Hand-Assisted Laparoscopic Donor Nephrectomy-A Decade's Experience in an Australian Transplant Centre

Hand-assisted laparoscopic donor nephrectomy (HALDN) is an internationally accepted technique to safely retrieve kidneys for live kidney donor transplantation. Locally published data regarding outcomes in the donors is lacking. This study aims to assess outcomes after HALDN in the Australian setting.

A retrospective review of all patients undergoing HALDN was conducted at Royal Melbourne Hospital and Melbourne Private Hospital between 24 March 2011 and 31 December 2022. Patients were identified and information collected from surgical and renal databases which collect data prospectively. The primary outcomes of interest were peri-operative complications (type and Clavien-Dindo classification). Secondary outcomes include length of stay, rate of conversion to open operation and readmission to hospital.

A total of 387 patients (55.6% female) underwent HALDN during the study period. The median age of donors was 58 years (range 29-75) and median body mass index was 26.7 kg/m² (range 18.6-39.8). The left kidney was donated in 85.3% of patients. The post-operative complication rate was 11.6% (n = 45), and most complications (27/45) were classified as Clavien-Dindo II. Eight patients (1.9%) required return to the operating theatre, and one procedure (0.25%) converted to open operation due to bleeding from stapler malfunction. Median length of stay in hospital was 5 days (range 3-24) and the hospital readmission rate was 3.6%. Median donor creatinine was 69 μmol/L pre-operatively and 99 μmol/L at discharge.

HALDN is a safe method of kidney donation, with low rates of conversion to open, post-operative complications and hospital readmission.