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Hamid R, Khan M, Aziz T, Mubarak M, Hashmi A, Hussain Z, Naqvi SA, Rizvi SAH. Short- and Intermediate-Term Outcomes in Living-Related Renal Transplant Donors. EXP CLIN TRANSPLANT 2018; 16:656-659. [PMID: 29292682 DOI: 10.6002/ect.2017.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of the present study was to evaluate the short- and intermediate-term outcomes of living-related kidney donors in terms of renal function and postnephrectomy complications at a single center in Pakistan. MATERIALS AND METHODS Our study included healthy donors who underwent unilateral nephroureterectomy for living-related renal transplant procedures at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan) between January 2005 and January 2006. All patients were evaluated for early postoperative complications and renal functions at last follow-up. The mean follow-up duration was 1.7 ± 1.3 years. RESULTS A total of 256 living-related donors underwent nephroureterectomy during the study period, which included 142 men (55.5%) and 114 women (44.5%). The mean age of donors was 33.7 ± 10.0 years. Most donors were between 21 and 40 years old. Of total donors, most were siblings (n = 143, 55.8%), followed by offspring, parents, and spouses. Left nephrectomy was performed in 206 donors (80.4%) and right in 50 donors (19.5%). There were no deaths during transplant. The mean postoperative hospital stay was 6.37 ± 0.95 days. A total of 38 donors (14.8%) had one or more surgical complication. Hypertension developed in 25 (9.7%) and diabetes mellitus in 9 donors (5%). Creatinine clearance was > 90 mL/min in 96 (41%), 60 to 90 mL/min in 120 (51%), and ≤ 60 mL/min in 18 donors (8%). CONCLUSIONS Living-related donor nephrectomy remains a valuable source of kidneys for transplant procedures and carries a small risk. With careful donor selection and good surgical management, operative complications can be minimized.
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Affiliation(s)
- Rashid Hamid
- From the Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Brook NR, Nicholson ML. Minimally Invasive Surgery for Live Kidney Donors: Techniques and Challenges. Prog Transplant 2016; 15:257-63. [PMID: 16252632 DOI: 10.1177/152692480501500309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Live kidney donation is assuming an increasingly prominent role in kidney transplantation programs. The traditional operative approach has been through an incision in the upper quadrant of the abdomen or in the loin, with the attendant potential postoperative complications associated with a large surgical wound. These problems may act as disincentives to prospective donors. The introduction of laparoscopic donor surgery in 1995 heralded a new era offering reduced postoperative pain and improved cosmetic result. It is hoped that these benefits may counter some disincentives and thereby increase donation rates. Three minimal-access approaches and their advantages and disadvantages are described: classical laparoscopic, hand-assisted laparoscopic, and retroperitoneoscopic surgery. Published reports indicate extensive experience with the first 2 of these approaches and less experience with the latter. All 3 approaches present technical, physiological, and anatomical challenges in the context of retrieving an organ that is fit for transplantation. For minimal-access surgery to be accepted as the procedure of choice for live kidney donors, it must be demonstrated that morbidity is not transferred from donor to recipient when these techniques are used. Some concerns about these procedures are addressed. High-level evidence in the form of randomized controlled trials is generally lacking, but experiences of surgeons and patients suggest that, with appropriate modifications, these techniques are safe for both donors and allografts and also benefit donors' recovery.
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Affiliation(s)
- Nicholas R Brook
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Rashid RJ, Tarzemani MK, Mohtasham MA, Zomorrodi A, Kakaei F, Jalili J, Habibzadeh A. Diagnostic accuracy of 64-MDCT angiography in the preoperative evaluation of renal vessels and compared with laparotomy findings in living donor kidney. Ren Fail 2013; 36:327-31. [PMID: 24289242 DOI: 10.3109/0886022x.2013.862768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Multidetector-row computed tomography (MDCT) angiography is a reliable technique in preoperative renal anatomy evaluation in live renal donors. OBJECTIVES To investigate the accuracy of early arterial phase findings and compares them with intraoperative findings. METHODS In this prospective study, 100 potential live donors undergoing preoperative MDCT and nephrectomy during 2010-2013 were included. The examination was performed with a 64-detector scanner including early arterial and venous phase. MDCT angiography started by bolus tracking and venous phase was acquired 9 s after arterial phase. Anatomical findings and vein and artery attenuation values were recorded and arterial phase findings were compared with intraoperative findings. RESULTS All anatomical findings reported by MDCT in early arterial phase were confirmed by intraoperative findings with sensitivity of 100%. Right renal vein was supernumerary in 17 cases and left renal vein was circumaortic in 3 and retroaortic in 5 cases. Renal arteries had early branching in 13, two arteries in 12 and accessory in 8 cases. Vein and artery attenuation values had significant difference between early arterial and venous phase (p < 0.001). CONCLUSION Early arterial phase has similar results to venous phase in preoperative evaluation and intraoperative findings and could be used alone to reduce radiation dose.
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[Surgical aspects of living donor nephrectomy]. Actas Urol Esp 2013; 37:181-7. [PMID: 22840385 DOI: 10.1016/j.acuro.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/11/2012] [Indexed: 11/21/2022]
Abstract
CONTEXT Living donor renal transplant surgery has evolved from the classical nephrectomy by lumbotomy to less invasive surgery, the laparoscopic and robotic nephrectomy currently being the most important. It is important to know the available evidence on whether nephrectomy in patients with multiple arteries, right kidney and in obese patients can be performed safely when there is a correct indication. OBJECTIVE To perform a review of the different surgical techniques in living donor nephrectomy, adapted to the current surgical evidence and other aspects related to the indication. EVIDENCE ACQUISITION A systematic review was made in PubMed (1997-2011). This included previous reviews randomized controlled clinical studies, cohort studies, and meta-analyses of this surgical aspects of living donor nephrectomy. CONCLUSIONS Currently, there is sufficient evidence to consider living donor laparoscopic nephrectomy as the technique of choice, although the role of hand-assisted retroperitoneoscopic technique is still not totally clear. Open surgery techniques using mini-incision are an acceptable alternative for the sites that have not yet implemented laparoscopic surgery. Right kidney nephrectomy, of those cases that present multiple pedicles and in obese donors, is justified in selected cases.
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Cho H, Lee J, Kim J, Kim S, Hwang TK, Hong SH. How Safe and Effective Is Routine Left Hand-Assisted Laparoscopic Donor Nephrectomy With Multiple Renal Arteries? A High-Volume, Single-Center Experience. Transplant Proc 2012. [DOI: 10.1016/j.transproceed.2012.04.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vascular Constraints in Laparoscopic Renal Allograft: Comparative Analysis of Multiple and Single Renal Arteries in 976 Laparoscopic Donor Nephrectomies. World J Surg 2011; 35:2159-66. [DOI: 10.1007/s00268-011-1168-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Live kidney donation is an excellent way of increasing the donor pool. The introduction of the laparoscopic donor nephrectomy has resulted in an increase in live organ donation in the western hemisphere. There is no data on its impact on organ donation in India. However attractive as it may seem, the procedure is associated with a definite learning curve and does compromise donor safety. The procedure is also expensive in terms of the equipment required. The mini-donor nephrectomy is an excellent alternative, has no learning curve and is ideally suited for donors in India who have a low BMI. The procedure is also relatively inexpensive. We are in need of a donor registry rather than reports from single institutions to fully evaluate the risks and benefits of both procedures.
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Affiliation(s)
- Sandeep Guleria
- Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India
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Kim MU, Choi KH, Yang SC, Oh YT, Han WK. Prospective Evaluation of the Accuracy of MDCT Angiography for Living Kidney Donor. Korean J Urol 2011; 52:124-9. [PMID: 21379430 PMCID: PMC3045718 DOI: 10.4111/kju.2011.52.2.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 01/24/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE In donor nephrectomy, it is important to understand the exact anatomy of the blood vessels during minimally invasive surgery. We prospectively analyzed the accuracy of the vessel structures obtained by use of 64-row multi-detector computed tomography (MDCT) angiography compared with the actual vessel structure observed during surgery. MATERIALS AND METHODS We analyzed 238 patients who underwent donor nephrectomy from July 2007 to August 2010. Before the operation, MDCT angiography was performed, and after the operation, the surgeons themselves wrote the protocol. The ipsilateral artery, the number of veins, the association with the run of the hilar vessel, and other vascular anomalies in computed tomography (CT) angiography and in the donor protocol were summarized. RESULTS Among 238 patients, nephrectomy was performed on the left side in 199 patients. The accuracy of MDCT for the artery and the vein was 93.3% and 92.4%, respectively. Accuracy did not differ significantly on the left and right sides (artery: p=0.124; vein: p=0.174). In 199 patients, the CT findings for the lumbar vein were compared with the surgical findings. The overall accuracy was shown to be 84.9%, and the accuracy of the group drained to the inferior vena cava (54%) was significantly different (p<0.01) from that of the group drained to the renal vein (98.6%). Thus, it may be necessary to pay close attention to the interpretation of the findings for the lumbar vein. CONCLUSIONS MDCT angiography is important for understanding the exact anatomy of blood vessels before minimally invasive surgery. We showed that 64-channel MDCT has high accuracy in the main vessel and hilar vessels. However, close attention to the interpretation of the CT findings for the lumbar vein may be required.
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Affiliation(s)
- Myung Up Kim
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
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Open and laparoscopic donor nephrectomy: activity and outcomes from all Australasian transplant centers. Transplantation 2010; 89:1482-8. [PMID: 20418804 DOI: 10.1097/tp.0b013e3181dd35a0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic donor nephrectomy (LapDN) has been widely adopted despite a lack of randomized trials comparing recipient outcomes with open surgery. Review of registry data now seems the most realistic mechanism to compare outcomes. The Australia and New Zealand Dialysis and Transplant Registry prospectively captures data on all renal transplants performed in Australia and New Zealand including long-term follow-up of recipients. AIM.: To compare graft outcomes among recipient of kidneys from donors undergoing nephrectomy using open and laparoscopic techniques, through analysis of the Australia and New Zealand Dialysis and Transplant Registry after the introduction of laparoscopic donor surgery in Australia and New Zealand in 1997. METHODS Operative technique data for live donor transplants were collected from all surgeons performing live kidney donation procedures from May 1997 to December 2003; the outcomes of all live donor transplants were examined with follow-up to December 2007. Donor and recipient demographic variables and graft outcomes were compared between the laparoscopic and the open donor groups. RESULTS One thousand four hundred seventy-four live donor transplants were performed in 27 transplant centers. Of these, 315 (21%) were performed laparoscopically in 11 centers. Nineteen laparoscopic cases (6%) were converted to open. Total ischemic time was longer in the LapDN group (3.16 hr) than in the open donor group (1.61 hr, P<0.0001). The LapDN group experienced a lower incidence of rejection episodes (29.2% vs. 38.6%, P=0.002). Delayed graft function and technical failure rates were statistically equal across the groups. There were a total of 242 graft failures (175 graft losses and 67 deaths with a functioning graft, NS). Among surviving grafts, there was no consistent difference in serum creatinine at any time point. Graft and patient survivals were similar in both groups during 10-year follow-up. CONCLUSION This study suggests that there is no difference in short- or long-term recipient outcomes for open and laparoscopic live donor nephrectomy.
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A Fast and Safe Living Donor “Finger-Assisted” Nephrectomy Technique: Results of 359 Cases. Transplant Proc 2010; 42:165-70. [DOI: 10.1016/j.transproceed.2009.12.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Morbidity and Mortality in 1022 Consecutive Living Donor Nephrectomies: Benefits of a Living Donor Registry. Transplantation 2009; 88:1273-9. [DOI: 10.1097/tp.0b013e3181bb44fd] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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12
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Comparison of CT Angiography With MR Angiography in the Preoperative Assessment of Living Kidney Donors. Transplantation 2008; 86:1249-56. [DOI: 10.1097/tp.0b013e3181890810] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kaneko N, Kobayashi Y, Okada Y. Anatomic variations of the renal vessels pertinent to transperitoneal vascular control in the management of trauma. Surgery 2008; 143:616-22. [PMID: 18436009 DOI: 10.1016/j.surg.2008.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Operative exposure and control of the renal vessels through a transabdominal retroperitoneal (TARP) approach has been advocated for emergency management of renal trauma. The pertinent anatomic variations of the renal vasculature have not been well described. METHODS In 190 cadavers, the renal vessels were examined. The first 20 cadavers were examined via TARP approach, and 170 cadavers were investigated after evisceration. The findings were interpreted as they might relate to the TARP approach to the renal pedicle. RESULTS The renal artery (RA) originated dorsally or inferiorly to the left renal vein (RV) in 70% of the cadavers on each side. Additional RAs emerging below the inferior mesenteric artery were present in 2.4% of cadavers on the right side and 1.8% on the left. Approach to the inferior vena cava (IVC) adequate for the management of trauma through the TARP approach was impossible, although it has been recommended in some research. The clinically significant incidence of variations was as follows: 47% multiple RAs, 13% multiple RVs, and 50% of at least 1 RA that coursed superior to the right RV on the right margin of the IVC. CONCLUSION Knowledge of the varied anatomy of the renal vessels facilitates a safe approach to the kidneys in trauma management. The varied and unpredictable anatomy of the renal vasculature requires prompt change when the TARP approach fails to provide access to the vessels. In such cases, the colon should be mobilized promptly. On the right side of the IVC, the vessels are located so as to require clamping together almost always.
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Affiliation(s)
- Naoyuki Kaneko
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan.
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Bargman V, Sundaram CP, Bernie J, Goggins W. Third Prize: Randomized Trial of Laparoscopic Donor Nephrectomy with and without Hand Assistance. J Endourol 2006; 20:717-22. [PMID: 17094745 DOI: 10.1089/end.2006.20.717] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To compare the early results of standard laparoscopic (SL) and hand-assisted laparoscopic (HAL) donor nephrectomy in a randomized study. PATIENTS AND METHODS Forty donors were randomly assigned in equal numbers to either SL or HAL. Two donors in the SL group and three patients in the HAL group underwent right nephrectomy; the others underwent left nephrectomy. In the SL group, specimen extraction was performed via a Pfannenstiel incision and in HAL group through a periumbilical midline incision. Objective intraoperative, hospital stay, and postoperative data as well as pain analog scores were collected prospectively. Patients completed the quality-of-life (QoL) SF-36 questionnaire preoperatively and at 1 month and 3 months of follow-up. RESULTS There was a statistically significant difference in the mean operative time in the two groups (200 +/- 20.8 minutes for SL v 219 +/- 28.3 minutes for HAL; P = 0.02). There was no difference in the mean estimated blood loss (141.5 +/- 221.8 mL v 97.4 +/- 73 mL, respectively; P = 0.41), warm ischemia time (157.5 +/- 76.3 seconds v 135.5 +/- 53.7 seconds; P = 0.32), length of postoperative hospital stay (1.9 +/- 0.5 days v 2.1 +/- 0.5 days; P = 0.61), intravenous analgesia (22.1 +/- 14.0 mg v 28.3 +/- 14.8 mg of morphine sulfate equivalent; P = 0.18), or pain score on postoperative day 1 (6.1 +/- 1.0 v 6.2 +/- 1.1) and 2 (3.3 +/- 1.2 and 3.4 +/- 1.3). There were five minor complications in the SL group and three in the HAL group. The mean preoperative (89.7 +/- 4.8 v 89.2 +/- 7.4; P = 0.84), 1-month (63.4 +/- 13.9 v 64.5 +/- 12.6; P = 0.82), and 3-month (82.7 +/- 7.4 v 80.2 +/- 8.4; P = 0.41) postoperative QoL scores did not differ significantly between the groups. None of the recipients required postoperative dialysis, and there was no statistical difference between the two groups in the serum creatinine concentration. CONCLUSION Laparoscopic and hand-assisted donor nephrectomies have similar outcomes and postoperative pain. Both approaches are well tolerated with minimal complication rates and have similar impact on patients' quality of life.
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Affiliation(s)
- Vladislav Bargman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Glockner JF, Vrtiska TJ. Renal MR and CT angiography: current concepts. ACTA ACUST UNITED AC 2006; 32:407-20. [PMID: 16952021 DOI: 10.1007/s00261-006-9066-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 05/19/2006] [Indexed: 11/24/2022]
Abstract
During the past decade, noninvasive CTA and MRA imaging techniques have replaced catheter angiography for evaluation of the renal arteries. This article reviews techniques for optimizing renal MRA and CTA, assesses the advantages and limitations of MRA and CTA, and provides the current indications for renal vascular imaging including renal artery stenosis screening. New and future developments in these rapidly evolving techniques are also discussed.
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Affiliation(s)
- James F Glockner
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Gorodner V, Horgan S, Galvani C, Manzelli A, Oberholzer J, Sankary H, Testa G, Benedetti E. Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies. Transpl Int 2006; 19:636-40. [PMID: 16827680 DOI: 10.1111/j.1432-2277.2006.00315.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The classic approach to donor nephrectomy consists of preferential procurement of the kidney without vascular anomalies. We studied the effect of routine procurement of the left kidney regardless the presence of multiple arteries on the outcomes of robotic-assisted laparoscopic living donor nephrectomy (LLDN) with particular reference to the incidence of urological complications. From August 2000 to July 2005, 209 left LLDNs were performed. We analyzed the outcomes of donors and recipients in relation to the presence of multiple vessels versus normal anatomy. We divided the patients into two groups: group A (n = 148) with normal vascular anatomy and group B (n = 61) with vascular anomalies. In the donors, no significant difference in conversion to open surgery rate, blood loss, length of stay, was noted between the two groups; operative time and warm ischemia time were slightly higher in group B. One-year patient survival was 98% in both groups while the 1-year graft survival was 96.6% in group A and 96% in group B. Only one urological complication was noted in the group with normal anatomy (0.7%) versus none in the group with multiple arteries. Left kidney procurement using robotic-assisted laparoscopic technique is safe and effective, even in the presence of vascular anomalies.
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Affiliation(s)
- Verónica Gorodner
- Division of General Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
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Torgay A, Donmez A, Varol G, Durmaz L, Arslan G, Haberal M. Intra- and postoperative complications of donor nephrectomies. Transplant Proc 2006; 37:2941-3. [PMID: 16213268 DOI: 10.1016/j.transproceed.2005.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Living-donor renal transplantation has become common worldwide. However, living-donor nephrectomy is not a complication-free procedure. This retrospective study reviews the intra-and postoperative risks and complications of donor nephrectomies at our institution between 1994 and 2002. METHOD Two hundred fifty-seven consecutive donor nephrectomy patients were evaluated using medical records and anesthetic charts. RESULTS The mean age of living donors was 42 +/- 12 years: 19 were older than 61 years, and 143 (55.6%) were women. Anesthesia for donor nephrectomy included general anesthesia, combined spinal-epidural anesthesia (CSE), general + CSE, and general + epidural anesthesia. We observed 51 intra- and postoperative complications in 26 patients. The minor complication rate was 10.1%. The duration of surgery was 3.56 +/- 0.26 hours (range, 2 to 5 hours). Serum creatinine levels were increased significantly (P < .05) on postoperative days 1, 3, and 5 compared with the preoperative levels (P < .05). There was no mortality. CONCLUSIONS Like other surgical operations, living-donor nephrectomy is associated with intra- and postoperative complications. Although these complications are minor, maximal efforts must be applied in the anesthetic approach to minimize donor complications, and donors should be informed about potential risks.
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Affiliation(s)
- A Torgay
- Başkent University School of Medicine, Department of Anesthesiology, Ankara, Turkey.
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Brook NR, Wilson CH, Nicholson ML. Current status of live-donor renal transplantation. ACTA ACUST UNITED AC 2005. [DOI: 10.2217/14750708.2.6.909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brook N, Nicholson M. Minimally invasive surgery for live kidney donors: techniques and challenges. Prog Transplant 2005. [DOI: 10.7182/prtr.15.3.cr20768m202m5545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stothers L, Gourlay WA, Liu L. Attitudes and predictive factors for live kidney donation: a comparison of live kidney donors versus nondonors. Kidney Int 2005; 67:1105-11. [PMID: 15698451 DOI: 10.1111/j.1523-1755.2005.00176.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Live donor kidney transplantation (LDKT), although far from risk free, is a reasonably safe procedure for medically suitable donors. We hypothesized that both potential recipients and donors have identifiable and modifiable factors that contribute to the likelihood of LDKT. The objectives of this study were to describe and quantify these factors using anonymous, confidential questionnaires. METHODS Specifically designed questionnaires addressing personal characteristics, knowledge, and beliefs about LDKT were mailed to 127 previous donors and 387 relatives of patients newly listed on the cadaver transplant wait-list. Ninety-eight (77%) and 243 (63%) responses were returned by donors and nondonors, respectively. RESULTS There were significant differences between groups in gender, ethnicity, hours worked per week, and annual income. Significant differences were seen in both knowledge and beliefs about LDKT. Most donors indicated they made their decisions without lengthy deliberation or research about kidney donation. Only 20% of nondonors feel they are well informed about LDKT. CONCLUSION It is likely possible to improve knowledge about LDKT among friends and relations of patients with renal failure, but it is not certain that this will lead to increased donation because most donors don't appear to deliberate or research organ donation before making a commitment to donate. Strategies to educate potential donors should initially focus on the recipient.
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Affiliation(s)
- Lynn Stothers
- Department of Surgery and Division of Urology, University of British Columbia, The Bladder Care Centre, Vancouver, British Columbia, Canada.
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Carter JT, Freise CE, McTaggart RA, Mahanty HD, Kang SM, Chan SH, Feng S, Roberts JP, Posselt AM. Laparoscopic procurement of kidneys with multiple renal arteries is associated with increased ureteral complications in the recipient. Am J Transplant 2005; 5:1312-8. [PMID: 15888035 DOI: 10.1111/j.1600-6143.2005.00859.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study investigates the effect of renal artery multiplicity on donor and recipient outcomes after laparoscopic donor nephrectomy. Three-hundred and sixty-one sequential procedures were performed over a 4-year period. Forty-nine involved accessory renal arteries; of these, 36 required revascularization and 13 were small polar vessels and ligated. The 312 remaining kidneys with single arteries served as controls. Study variables included operative times, blood loss, hospital stay, graft function and donor and recipient complications. Kidneys with multiple revascularized arteries had a longer mean warm ischemia time (35.3 vs. 29.2 min, p = 0.0003), and more ureteral complications (6/36 vs. 10/312, p = 0.0013) than single-artery controls. In contrast, ligation of a small superior accessory artery had no significant effect on donor operative time, blood loss, or complication rate while providing similar recipient graft function compared to single-artery controls. Renal artery number is important in selecting the appropriate kidney for laparoscopic procurement. Given the current excellent results with right-sided donor nephrectomy, kidneys with single arteries should be preferentially procured, irrespective of side.
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Affiliation(s)
- Jonathan T Carter
- Division of Transplantation Surgery, University of California - San Francisco, USA
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Orsenigo E, Fiorina P, Cristallo M, Socci C, La Rocca E, Maffi P, Invernizzi L, Zuber V, Secchi A, Di Carlo V. Long-term survival after kidney and kidney-pancreas transplantation in diabetic patients. Transplant Proc 2005; 36:1072-5. [PMID: 15194372 DOI: 10.1016/j.transproceed.2004.04.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the influence of diabetes mellitus on patient and graft survival among renal versus renal-pancreatic recipients. METHODS Among 270 renal transplants performed from 1985 to 2002, a total of 204 (75%) were in diabetic patients and 66 (25%) in nondiabetic patients. Among the 204 diabetic patients 161 (60%) kidneys were transplanted simultaneously with a pancreatic graft (SKPT group). The overall group of patient included 164 (61%) men and 106 (39%) women with mean time on dialysis of 31 +/- 21 months (range 0 to 126 months). The mean duration of diabetes was 24 +/- 7 years (range 5 to 51 years). Ninety-nine percent of the patients were on renal replacement therapy (79% hemodialysis and 20% peritoneal dialysis). RESULTS The overall rejection rate was similar (NS). Both patient and kidney graft survival rates were worse in diabetics. Patient survival was 82% at 5 years among patients undergoing SKPT, 60% in diabetics receiving only a kidney, and 88% in nondiabetic transplanted patients. Kidney graft survival at 5 years was 77% in diabetics receiving SKPT, 68% in diabetics receiving a kidney alone, and 82% in nondiabetic patients. Overall patient survival was significantly greater among nondiabetics (P =.002) or in diabetics who received SKPT compared with diabetics who only had a kidney transplant (P =.001). CONCLUSIONS This retrospective clinical evaluation confirms that combined pancreas and kidney transplantation should be the first choice to insulin-dependent diabetes mellitus (IDDM) patients with end-stage diabetic nephropathy.
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Affiliation(s)
- E Orsenigo
- Department of Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy.
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Latchamsetty KC, La Rochelle JC, Hoeksema J, Coogan CL. Is routine postoperative chest radiography needed after open nephrectomy? Urology 2005; 65:256-9. [PMID: 15708033 DOI: 10.1016/j.urology.2004.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Accepted: 09/07/2004] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess whether routine postoperative chest radiography (CXR) is required after open nephrectomy for the detection and possible management of a pneumothorax. It has become the standard of care by many urologists to obtain routine postoperative CXRs after open nephrectomy to assess for the presence of a pneumothorax. However, at our institution, very few patients have developed a pneumothorax postoperatively, and, furthermore, the CXR findings almost never affected the clinical management. METHODS Retrospective data were collected on the last 150 open nephrectomies performed by two urologists at our institution. All laparoscopic nephrectomies and thoracoabdominal nephrectomies were excluded from analysis. RESULTS A total of 150 patients underwent open nephrectomy between 1998 and 2003. The procedure was performed with an anterior subcostal, 11th rib, 12th rib, midline, and 10th rib incision in 60 (40%), 51 (34%), 18 (12%), 20 (13.3%), and 1 (0.67%) patient, respectively. Of the 150 patients, 92 (61.3%) underwent postoperative CXR and 58 (38.7%) did not. Of the 150 patients, 92 of whom had undergone postoperative CXR, 4 (2.7%) had a postoperative pneumothorax. One of these patients (0.67%) received a chest tube. Of the 4 patients with a pneumothorax, 3 had had a recognized pleural tear that was repaired at nephrectomy and the fourth had had an unrecognized pleural injury. CONCLUSIONS Routine postoperative CXRs are not needed after open nephrectomy. Obtaining a selective CXR when a recognized intraoperative pleural tear has occurred, a central line is placed, the physical examination reveals an abnormality (ie, decreased breath sounds), or the patient experiences respiratory difficulties in the postoperative period is safe, cost-effective, and decreases the radiation exposure to patients.
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Affiliation(s)
- Kalyan C Latchamsetty
- Department of Urology, Rush University Medical Center, Chicago, Illinois 60612 , USA.
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24
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Abstract
BACKGROUND The demand for renal transplants is greater than the available kidneys. Live donation is one way of increasing the supply. Laparoscopic removal of the donor kidney appears to reduce morbidity for the donors. Some who are hesitant because of the morbidity associated with open nephrectomy are willing to consider the laparoscopic donor nephrectomy. METHODS Laparoscopic donor nephrectomy was offered to all but three donors since the commencement of the programme in 1997. Data were collected both prospectively and retrospectively for the first 120 donors. Venous and arterial anatomy was assessed preoperatively by computed tomographic angiography. RESULTS All but four donor procedures were completed laparoscopically. Three of these were for bleeding that could not be safely controlled laparoscopically and the fourth was a planned conversion to deal with the renal vessels, in the first right nephrectomy. Two kidneys were lost due to arterial thrombosis and two underwent segmental infarction after the loss of one of two or three separately anastomosed vessels. Three recipients had delayed function and two of them required dialysis postoperatively. Other minor complications occurred but were uncommon. CONCLUSIONS Laparoscopic live donor nephrectomy is safe for the donor and the transplant kidney. It offers the advantage of decreased morbidity for the donor, with a shorter hospital stay, earlier return to normal activity and, for some, early return to work.
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Affiliation(s)
- M Mohan Rao
- Department of Surgery/Renal Unit, Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia.
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25
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Giessing M, Reuter S, Schönberger B, Deger S, Tuerk I, Hirte I, Budde K, Fritsche L, Morgera S, Neumayer HH, Loening SA. Quality of life of living kidney donors in Germany: a survey with the Validated Short Form-36 and Giessen Subjective Complaints List-24 questionnaires. Transplantation 2004; 78:864-72. [PMID: 15385806 DOI: 10.1097/01.tp.0000133307.00604.86] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most studies evaluating the impact of kidney donation on donors' quality of life (QOL) have limitations such as small cohort size, unmatched references, use of nonstandardized and nonvalidated questionnaires, or low response rates. METHODS We performed a study on donors' QOL that was designed to avoid these limitations. All available living renal donors in our department in the last 18 years were included in the study. QOL was assessed with two validated, standardized questionnaires (Short Form-36, Giessen Subjective Complaints List [Giessener Beschwerdebogen]-24) and compared with gender- and age-matched references. In addition, specific questions relating to kidney donation were asked. RESULTS The response rate (89.8%) is one of the highest reported for studies on QOL of living kidney donors. Most donors had an equal or better QOL than the healthy population. Donors' willingness to donate again (93.4%) or recommend living-donor kidney transplantation (92.4%) was high, irrespective of complications. A small number of donors experienced financial drawbacks or occupational disadvantages. Donors aged 31 to 40 years were found to be at risk of QOL deterioration after organ donation. Donor and recipient complications had a significant impact on donors' QOL. One third of the donors found that the psychologic care preceding and after kidney donation was insufficient. CONCLUSIONS Our findings support the practice of living-donor kidney transplantation as a good means to meet the persisting organ shortage. Further effort must be put into minimizing donor and recipient complications. The specific demands of younger donors should be further elucidated. In addition to medical follow-up, living kidney donors should also be offered lifelong psychologic counseling.
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Affiliation(s)
- Markus Giessing
- Department of Urology, Charité University Hospital, Campus Mitte, Berlin, Germany.
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26
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Schostak M, Wloch H, Müller M, Schrader M, Offermann G, Miller K. Optimizing open live-donor nephrectomy - long-term donor outcome. Clin Transplant 2004; 18:301-5. [PMID: 15142052 DOI: 10.1111/j.1399-0012.2004.00165.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The technique of laparoscopic or retroperitoneoscopic donor nephrectomy has been increasingly propagated in recent years. The central advantage is supposed to be a reduction of perioperative discomfort. However, there have not been many reports describing the subjective feeling associated with an open donor nephrectomy, particularly with respect to the pain level in the perioperative and long-term course. This retrospective study examines the perioperative pain and morbidity and long-term outcome of living kidney donors from 35 yr of experience at the University Hospital Benjamin Franklin of the Free University of Berlin. METHODS A total of 102 living kidney donors were asked to fill out a questionnaire. Five epidemiological questions were posed and the rest dealt mainly with lasting subjective and objective surgical impairments. There were also questions relating to the perioperative pain level (VAS/NAS-Score). In addition, basic information was obtained regarding the donor's current health status (physical examination, serum creatinine; sometimes also ultrasound, protein IU, blood pressure), and/or examinations were performed. RESULTS The mean age at the time of donation was 45.5 and 55% were women. Donor nephrectomies were left-sided in 78 cases and right-sided in 24. There was a total complication rate of 53%, but serious complications only occurred in two cases (1.9%). A total of 53 donors could be reached. Although 41.5% felt they had a lasting impairment, somatic sequelae like respiratory, abdominal or scar problems were rare, affecting a maximum of only four patients in each case. Fifteen patients reported neurological problems such as sensory disturbances. The mean serum creatinine was 89.9 micromol/L in female and 114.2 micromol/L in male donors. Microalbuminuria was found in 22.6% of the donors, hypertension in 35.8%. Persistent pain was reported by 20.7%, its occurrence being permanent in two of the donors and very frequent in one. All the others rarely have pain. The median perioperative VAS/NAS score was 8 on the first day after surgery, 5 after 1 wk and 1 after 1 month. The analgesia was rated as good or very good by 71%. Everyday life was managed as well as before surgery after 2-4 wk by the highest percentage (42%) of patients, but working capacity was only regained after 1-3 months by a comparable percentage (44%). Forty-six percent had a very good and 33% a good feeling after the kidney donation. The relationship to the recipient had intensified in most cases. Ninety-one percent would again decide in favor of a donation. CONCLUSION Donor nephrectomy in an open technique is a safe and reliable procedure with low morbidity. After a median post-operative period of 7 yr, however, 42% of the donors still report general impairment due to the intervention, although concrete somatic problems were only detected in a few cases. Nearly all these patients underwent surgery in a full flank position. Wound-healing impairments were also significantly more frequent with this surgical technique. This positioning should thus be avoided. The post-operative pain level was relatively high, but a marked improvement was achieved in the course of the observation period by optimizing analgesic management.
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Affiliation(s)
- M Schostak
- Department of Urology, Charité, Campus Benjamin Franklin, Univeritätsmedizin Berlin, Berlin, Germany.
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27
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Firat A, Akin O, Agildere AM, Aytekin C, Haberal M. Contrast-enhanced magnetic resonance angiography: evaluation of renal arteries in living renal transplant donors. Eur J Radiol 2004; 52:84-93. [PMID: 15380851 DOI: 10.1016/j.ejrad.2003.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2003] [Revised: 08/01/2003] [Accepted: 08/06/2003] [Indexed: 10/26/2022]
Abstract
One of the most important steps before living-donor nephrectomy is assessment of renal vascular anatomy. The number, origins and lengths of the renal arteries and variations of renal veins must be determined in order to identify the kidney that is most suitable for transplantation. Digital subtraction angiography was long considered the standard procedure for this purpose, but this method has been replaced by non-invasive techniques. Contrast-enhanced magnetic resonance angiography is an accurate, safe and reliable method for imaging vasculature. This article reviews the technique and the clinical features of this method in the evaluation of living renal transplant donors.
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Affiliation(s)
- Ali Firat
- Department of Radiology, Baskent University Faculty of Medicine, Fevzi Cakmak Cad., 10. Sok., No:45, Bahcelievler, 06490 Ankara, Turkey
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Su LM, Ratner LE, Montgomery RA, Jarrett TW, Trock BJ, Sinkov V, Bluebond-Langner R, Kavoussi LR. Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases. Ann Surg 2004; 240:358-63. [PMID: 15273562 PMCID: PMC1356414 DOI: 10.1097/01.sla.0000133351.98195.1c] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review a single-institution 6-year experience with laparoscopic live donor nephrectomy detailing the technical modifications, clinical results, as well as the trends in donor and recipient morbidity. SUMMARY BACKGROUND DATA Since 1995, laparoscopic donor nephrectomy has had a significant impact on the field of renal transplantation, resulting in decreased donor morbidity, without jeopardizing procurement of a high-quality renal allograft. This technique has become the preferred method of allograft procurement for many transplantation centers worldwide but still remains technically challenging with a steep learning curve. METHODS Records from 381 consecutive laparoscopic donor nephrectomies were reviewed with evaluation of both donor and recipient outcomes. Trends in donor and recipient complications were assessed over time by comparing the outcomes between four equally divided groups. RESULTS All 381 kidneys were procured and transplanted successfully with only 8 (2.1%) open conversions. Mean operative time was 252.9 +/- 55.7 minutes, estimated blood loss 344.2 +/- 690.3 mL, warm ischemia time 4.9 +/- 3.4 minutes, and donor length of stay was 3.3 +/- 4.5 days. There was a significant decline in total donor complications, allograft loss, and rate of vascular thrombosis with experience. The rate of ureteral complications declined significantly when comparing our early (Group A) versus later (Groups B-D) experience. CONCLUSION Laparoscopic donor nephrectomy has remained a safe, less invasive, and effective technique for renal allograft procurement. Over our 6-year experience and with specific refinements in surgical technique, we have observed a decline in both donor and recipient morbidity following laparoscopic live donor nephrectomy.
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Affiliation(s)
- Li-Ming Su
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA.
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29
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Schostak M, Wloch H, Müller M, Schrader M, Christoph F, Offermann G, Miller K. Living donor nephrectomy in an open technique; a long-term analysis of donor outcome. Transplant Proc 2004; 35:2096-8. [PMID: 14529852 DOI: 10.1016/s0041-1345(03)00677-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Schostak
- Department of Urology, Charité--Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
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30
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Brook NR, Nicholson ML. An audit over 2 years’ practice of open and laparoscopic live-donor nephrectomy at renal transplant centres in the UK and Ireland. BJU Int 2004; 93:1027-31. [PMID: 15142157 DOI: 10.1111/j.1464-410x.2003.04775.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To collate information on the practice of live-donor nephrectomy and compare this with the published British Transplantation Society (BTS) guidelines for best practice, using two questionnaires sent to all renal transplant centres in the UK and Ireland to cover practice for the years 2000 and 2002. METHODS A postal questionnaire was sent to all surgical kidney transplant consultants in the UK and Ireland, including questions on the practice of live-donor nephrectomy in the year 2000 (the questionnaire was sent in 2001) and 2002 (questionnaire sent in 2003). RESULTS All 28 centres responded fully for both years; 27 centres used live kidney donation in 2000, decreasing to 24 in 2002. Consultants reported 356 operations in 2000, representing 19% of all kidney transplants, and 403 in 2002, representing 23% of all kidney transplants. Three centres offered laparoscopic donor nephrectomy in 2000, and five did so in 2002. Most centres organize donor and recipient operations synchronously, and most have a consultant anaesthetist present for the donor procedure. There were variations in the use of analgesia and thromboprophylaxis, and in donor follow-up. CONCLUSIONS There is widespread application of live-donor nephrectomy in the UK but BTS guidelines are not closely followed. Minimal access donor nephrectomy is offered at a few centres but many have plans to introduce this into their practice.
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Affiliation(s)
- N R Brook
- Division of Transplantation, The University Department of Surgery, Leicester General Hospital, Leicester, UK.
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31
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Siebels M, Theodorakis J, Schmeller N, Corvin S, Mistry-Burchardi N, Hillebrand G, Frimberger D, Reich O, Land W, Hofstetter A. Risks and complications in 160 living kidney donors who underwent nephroureterectomy. Nephrol Dial Transplant 2003; 18:2648-54. [PMID: 14605291 DOI: 10.1093/ndt/gfg482] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The rate of living donor renal transplantations has increased. However, in view of the possible complications, the question as to whether the condition of the recipient justifies operation of the donor still remains unanswered. The present retrospective study evaluates the perioperative and post-operative risks and complications for the donor at a single major transplantation centre. METHODS From 1994 to 2001, 160 live donor nephroureterectomies were performed. The median age of living donors was 51 years (range 21-77 years); 19 patients were older than 61 years. After confirming blood group compatibility and negative cross-match, donors underwent an extensive medical and psychological examination. Comorbidities and anatomical features of the donor were evaluated and the impact they may have on the outcome was determined. The nephroureterectomies were performed transperitoneally, with the right kidney being preferred. Pre-operative, intraoperative and post-operative complications were documented. Serum creatinine levels as well as new-onset proteinuria or hypertension were used as criteria for assessing long-term renal function. RESULTS Complications were observed in 41 donors: 35 were minor and six were major (splenectomy; revisions due to liver bleeding, incarcerated umbilical hernia or infected pancreatic pseudocyst; pneumothorax; and acute renal failure). No patient died. Multiple arteries (14 patients), significant renal artery stenosis (two patients) and additional risk factors (e.g. increased age and previous operations) did not affect the complication rate. In the post-operative follow-up period of 0.5-62 months (mean: 38 months), renal function remained stable in all donors. CONCLUSIONS Living donor nephrectomy appears to be a safe intervention in specialized centres, where it entails a low morbidity for the donor. Even in high-risk donors, long-term complications were not observed.
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Affiliation(s)
- Michael Siebels
- Department of Urology, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistrasse 15, D-81377 Munich, Germany.
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Hakim N, Zarka ZA, El-Tayar A, Mustafa N, Papalois V. A fast and safe living donor nephrectomy technique. Transplant Proc 2003; 35:2555-6. [PMID: 14612013 DOI: 10.1016/j.transproceed.2003.09.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- N Hakim
- St. Mary's Hospital, London, United Kingdom.
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Giessing M, Kroencke TJ, Taupitz M, Feldmann C, Deger S, Turk I, Budde K, Ebeling V, Schoenberger B, Loening SA. Gadolinium-enhanced three-dimensional magnetic resonance angiography versus conventional digital subtraction angiography: which modality is superior in evaluating living kidney donors?1. Transplantation 2003; 76:1000-2. [PMID: 14508369 DOI: 10.1097/01.tp.0000084307.39680.7d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study evaluates the correlation of magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) with the operative vessel findings in living kidney donors. The intraoperative vessel findings of 52 living renal donors were compared with the preoperative diagnoses of each imaging technique. Sixty-seven arteries were found during explantation. Forty kidneys showed a single arterial blood supply, and 12 kidneys showed a multiple arterial blood supply. No advantage of either imaging method was found for arterial imaging. There were 55 veins identified during organ harvesting. MRA could not determine the venous system in one donor (1.9%) and failed to detect one small pole vein in another. DSA did not yield a venous diagnosis in seven patients (13.5%) and yielded misdiagnoses in four patients. The correct diagnosis of renal donor veins differed significantly in favor of MRA (kappa 0.79 vs. 0.45; P=0.008). MRA is superior to DSA in assessing the renal vasculature in living kidney donors.
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Affiliation(s)
- Markus Giessing
- Department of Urology, Charité University Hospital, Berlin, Germany.
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Cabrer C, Oppenhaimer F, Manyalich M, Paredes D, Navarro A, Trias E, Lacy A, Rodríguez-Villar C, Vilarrodona A, Ruiz A, Gutierrez R. The living kidney donation process: the donor perspective. Transplant Proc 2003; 35:1631-2. [PMID: 12962736 DOI: 10.1016/s0041-1345(03)00697-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the living kidney donation (LKD) process using donors' opinions on the impact on social, emotional, and financial aspects affecting donor quality of life. MATERIALS AND METHODS From May 2000 to December 2002, we studied 22 donors of living kidneys at the Hospital Clinic, Barcelona, Spain, who completed an anonymous survey 6 months after donation. RESULTS Most donors (86%) had themselves informed the recipient about their wish to donate, the other 14% were asked by family members. Eighty-eight percent stated that the information provided to the donor about the evaluation process was well explained and understood whereas 12% disagreed with the statement. At the time of thin decision, 90.5% of donors understood the vital risk. For 95%, the explanations about the process corresponded with the actual experience. One hundred percent of donors stated after donation that they would again favor it. Mean hospital stay was 6 days (range, 3-9 days). Those donors with a labor contract have been out of work for an average of 57.8 days (range, 18 days to 6 months). Twenty-five percent of donors admitted financial effects as a result of donation. All but 1 felt completely recovered with the same quality of life after donation. DISCUSSION LKD is a good therapeutic alternative. Some aspects should be developed, such as more information about living donation and the need to considering donors as healthy persons without loss of earnings. Recognition of the benefits of living donation requires more wide participation of all citizens nationally.
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Affiliation(s)
- C Cabrer
- Hospital Clinic-Barcelona, Spain, Transplant Coordination Service, Barcelona, Spain
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Hussain SM, Kock MCJM, IJzermans JNM, Pattynama PMT, Hunink MGM, Krestin GP. MR imaging: a "one-stop shop" modality for preoperative evaluation of potential living kidney donors. Radiographics 2003; 23:505-20. [PMID: 12640163 DOI: 10.1148/rg.232025063] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
At many institutions, magnetic resonance (MR) angiography is the technique of choice for assessment of the renal arteries and renal parenchyma in potential living kidney donors. The renal arteries and renal veins have a varied anatomy and may consist of one or more vessels at several levels with variable calibers and levels of branching. These findings may play an important role in the surgeon's decision about which kidney to harvest, especially if laparoscopic nephrectomy is used. A comprehensive MR imaging protocol is used at one hospital to assess the arteries, veins, parenchyma, and collecting system of the kidneys. The protocol includes T2-weighted single-shot fast spin-echo imaging, fat-saturated T2-weighted fast spin-echo imaging, three-dimensional MR angiography and MR venography, and delayed fat-saturated three-dimensional T1-weighted gradient-echo imaging. Meticulous assessment of the source images as well as images produced with various postprocessing methods, such as full maximum intensity projection, targeted maximum intensity projection, and axial and oblique reformation, allows detailed description of the vascular anatomy and its relationship to the collecting system and parenchyma to facilitate the surgeon's decision making. The findings of MR imaging are comparable with those of other imaging modalities.
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Affiliation(s)
- Shahid M Hussain
- Department of Radiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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36
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Affiliation(s)
- S Guleria
- Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Chueh SC, Lai MK. Initial experience with laparoscopic live donor nephrectomy in Taiwan. Transplant Proc 2003; 35:45-6. [PMID: 12591300 DOI: 10.1016/s0041-1345(02)03974-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S-C Chueh
- Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Liem YS, Kock MCJM, Ijzermans JNM, Weimar W, Visser K, Hunink MGM. Living renal donors: optimizing the imaging strategy--decision- and cost-effectiveness analysis. Radiology 2003; 226:53-62. [PMID: 12511668 DOI: 10.1148/radiol.2261011893] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the most cost-effective strategy for preoperative imaging performed in potential living renal donors. MATERIALS AND METHODS In a decision-analytic model, the societal cost-effectiveness of digital subtraction angiography (DSA), gadolinium-enhanced magnetic resonance (MR) angiography, contrast material-enhanced spiral computed tomographic (CT) angiography, and combinations of these imaging techniques was evaluated. Outcome measures included lifetime cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. A base-case analysis was performed with a 40-year-old female donor and a 40-year-old female recipient. RESULTS For the donor, MR angiography (24.05 QALYs and 9,000 dollars) dominated all strategies except for MR angiography with CT angiography, which had an incremental ratio of 245,000 dollars per QALY. For the recipient, DSA and DSA with MR angiography yielded similar results (10.46 QALYs and 179,000 dollars) and dominated all other strategies. When results for donor and recipient were combined, DSA dominated all other strategies (34.51 QALYs and 188,000 dollars). If DSA was associated with a 99% specificity or less for detection of renal disease, MR angiography with CT angiography was superior (34.47 QALYs and 190,000 dollars). CONCLUSION For preoperative imaging in a potential renal donor, DSA is the most cost-effective strategy if it has a specificity greater than 99% for detection of renal disease; otherwise, MR angiography with CT angiography is the most cost-effective strategy.
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Affiliation(s)
- Ylian S Liem
- Program for the Assessment of Radiological Technology (ART Program) and the Department of Epidemiology and Biostatistics, Erasmus MC Rotterdam, The Netherlands
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Fisher MS. Psychosocial evaluation interview protocol for living related and living unrelated kidney donors. SOCIAL WORK IN HEALTH CARE 2003; 38:39-61. [PMID: 14984248 DOI: 10.1300/j010v38n01_03] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article is intended to help mental health clinicians who work with kidney transplant teams enhance their understanding, abilities and skills to determine the best possible psychosocially stable living donor candidates who present for evaluation. Additionally, this article is intended to help the clinician gain a better understanding of the donor ability and willingness to give informed consent, and determine those who present for donorship which may be at high risk due to either historic or current mental health, substance use and current lifestyle issues. Finally, this article considers the rationale and goals of pretransplant psychosocial evaluation of potential kidney donors as well as the net effects on the families. The intent is to provide a clinical protocol useful in both private and public hospitals. The current protocol is currently being used at HCA: Henrico Doctors' Hospital, Virginia Transplant Center in Richmond, Virginia. Early post-transplant psychosocial problems and their management and the long-term adaptation for the donors are discussed. Additionally, ethical considerations are addressed.
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Affiliation(s)
- Maurice S Fisher
- Virginia Transplant Center, HCA Henrico Hospital, Richmond, VA, USA.
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40
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Prasad S, Russ G, Faull R. Live donor renal transplantation in Australia 1964-1999: an evolving practice. Intern Med J 2002; 32:569-74. [PMID: 12512749 DOI: 10.1046/j.1445-5994.2002.00325.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Australia has a low cadaver organ donor (CD) rate by international standards, leading to the increasing use of live donor (LD) renal grafts. AIMS To review the Australian experience with LD transplants from 1964 to 1999. METHODS Data were obtained from the Australian and New Zealand Dialysis and Transplant Registry. Survival was assessed by the Kaplan-Meier method. RESULTS A total of 1584 LD and 10 252 CD transplants was performed between 1964 and 1999. While the CD rate dropped over the last decade, the LD rate increased, maintaining the overall transplantation rate. Only 3.6% of grafts before 1980 were LD, increasing to 28.4% during 1995-1999. Patient and graft survival of LD grafts was superior to CD grafts. Most LD grafts were from live related donors (LRD), most commonly parents or siblings. The number of transplants from live unrelated donors (LURD) has risen (1980-1989, n = 6; 1990-1999, n = 143), primarily due to more spousal donation, with no difference in survival between LRD and LURD groups. Grafts from older donors (> 50 years of age) increased, with no graft survival difference between donors < 50 years and donors > 50 years. LD transplants performed prior to commencement of dialysis increased, with survival similar to grafts performed after dialysis. CONCLUSION The pattern of renal transplantation in Australia has changed, with increasing numbers of LD transplants, growing use of unrelated and older donors, and more transplants before dialysis commences. Long-term patient and graft survival advantages have been maintained, supporting the growing use of live donors to expand the donor pool.
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Affiliation(s)
- S Prasad
- Renal Unit, Royal Adelaide Hospital, Australian
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Bayazit Y, Aridoğan IA, Tansuğ Z, Unsal I, Erken U. Morbidity of flank incision in 100 renal donors. Int Urol Nephrol 2002; 32:709-11. [PMID: 11989570 DOI: 10.1023/a:1015000328796] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the morbidity of lumbotomy incision used in the last 100 living related donor nephrectomies retrospectively. METHODS Since March 1991, 100 donor nephrectomies were made to living donors with lumbar incision. Incisions made in lateral decubitus position, subcostally or by an 11th or 12th rib resection. Left nephrectomy to 83, and right nephrectomy to 17 donors was performed. In 2 patients, there had been a peritoneal defect which was closed with primary sutures. In 19 patients 3 cm or shorter and in 5 patients longer than 3 cm of pleural entry had occurred. In all of the patients laceration was repaired without placement of a chest tube, however a chest tube had to be placed in 2 donors after obtaining a control chest x-ray postoperatively. RESULTS All the patients mobilized and began to take orally in the first post-operative day. Wound infection, pneumonia and deep vein thrombosis had detected in none of the patients. The patients were discharged on the 4th and 5th postoperative day. During their control after 1 month from the operation it was found that all of them had returned to their daily life. In the postoperative period incisional hernia occurred in 7 patients which didn't need surgical repair and none of them complained of cosmetic problem. There was no any other late term complication was seen due to flank incision. CONCLUSION Lumbotomy incision in donor nephrectomy, either a rib resection or supracostal approach, is reliable, provides excellent exposure for surgeon and has minimal morbidity.
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Affiliation(s)
- Y Bayazit
- University of Cukurova, Faculty of Medicine, Department of Urology and University of Cukurova Organ Transplantation Center, Adana, Turkey
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Yang SL, Harkaway R, Badosa F, Ginsberg P, Greenstein MA. Minimal incision living donor nephrectomy: improvement in patient outcome. Urology 2002; 59:673-7. [PMID: 11992838 DOI: 10.1016/s0090-4295(02)01516-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To analyze the minimal incision living donor (MILD) nephrectomy and compare it with the standard open donor (SOD) nephrectomy with respect to incision size, operative time, complication rate, length of hospital stay, and recipient creatinine. METHODS Forty-five consecutive patients who underwent MILD nephrectomy were compared with 13 patients who had previously undergone SOD nephrectomy. The MILD nephrectomy was performed through a minimally invasive incision using a modified, anterolateral, retroperitoneal approach without a rib resection. The incision length, operative time, complication rates, length of hospital stay, and recipient creatinine were analyzed. RESULTS The average incision length in the MILD group was 8.6 cm compared with 21.8 cm in the SOD group (P >0.005.) The operative times (209 minutes in the MILD group versus 191 minutes in the SOD group) were not significantly different. Four postoperative complications were encountered in the SOD group and seven in the MILD group. The average hospital stay for the MILD patients was 2.5 days compared with 4.6 days in the SOD group, and as the procedure was refined, the length of stay was reduced to 1 day in 3 patients. The recipient creatinine at 1 and 6 months was 1.39 and 1.4 mg/dL in the MILD group, respectively. CONCLUSIONS The MILD nephrectomy allows the patient to undergo a less morbid procedure with a more aesthetic incision. Patients have fewer complications, minimal anesthesia exposure, and short hospital stays.
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Affiliation(s)
- Shuin-Lin Yang
- Department of Kidney Transplantation, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
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43
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Rabii R, Joual A, Fekak H, Moufid K, el Mrini M, Benjelloun S, Khaleq K, Idali B, Harti A, Barrou L, Fatihi M, Benghanem M, Hachim J, Ramdani B, Zaid D. [Surgical complications of nephrectomy in living donors]. ANNALES D'UROLOGIE 2002; 36:162-7. [PMID: 12056087 DOI: 10.1016/s0003-4401(02)00093-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Renal transplantation from a living donor is now considered the best treatment for chronic renal failure. We reviewed the operative complications in 38 living related donor nephrectomies performed at our institution over the past 14 years. The mean age of our donors was 30 years old with age range between 18 and 58 years old and female predominance (55.2%). These swabs were realized by a posterolateral lumbar lombotomy with resection of the 11 third. The left kidney was removed in 34 donors (90%), surgical complications were noted in 39.4% of the cases: one case of wound of inferior vena cava (2.6%), one case of release of the renal artery clamp (2.6%), four cases of pleural grap (10.5%), one case of pneumothorax (2.6%), one case of pleurisy (2.6%), three cases of urinary infection (7.8%), three cases of parietal infection (7.8%) and one case of patient pain at the level of the wound (2.6%). There were no mortalities. We conclude that the morbidity of living donor nephrectomy is negligible compared with the advantages for the recipient.
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Affiliation(s)
- R Rabii
- Service d'Urologie, CHU Ibn Rochd, Casablanca, Maroc
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Vallet C, Bettschart V, Meuli R, Wauters JP, Mosimann F. Preoperative assessment of laparoscopic live kidney donors by gadolinium-enhanced magnetic resonance angiography. Transplant Proc 2002; 34:795-6. [PMID: 12034185 DOI: 10.1016/s0041-1345(01)02913-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- C Vallet
- Department of Surgery, Lausanne, Switzerland.
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45
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Waller JR, Hiley AL, Mullin EJ, Veitch PS, Nicholson ML. Living kidney donation: a comparison of laparoscopic and conventional open operations. Postgrad Med J 2002; 78:153-7. [PMID: 11884697 PMCID: PMC1742295 DOI: 10.1136/pmj.78.917.153] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Laparoscopic donor nephrectomy has the potential to lessen the burden placed on live kidney donors. This study describes the first British comparison of donor morbidity and recovery following conventional open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). An initial series of LDN (n=20) was compared to a historical control group of ODN (n=34). Laparoscopic operations were performed via a transperitoneal approach, the kidney being removed through a 6--12 cm Pfannensteil incision. Open operations were performed using a retroperitoneal flank approach with resection of the 12th rib. Postoperatively, donors were managed with a patient controlled analgesia system. LDN was associated with shorter mean (SD) inpatient stay (6 (2) v 4 (1) days; p=0.0001) and lower parenteral narcotic requirements (morphine 179 (108) v 67 (54) mg; p=0.0001). Laparoscopic donors started driving their cars sooner (2 (1.5) v 6 (4) weeks; p=0.0001) and returned to work more quickly (5 (3) v 12 (6) weeks; p=0.0001) than open nephrectomy donors. There were no differences in recipient serum creatinine levels at three months post-transplant but two recipients of transplant kidneys retrieved laparoscopically (10%) developed ureteric obstruction, whereas this complication did not occur after ODN (p=0.13). LDN is associated with less postoperative pain and a substantial improvement in donor recovery times. It is not yet clear whether or not the outcome of the recipient kidney transplants are the same after ODN and LDN and much more experience is required before the place of this new technique can be defined.
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Affiliation(s)
- J R Waller
- University Division of Transplant Surgery, Leicester General Hospital, UK
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Waller JR, Veitch PS, Nicholson ML. Laparoscopic live donor nephrectomy: a comparison with the open operation. Transplant Proc 2001; 33:3787-8. [PMID: 11750612 DOI: 10.1016/s0041-1345(01)02602-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J R Waller
- University Division of Transplant Surgery, Leicester General Hospital, Gwendolen Road, Leicester, United Kingdom
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47
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Potter SR, Buell JF, Hanaway M, Woodle ES. Laparoscopic live donor nephrectomy: rationale, techniques, and implications. Semin Dial 2001; 14:365-72. [PMID: 11679106 DOI: 10.1046/j.1525-139x.2001.00089.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Laparoscopic live donor nephrectomy (LDN) was conceived as a means for decreasing donor nephrectomy morbidity and reducing disincentives for kidney donation. Since LDN was first reported in 1995, explosive growth has led to its performance at more than 100 centers worldwide. Despite initial skepticism in some segments of the transplant community, the results of LDN have improved progressively so that it is emerging as a new standard of care for live kidney donation. We review the development and refinement of LDN and its current rationale and applications.
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Affiliation(s)
- S R Potter
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio, USA
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Abstract
Laparoscopic donor nephrectomy offers numerous advantages when compared with the traditional open approach. For the donor, it has resulted in a shorter hospital stay, fewer postoperative analgesic requirements, earlier return to activities of daily living and employment, and decreased financial loss owing to absence from the workforce. For the recipient, the procedure does not adversely impact on allograft function, graft survival, or patient survival.
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Affiliation(s)
- M J Novotny
- Department of Urology, University of California, Davis School of Medicine, Sacramento, California, USA
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49
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Affiliation(s)
- J M Barry
- Department of Surgery, The Oregon Health Sciences University, Portland 97201, USA.
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50
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Leventhal JR, Deeik RK, Joehl RJ, Rege RV, Herman CH, Fryer JP, Kaufman D, Abecassis M, Stuart FP. Laparoscopic live donor nephrectomy--is it safe? Transplantation 2000; 70:602-6. [PMID: 10972217 DOI: 10.1097/00007890-200008270-00012] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Laparoscopic live donor nephrectomy (LDN) is a less invasive alternative to open nephrectomy (ODN) for living kidney donation. Concerns have been raised regarding the safety of LDN, the short and long term function of kidneys removed by LDN, and a potential higher incidence of urologic complications in LDN transplant recipients. METHODS Between October 1997 and May 1999, 80 LDNs were performed at our center. All patients were followed longitudinally with office visits and telephone interviews. These LDNs were compared with 50 ODN performed from January 1996 to October 1997. RESULTS LDN procedures took significantly longer than ODN (4.6 vs. 3.1 hr). However, LDN was associated with significant reduction in i.v. narcotic use, a rapid return to diet, and shorter hospital stay. Of the 80 LDN procedures, a total of 75 (94%) were completed laparoscopically. Five patients were converted to laparotomy: three for hemorrhage and two for complex vascular anatomy. ODN conversion was associated with large donor body habitus and/or obesity. Seven LDN patients had minor complications and 4 had major complications. All major complications consisted of vascular injuries (2 lumbar vein injuries, 1 renal artery, and 1 aortic injury). All patients made complete recoveries. All LDN kidneys functioned immediately posttransplant. We have observed 100% patient and 97% 1-year actuarial graft survival in LDN transplant recipients. There have been no short-or long-term urologic complications in this series. CONCLUSION With increasing experience and standardization of technique, LDN is a safe and effective procedure. Patients undergoing LDN demonstrate clinically significant, more rapid postoperative recoveries and shorter hospital stays than ODN patients. Excellent initial graft function and long-term graft survival have been observed with LDN kidneys. Urologic complications can be avoided. LDN has become the preferred surgical approach for living kidney donation at our center.
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Affiliation(s)
- J R Leventhal
- Department of Surgery, Northwestern University Medical School, Chicago, Illinois 60610, USA
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