Enhanced Recovery Open vs Laparoscopic Left Donor Nephrectomy: A Randomized Controlled Trial.

Area of Science:

• Nephrology
• Surgical Innovation
• Transplantation Medicine

Background:

• Donor nephrectomy is crucial for kidney transplantation.
• Enhanced Recovery Programs (ERP) aim to optimize surgical recovery.
• Comparing minimally invasive (laparoscopic) versus traditional open donor nephrectomy is essential for improving donor outcomes.

Purpose of the Study:

• To compare recovery outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy (ODN).
• To evaluate the impact of a standardized enhanced recovery program (ERP) on donor recovery after left kidney donation.

Main Methods:

• A phase III randomized trial involving 224 left kidney donors randomized 1:1 to LDN or ODN.
• Recovery was optimized using a standardized ERP.
• Primary outcome: physical fatigue measured by the Multidimensional Fatigue Inventory 20 (MFI-20).
• Secondary outcomes: pain, hospital stay, complications, and graft outcomes.

Main Results:

• LDN group reported significantly lower physical fatigue scores at 6 weeks postoperatively (P=.007).
• Median hospital stay was significantly shorter in the LDN group (2 days vs. 4 days, P=.002).
• LDN was associated with reduced postoperative pain and analgesic requirements.

Conclusions:

• Laparoscopic donor nephrectomy (LDN) offers superior recovery outcomes compared to open surgery for left kidney donation, even within an ERP.
• LDN is associated with less general and physical fatigue and improved physical function at 6 weeks post-operation.
• These findings support LDN as a preferred approach for kidney donors when feasible.