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Dagnæs-Hansen J, Kristensen GH, Stroomberg HV, Rohrsted M, Sørensen SS, Røder A. Surgical Complications Following Renal Transplantation in a Large Institutional Cohort. Transplant Direct 2024; 10:e1626. [PMID: 38757053 PMCID: PMC11098183 DOI: 10.1097/txd.0000000000001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 05/18/2024] Open
Abstract
Background Successful renal transplantation (RTx) relies on immunosuppression and an optimal surgical course with few surgical complications. Studies reporting the postoperative complications after RTx are heterogeneous and often lack systematic reporting of complications. This study aims to describe and identify postoperative short-term and long-term complications after RTx in a large institutional cohort and identify risk factors for a complicated surgical course. Methods The study is a retrospective single-center cohort of 571 recipients who underwent living or deceased donor open RTx between 2014 and 2021. Data were collected on background information and perioperative and postoperative data. Complications were defined as short-term (<30 d) or long-term (>30 d) after transplantation and graded according to the Clavien-Dindo classification. Multivariable logistic regression was performed to evaluate risk factors for serious short-term complications and multivariable time-dependent Cox regression to evaluate risk factors for long-term complications. Results A total of 351 patients received a graft from a deceased donor, and 144 of these grafts were on perfusion machine before transplantation. One or more short-term complications occurred in 345 (60%) patients. Previous RTx was associated with short-term Clavien-Dindo >2 complications in recipients (odds ratio = 2.08; 95% confidence interval [CI], 1.18-3.69; P = 0.01). Being underweight (body mass index <18.5) in combination with increasing age increased the odds of short-term Clavien-Dindo >2 and vascular complications. Increasing blood loss per 100 mL was associated with increased odds of short-term Clavien-Dindo >2 (odds ratio = 1.11; 95% CI, 1.01-1.21; P = 0.032). No associations were found for long-term complications after RTx. The 5-y cumulative incidence of graft loss was 12.6% (95% CI, 8.9-16.3). Conclusions Short-term complications are common after RTx, and risk factors for severe short-term complications include previous RTx, increasing age, and low body mass index. No risk factors were identified for severe long-term complications. Further studies should explore whether new surgical techniques can reduce surgical complications in RTx.
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Affiliation(s)
- Julia Dagnæs-Hansen
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gitte H. Kristensen
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hein V. Stroomberg
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Malene Rohrsted
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren S. Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Røder
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Dagnæs-Hansen J, Kristensen GH, Stroomberg HV, Sørensen SS, Røder MA. Surgical Approaches and Outcomes in Living Donor Nephrectomy: A Systematic Review and Meta-analysis. Eur Urol Focus 2022; 8:1795-1801. [PMID: 35469780 DOI: 10.1016/j.euf.2022.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 03/30/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT The use of living kidney donors is increasing and there are several surgical approaches for donor nephrectomy but it remains unknown which procedure is optimal for the patient and the graft. OBJECTIVE To review different surgical techniques for living donor nephrectomy and compare complication rates, warm ischemia time, and delayed graft function. EVIDENCE ACQUISITION A systematic review of prospective studies involving surgical complications following living donor nephrectomy was conducted in the MEDLINE/PubMed and EMBASE databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Baseline data, perioperative and postoperative parameters, and postoperative complications are reported. Overall complication rates between surgical techniques were compared via analysis of variance with post hoc analysis. We included 35 studies involving 6398 patients and representing six different surgical procedures for living donor nephrectomy. EVIDENCE SYNTHESIS Hand-assisted laparoscopic donor nephrectomy had a significantly higher overall complication rate compared to open, laparoscopic, retroperitoneoscopic, and laparoendoscopic single-site techniques (p < 0.005). The complication rates were low and no mortality was observed. The main limitation was varying reporting of complications, with only one-third of the studies using the Clavien-Dindo classification. CONCLUSIONS No specific surgical approach seems superior in terms of complications, which were generally low. Different factors such as warm ischemia time, blood loss, and surgeon expertise define which surgical approach should be chosen. PATIENT SUMMARY We looked at the different surgical methods for removing the kidney from a living kidney donor. Overall, the different surgical techniques were similar in terms of complications and no donors died in the studies we reviewed. The choice of procedure depends on multiple factors such as the expertise of the surgeon and the surgical center.
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Affiliation(s)
- Julia Dagnæs-Hansen
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Hein V Stroomberg
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Nephrology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Andreas Røder
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Thai MS, Chau QT, Hoang KC, Ngo XT, Tran TT, Nguyen TH, Thai KL, Vu DH, Dinh LQV, Pham DM, Tiong HY, Nguyen TT. Introducing robot-assisted laparoscopic donor nephrectomy after experience in retroperitoneal endoscopic approach: a matched propensity score analysis. ANZ J Surg 2021; 92:531-537. [PMID: 34927326 DOI: 10.1111/ans.17424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of introducing robotic-assisted laparoscopic donor nephrectomy (RALDN) to the standard retroperitoneal endoscopic donor nephrectomy (REDN). METHODS Data were collected prospectively from 124 consecutive living kidney donors (93 for REDN subgroup and 31 for RALDN subgroup) from February 2018 to December 2020. Donor baseline demographics, perioperative outcomes and recipient outcomes were recorded, and these parameters were compared between the two subgroups before and after propensity-score matching. RESULTS Mean age was 51.1 ± 9.1 years; 42.7% were males; mean body mass index was 22.7 ± 2.4; and there were 109 (88%) left kidneys. The following data of REDN and RALDN was, respectively, recorded: operative time (213 ± 43 versus 216 ± 39 min, p = 0.721), warm ischemic time (4.7 ± 1.2 versus 4.9 ± 1.4 min, p = 0.399), postoperative complications (5.4% versus 6.5%, p = 1), haemoglobin (g/L) drop (9.4 ± 7.2 versus 9.7 ± 6.6, p = 0.836), blood creatinine at 6 month (1.15 ± 0.23 versus 1.13 ± 0.24 mg/dL, p = 0.734) and at 1 year (1.09 ± 0.22 versus 1.17 ± 0.28 mg/dL, p = 0.591). In post-propensity score matched analyses, there was no significant differences between the two groups including intraoperative and postoperative complications. CONCLUSIONS RALDN could be safely introduced into a living donor program experienced in laparoscopic donor nephrectomy. The outcomes of our study comparing these minimally invasive techniques are mostly similar in terms of intraoperative and postoperative outcomes for kidney donors.
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Affiliation(s)
- Minh Sam Thai
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Quy Thuan Chau
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Khac Chuan Hoang
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Xuan Thai Ngo
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Trong Tri Tran
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | | | - Kinh Luan Thai
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Duc Huy Vu
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Le Quy Van Dinh
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Duc Minh Pham
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Ho Yee Tiong
- Urology Department, National University Hospital, Singapore
| | - Tuan Thanh Nguyen
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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Al-Kaabneh A, Qamar AA, Al-Hammouri F, Al-Majali A, Alasmar A, Al-Sayedeh N, Khori F, Qapaha A, Beidas M. The effect of anaesthesia on flank incisional pain: infiltration versus intercostal nerve block, a comparative study. Pan Afr Med J 2020; 36:356. [PMID: 33224422 PMCID: PMC7664139 DOI: 10.11604/pamj.2020.36.356.24279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
The object of this study is to determine which local wound analgesic option is superior, local anaesthetic infiltration or intercostal nerve block, by combined local anaesthetic agents (0.5% bupivacaine + 2% lidocaine) and to detect which option can best alleviate the post-operative pain management and significantly prolong the time to the first rescue analgesic requirement and the total consumption of opioids in the first post-operative 72 hrs. The medical records of 1458 patients who underwent flank incision procedures by two different surgeons in our institute were retrospectively reviewed. Each surgeon used a different type of local incisional pain management; the first one used infiltration of flank incision routinely, the second surgeon used an intercostal block with all his patients. These elective procedures were carried out in our Urology Centre between June 2007 and June 2019. The duration of follow-up was from the recovery transfer until the end of the third post-operative day. Patients were divided into two groups: group 1 (729 patients-infiltration of flank incision) and group 2 (729 patients-intercostal nerve block). Patients were aged between 19-78 years. No significant differences were seen regarding the demographic data between both groups, P > 0.05. On the other hand, there were significant differences between group 1 and group 2 according to the mean visual analogue scale score (lower in group 1, P < 0.05), the total mean analgesic requirements during the first post-operative 72 hrs (lower in group 1, P < 0.05) and the time to the first analgesic demand (higher in group 1, P < 0.05). There were no statistically significant differences in post-operative complications between both groups, P > 0.05. The infiltration of flank incision with combined local anaesthetic agents (0.5% Bupivacaine + 2% lidocaine) is more effective in alleviating post-operative pain, decreasing total analgesic consumption during the first post-operative 72 hrs and prolonging the time required for the first rescue opioid.
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Affiliation(s)
- Awad Al-Kaabneh
- Department of Urology, Prince Hussein Urology Institute, King Hussein Medical Centre, Amman, Jordan
| | - Adnan Abo Qamar
- Department of Urology, Prince Hussein Urology Institute, King Hussein Medical Centre, Amman, Jordan
| | - Firas Al-Hammouri
- Department of Urology, Prince Hussein Urology Institute, King Hussein Medical Centre, Amman, Jordan
| | - Ashraf Al-Majali
- Department of Urology, Prince Hussein Urology Institute, King Hussein Medical Centre, Amman, Jordan
| | - Ali Alasmar
- Department of Urology, Prince Hussein Urology Institute, King Hussein Medical Centre, Amman, Jordan
| | - Nizar Al-Sayedeh
- Department of Urology, Prince Hussein Urology Institute, King Hussein Medical Centre, Amman, Jordan
| | - Firas Khori
- Department of Urology, Prince Hussein Urology Institute, King Hussein Medical Centre, Amman, Jordan
| | - Anan Qapaha
- Anaesthesia Department, King Hussein Medical Centre, Amman, Jordan
| | - Mohammad Beidas
- Anaesthesia Department, King Hussein Medical Centre, Amman, Jordan
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Appoloni AH, Herdman TH, Napoleão AA, Campos de Carvalho E, Hortense P. Concept Analysis and Validation of the Nursing Diagnosis, Delayed Surgical Recovery. Int J Nurs Knowl 2013; 24:115-21. [DOI: 10.1111/j.2047-3095.2013.01241.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Aline Helena Appoloni
- Graduate Program in Fundamental Nursing; Universidade do São Paulo-Ribeirão Preto, College of Nursing; Ribeirão Preto; São Paulo; Brazil
| | | | - Anamaria Alves Napoleão
- Department of Nursing; Universidade Federal de São Carlos (UFSCar); São Carlos; São Paulo; Brazil
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The Safety and Efficacy of Laparoscopic Donor Nephrectomy for Renal Transplantation: An Updated Meta-analysis. Transplant Proc 2013; 45:65-76. [DOI: 10.1016/j.transproceed.2012.07.152] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/21/2012] [Accepted: 07/19/2012] [Indexed: 11/18/2022]
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Ungbhakorn P, Kongchareonsombat W, Leenanupan C, Kijvikai K, Wisetsingh W, Patcharatrakul S, Jirasiritam S. Comparative Outcomes of Open Nephrectomy, Hand-Assisted Laparoscopic Nephrectomy, and Full Laparoscopic Nephrectomy for Living Donors. Transplant Proc 2012; 44:22-5. [DOI: 10.1016/j.transproceed.2011.12.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kanashiro H, Lopes RI, Saito FA, Mitre AI, Denes FT, Chambô JL, Falci Jr R, Piovesan AC, David Neto E, Nahas WC. Comparison between laparoscopic and subcostal mini-incision for live donor nephrectomy. EINSTEIN-SAO PAULO 2010; 8:456-60. [DOI: 10.1590/s1679-45082010ao1671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objectives: The aim of this study was to compare the results of laparoscopic donor nephrectomy with open donor nephrectomy. Methods: A non-randomized prospective analysis was conducted of living donor kidney transplantations (118 open donor nephrectomies; 57 laparoscopic donor nephrectomies) between January 2005 and December 2007 in the Kidney Transplantation Unit of Hospital das Clínicas of Faculdade de Medicina of the Universidade de São Paulo. Results: Mean donor operative time, mean donor hospital stay, mean postoperative creatinine values, and rates of complications and graft survival were similar for both groups. A significant statistical difference in warm ischemia time was observed between the open donor nephrectomy and laparoscopic donor nephrectomy groups (p < 0.001). There was only one conversion in the laparoscopic donor nephrectomy group. Conclusions: Laparoscopic donor nephrectomy is a safe procedure for a donor nephrectomy, comparable to an open procedure with similar results despite a longer warm ischemia time.
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Kanashiro H, Falci R, Piovisan AC, Saito F, Torricelli FCM, Nahas WC. Subcostal mini incision: a good option for donor nephrectomy. Clinics (Sao Paulo) 2010; 65:507-10. [PMID: 20535369 PMCID: PMC2882545 DOI: 10.1590/s1807-59322010000500008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 02/22/2010] [Accepted: 03/01/2010] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES We describe the results of over one hundred nephrectomies performed using a subcostal mini incision. INTRODUCTION A major effort has been undertaken to encourage living donor renal transplantation. New techniques that use minimally invasive approaches to perform donor nephrectomy have been progressively accepted. Among these new procedures is the mini-incision approach. METHODS We prospectively analyzed one hundred and seventeen consecutive donors that were subjected to subcostal mini-incision nephrectomy at a single center. Surgical time, warm and cold ischemia time, intraoperative complications, time until hospital discharge, presence of infection, bleeding, the need for a second operation, and death were analyzed. Eventual loss of donor renal function was indicated by increases in serum creatinine and proteinuria. RESULTS The mean time of surgery was 180.5 +/- 26.2 minutes. The mean warm ischemia time was 93 +/-8.3 seconds, while the mean cold ischemia time was 85.9 (+/-23.5) minutes. We had one case with an intraoperative complication, and only two patients required another operation. An intra-abdominal abscess occurred in one patient (0.85%), proteinuria occurred in one patient (0.85%), and a transitory increase of creatinine levels occurred in two patients (1.7%). DISCUSSION Reducing the length of the abdominal incision did not influence surgical time or result in an increase in intraoperative complications relative to our historical data or literature reports. Organ preparation was accomplished successfully with a brief warm ischemia time. Additionally, the mean hospital stay was short, and few surgical complications occurred. CONCLUSION The use of a subcostal mini incision is both safe and similar to conventional techniques previously described in the literature.
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Affiliation(s)
- Hideki Kanashiro
- Department of Urology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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