy (LDN) is a standard procedure for kidney donation.
• Two primary surgical approaches exist: transperitoneal and retroperitoneal.
• Limited comparative data exists on immunologic and inflammatory responses between these LDN approaches.

Purpose of the Study:

• To prospectively compare the immunologic and inflammatory responses in kidney donors undergoing transperitoneal versus retroperitoneal laparoscopic donor nephrectomy (RLN).
• To evaluate operative parameters including operative time, warm ischemia time, and complications for both LDN approaches.

Main Methods:

• Prospective observational study involving 54 laparoscopic donor nephrectomies (38 transperitoneal, 16 retroperitoneal).
• Preoperative and 24-hour postoperative blood sampling for C-reactive protein (CRP), interleukin-6 (IL-6), total leukocyte count (TLC), blood urea nitrogen (BUN), and serum creatinine (SCr).
• Data collection on operative time, warm ischemia time, hospital stay, analgesia requirements, and complications.

Main Results:

• No significant difference in mean operative time between transperitoneal and retroperitoneal approaches.
• Significantly shorter warm ischemia time observed in the retroperitoneal laparoscopic donor nephrectomy (RLN) group.
• Similar postoperative increases in inflammatory markers (IL-6, CRP, TLC) and renal function markers (BUN, SCr) for both approaches.

Conclusions:

• Retroperitoneal laparoscopic donor nephrectomy (RLN) is a safe and effective alternative, particularly beneficial for preserving longer right renal veins.
• RLN combines advantages of hand assistance and the retroperitoneal approach, with a notable reduction in warm ischemic time.
• Both LDN approaches demonstrate comparable immunologic and inflammatory profiles in kidney donors.