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Updated: Sep 25, 2025
Single Port Donor Nephrectomy
Published on: March 12, 2011
Complications After Hand-Assisted Laparoscopic Living Donor Nephrectomy
Xiomara Benavides1, Richard T Rogers1, Ek Khoon Tan2
1William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
Insights
Most hand-assisted laparoscopic living donor nephrectomy (HALLDN) complications occur after discharge, highlighting the need for vigilant post-operative monitoring. This study reveals that 76% of complications and 85% of reoperations happened after patients left the hospital.
Area of Science:
- Nephrology
- Surgical Oncology
- Transplant Surgery
Background:
- Hand-assisted laparoscopic living donor nephrectomy (HALLDN) is a common procedure for kidney donation.
- Understanding post-discharge complications is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence and nature of complications following HALLDN, with a specific focus on those arising after hospital discharge up to 120 days.
- To identify risk factors associated with these complications.
Main Methods:
- Retrospective analysis of 3002 HALLDN procedures performed at a single center from 2000 to 2019.
- Complications were classified using the Clavien-Dindo grading system.
- Statistical modeling was employed to determine risk factors for pre- and post-discharge complications.
Main Results:
- The overall complication rate was 12.4%, with 76% occurring after discharge.
- Major complications occurred in 2.5% of patients; no specific risk factors were identified for these.
- Risk factors for any complication included paramedian incision, prior abdominopelvic surgery, male sex, non-White race, and earlier surgical era.
Conclusions:
- A significant majority of HALLDN complications manifest after hospital discharge.
- Current literature may underestimate the true incidence of post-discharge complications.
- Enhanced post-discharge surveillance is recommended for patients undergoing HALLDN.
Objective:
To study the complications of hand-assisted laparoscopic living donor nephrectomy (HALLDN) with an emphasis on complications occurring early after hospital discharge up to 120 days after surgery.
Patients And Methods:
We retrospectively categorized complications using the Clavien-Dindo classification in 3002 HALLDNs performed at 1 center from January 1, 2000, through December 31, 2019. In addition to overall summaries, modeling was used to identify correlates of complications before and after living donation.
Results:
Of these donors, 87% were White, 59% were female, the mean age was 45 years (range, 18-77 years), 30.3% had a body mass index of at least 30, and 36.3% had previous abdominopelvic surgery. There were no deaths related to the surgery. The incidence of major complications (intraoperative complications plus Clavien-Dindo grade ≥III postoperatively) was 2.5% (n=74). The overall complication rate was 12.4% (n=371), including 15 intraoperative, 76 postoperative before discharge, and 280 after discharge to 120 days. Reoperation was required in 1.8% of patients (n=54), and all but 1 of these were incision-related problems. Seventy-six percent of all complications occurred after discharge, including 85% of the reoperations. For major complications, no risk factor was found. Risk factors for any complication included paramedian incision (hazard ratio [HR], 2.54; 95% CI, 1.49 to 4.34; P<.001); a history of abdominopelvic surgery (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), male sex (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), non-White race (HR, 1.40; 95% CI, 1.05 to 1.88; P=.02), and early era of the experience.
Conclusion:
Most major complications of HALLDN occur after discharge, suggesting that close follow-up is warranted and that the current literature may underestimate the true incidence.
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