Open Versus Laparoscopic Donor Nephrectomy in Pediatric Kidney Transplantation: A Systematic Review and Meta-Analysis

Background/Objectives: Although minimally invasive laparoscopic donor nephrectomy (LDN) has been established as the standard method for donor nephrectomy for adult recipients in recent years, there might still be a role for conventional open donor nephrectomy (ODN) in pediatric kidney transplantation (KTx). To investigate this, we compared the outcomes of LDN with those of ODN in pediatric patients. Methods: A systematic literature search was conducted in Web of Science and Medline (via PubMed) databases, focusing on intraoperative data in donors and short-term postoperative outcomes in pediatric recipients following ODN and LDN. We used a subgroup analysis to compare these outcomes in recipients aged five years or younger. Results: Fifteen datasets comprising 1926 pediatric kidney transplant recipients (1036 ODN and 890 LDN) were included in the quantitative synthesis. There were no significant differences in operation time, warm ischemia time, or blood loss among donors (p > 0.05). There were also no significant differences in the rates of acute graft rejection, delayed graft function, or one-year graft survival between pediatric recipients undergoing ODN and LDN. In the subgroup analysis, the rates of delayed graft function and acute graft rejection were significantly lower in recipients aged ≤5 years in the ODN group compared with the LDN group (Odds ratio (OR), 0.26; p = 0.041 and OR, 0.29; p = 0.016, respectively). The certainty of evidence was very low across all outcomes according to the GRADE assessment. Conclusions: Our findings suggest that outcomes following ODN and LDN appear broadly comparable in pediatric kidney transplantation. However, as the available comparative evidence is derived primarily from studies conducted during the early adoption era of laparoscopic donor nephrectomy, these findings should be interpreted cautiously and mainly in a historical context. The overall certainty of evidence was rated as very low according to GRADE. Contemporary data from high-volume transplant centers are needed to better define outcomes in very young pediatric recipients.