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Kourounis G, Tingle SJ, Hoather TJ, Thompson ER, Rogers A, Page T, Sanni A, Rix DA, Soomro NA, Wilson C. Robotic versus laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev 2024; 5:CD006124. [PMID: 38721875 PMCID: PMC11079970 DOI: 10.1002/14651858.cd006124.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Waiting lists for kidney transplantation continue to grow. Live kidney donation significantly reduces waiting times and improves long-term outcomes for recipients. Major disincentives to potential kidney donors are the pain and morbidity associated with surgery. This is an update of a review published in 2011. OBJECTIVES To assess the benefits and harms of open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), hand-assisted LDN (HALDN) and robotic donor nephrectomy (RDN) as appropriate surgical techniques for live kidney donors. SEARCH METHODS We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 31 March 2024 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing LDN with ODN, HALDN, or RDN were included. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for eligibility, assessed study quality, and extracted data. We contacted study authors for additional information where necessary. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Thirteen studies randomising 1280 live kidney donors to ODN, LDN, HALDN, or RDN were included. All studies were assessed as having a low or unclear risk of bias for selection bias. Five studies had a high risk of bias for blinding. Seven studies randomised 815 live kidney donors to LDN or ODN. LDN was associated with reduced analgesia use (high certainty evidence) and shorter hospital stay, a longer procedure and longer warm ischaemia time (moderate certainty evidence). There were no overall differences in blood loss, perioperative complications, or need for operations (low or very low certainty evidence). Three studies randomised 270 live kidney donors to LDN or HALDN. There were no differences between HALDN and LDN for analgesia requirement, hospital stay (high certainty evidence), duration of procedure (moderate certainty evidence), blood loss, perioperative complications, or reoperations (low certainty evidence). The evidence for warm ischaemia time was very uncertain due to high heterogeneity. One study randomised 50 live kidney donors to retroperitoneal ODN or HALDN and reported less pain and analgesia requirements with ODN. It found decreased blood loss and duration of the procedure with HALDN. No differences were found in perioperative complications, reoperations, hospital stay, or primary warm ischaemia time. One study randomised 45 live kidney donors to LDN or RDN and reported a longer warm ischaemia time with RDN but no differences in analgesia requirement, duration of procedure, blood loss, perioperative complications, reoperations, or hospital stay. One study randomised 100 live kidney donors to two variations of LDN and reported no differences in hospital stay, duration of procedure, conversion rates, primary warm ischaemia times, or complications (not meta-analysed). The conversion rates to ODN were 6/587 (1.02%) in LDN, 1/160 (0.63%) in HALDN, and 0/15 in RDN. Graft outcomes were rarely or selectively reported across the studies. There were no differences between LDN and ODN for early graft loss, delayed graft function, acute rejection, ureteric complications, kidney function or one-year graft loss. In a meta-regression analysis between LDN and ODN, moderate certainty evidence on procedure duration changed significantly in favour of LDN over time (yearly reduction = 7.12 min, 95% CI 2.56 to 11.67; P = 0.0022). Differences in very low certainty evidence on perioperative complications also changed significantly in favour of LDN over time (yearly change in LnRR = 0.107, 95% CI 0.022 to 0.192; P = 0.014). Various different combinations of techniques were used in each study, resulting in heterogeneity among the results. AUTHORS' CONCLUSIONS LDN is associated with less pain compared to ODN and has comparable pain to HALDN and RDN. HALDN is comparable to LDN in all outcomes except warm ischaemia time, which may be associated with a reduction. One study reported kidneys obtained during RDN had greater warm ischaemia times. Complications and occurrences of perioperative events needing further intervention were equivalent between all methods.
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Affiliation(s)
- Georgios Kourounis
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Samuel J Tingle
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Thomas J Hoather
- Department of Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Emily R Thompson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Alistair Rogers
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tobias Page
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aliu Sanni
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David A Rix
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Naeem A Soomro
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Colin Wilson
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
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Hoontrakul T, Leenanupunth C, Siantong M, Sirisreetreerux P, Phongkitkarun S, Kongchareonsombat W, Kijvikai K. Residual renal volume as a long-term independent predictive factor of developing chronic kidney disease after donor nephrectomy. Sci Rep 2024; 14:5341. [PMID: 38438514 PMCID: PMC10912707 DOI: 10.1038/s41598-024-55499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/24/2024] [Indexed: 03/06/2024] Open
Abstract
To assess the long-term association between the residual renal volume and the progression of chronic kidney disease (CKD) in kidney donors following open or laparoscopic donor nephrectomy. A retrospective observational study involving 452 individuals who underwent open or laparoscopic donor nephrectomy at Ramathibodi Hospital, Bangkok, Thailand. The study spanned over a comprehensive 60-month monitoring period. Residual renal volume was determined through Computer Tomography. Patient characteristics, surgical techniques, donated kidney side, and estimated glomerular filtration rate (eGFR) were collected and analysed. In a multivariate analysis, a residual renal volume exceeding 50% of original volume is associated with an increased likelihood of developing CKD, with a hazard ratio (HR) of 1.675 (P < 0.05), and male gender has a hazard ratio (HR) of 4.013 (P < 0.001). Additionally, age is identified as a minor risk factor for developing CKD, with hazard ratio (HR) of 1.107 (P < 0.001). Higher residual renal volume, male gender, and older age were identified as independent risk factors for the development of CKD following open or laparoscopic donor nephrectomy during long-term follow-up.
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Affiliation(s)
| | - Charoen Leenanupunth
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mookdarat Siantong
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pokket Sirisreetreerux
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Sith Phongkitkarun
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wisoot Kongchareonsombat
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Bukhari MA. Willingness for Solid-Organ Donation in Saudi Arabia: A Skyscape View. EXP CLIN TRANSPLANT 2021; 20:500-513. [PMID: 33535934 DOI: 10.6002/ect.2020.0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The number of patients with organ failure in Saudi Arabia is increasing annually, and transplantation offers the best outcome for these patients. However, the number of donors does not meet these needs. MATERIALS AND METHODS A questionnaire was distributed to assess the behavior of participants in Saudi Arabia toward different types of organ donation. The questionnaire examined general willingness to donate, deceased donation, living donation, and refusal to donate, as well as paired-exchange donation and next-of-kin consenting. RESULTS Of the 1099 participants, most were men (64%) and middle-aged (46%, 31-45 years old), with 36% of participants currently willing to donate or already registered as donors. Although 592 participants (54%) were not yet willing to donate, they believed they could consider making donations in specific circumstances (eg, when a relative is in need). In all circumstances, 10% (n = 108) of the participants refused to donate. With regard to deceased donation, 74% of participants accepted this, but only 29% (n = 322) agreed to consent for donation as next of kin. Of 1099 participants, 143 (13%) were willing to accept altruistic donation. Paired-exchange donation was widely accepted in a cohort study (n = 725, 65%), as opposed to list exchange (n = 540, 49%). Religious beliefs were the main reason behind the refusal of donation in the study cohort (n = 37, 37%). Female participants were less likely to refuse organ donation (odds ratio: 0.562; 95% CI, 0.407-0.775; P < .001), whereas older participants (> 60 years) were more likely to refuse organ donation (odds ratio: 5.457; 95% CI, 1.894-15.722; P = .002). CONCLUSIONS This study described the willingness of the Saudi population to donate organs in general and under special conditions, such as deceased donation, living-unrelated donation, altruistic donation, paired-exchange donation, list exchange donation, and next-of-kin consent.
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Affiliation(s)
- Muhammad A Bukhari
- From the Division of Nephrology, Department of Medicine, Taif University, Taif, Saudi Arabia
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Xiao Q, Fu B, Song K, Chen S, Li J, Xiao J. Comparison of Surgical Techniques in Living Donor Nephrectomy: A Systematic Review and Bayesian Network Meta-Analysis. Ann Transplant 2020; 25:e926677. [PMID: 33122621 PMCID: PMC7607668 DOI: 10.12659/aot.926677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to compare and evaluate surgical techniques used for living donor nephrectomy (LDN). Material/Methods We performed a meta-analysis to compare 4 surgical techniques: open LDN (OLDN), laparoscopic LDN (LLDN), hand-assisted LLDN (HALLDN), and robot-assisted LLDN (RLDN). Results No significant differences were found among these surgical techniques in terms of BMI, donor postoperative complications, 1-year graft survival, and DGF. Compared to the OLDN, the other 3 surgical techniques preferred to harvest the left kidney. When the right kidney was chosen as a donor, OLDN was the first-choice surgical technique. EBL was significantly lower in the HALLDN, LLDN, and RLDN groups when compared to the OLDN group. However, operative time and WIT were significantly shorter in the OLDN group. The RLDN group had an increased rate of donor intraoperative complications and a significantly lower VAS on day 1. The OLDN group required more morphine intake than the LLDN group. The length of hospital stay was significantly longer and AR was significantly higher in the OLDN group than in the LLDN and HALLDN groups. Conclusions There are no significant differences in donor postoperative complications, recipient DGF, and graft survival among the 4 surgical techniques. OLDN reduces WIT and operation time, but increases EBL and AR. RLDN and LLDN reduce the length of hospital stay, morphine intake, and VAS, and thus accelerate recovery. However, RLDN is associated with increased intraoperative complications.
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Affiliation(s)
- Qi Xiao
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Biqi Fu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Keqin Song
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Sufen Chen
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Jianfeng Li
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Jiansheng Xiao
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
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Abdessater M, Champy CM, da Costa JB, Courcier J, Yiou R, Hoznek A, Vordos D, Grimbert P, Matignon M, Londero T, le Corvoisier P, Salomon L, De la Taille A, Ingels A. Comparison of the iliac, vaginal and umbilical graft extraction in robot-assisted laparoscopic living donor nephrectomy. World J Urol 2020; 39:2783-2788. [PMID: 33015741 DOI: 10.1007/s00345-020-03462-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare different extractions routes for robot-assisted living donor nephrectomy in terms of post-operative pain and renal function recovery. METHODS Live donor kidney transplantation data from our institution were reviewed from November 2011 to March 2017. Postoperative pain was estimated using cumulative painkillers consumption. Variables were compared between the 3 groups with ANOVA for continuous data, χ2 test for categorial data. A survival analysis with Kaplan-Meier curve assessing time to transplant recipient nadir was performed to compare the renal function recovery. RESULTS Sixty-three RLDN were performed (23 iliac, 23 vaginal and 17 umbilical extractions). There was no significant difference between the three groups in terms of operative time, blood lost, warm ischemia time, cumulative painkiller consumption and renal function recovery time. Postoperative complications for Umbilical, Vaginal and Iliac were, respectively, of 0, 3 and 1. No major difference was found between the 3 groups beside a slightly longer hospital stay in the iliac group. CONCLUSION Iliac incision might impact post-operative pain with a moderate but significant longer hospital stay. Vaginal extraction is an option when cosmetic outcomes present a real demand. The three options appeared to be safe and should be discussed with the patient in regard of the surgeon experience.
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Affiliation(s)
- Maher Abdessater
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Cécile M Champy
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - José Batista da Costa
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Jean Courcier
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - René Yiou
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Andras Hoznek
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Dimitri Vordos
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Philippe Grimbert
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Marie Matignon
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Tiphanie Londero
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Philippe le Corvoisier
- Department of Clinical Investigations, APHP, Henri Mondor University Hospital, UPEC, Créteil, France.,INSERM, CIC 1430, Créteil, France
| | - Laurent Salomon
- Department of Urology, Hôpital Mont-de-Marsan, Mont-de-Marsan, France
| | - Alexandre De la Taille
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Alexandre Ingels
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
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Gholamrezaie HR, Tabibi A, Nikravesh N, Bagheri-Amiri F, Mohsenirad H. Results of Pediatric Kidney Transplants in an 8-Year Period: A Retrospective Study. Transplant Proc 2020; 52:793-799. [PMID: 32146021 DOI: 10.1016/j.transproceed.2019.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/07/2019] [Accepted: 12/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patient survival and quality of life is better after a kidney transplant compared with dialysis. In this retrospective study, we analyzed the results of pediatric kidney transplants in an 8-year period in our center. METHODS We reviewed the files of 166 children and adolescents who had undergone kidney transplants between 2008 and 2015 in our center. All the patients were younger than 18 years old and had been followed up for at least 2 years. RESULTS The transplanted kidneys were taken from live donors in 146 (88%) of the cases and from cadavers in 20 (12%) of the cases. They were procured from unrelated and related donors in 129 (90%) and 17 (10%) of the cases, respectively. Laparoscopic nephrectomy was done on 141 donors. The kidney vessels were anastomosed to the aorta, the common iliac, and the internal iliac in 3.6%, 56%, and 40.4% of cases, respectively. Preemptive kidney transplants were performed on 62 patients. The mean of patient survival was 124 ± 1.37 months. One- and five-year patient survival rates were 99% and 97%, respectively. The mean of graft survival was 118.29 ± 2.47 months. One- and five-year graft survival rates were 94% and 93%, respectively. Preemptive kidney transplants had a higher graft survival rate (P < .02). CONCLUSION Kidney transplant is a safe and feasible procedure in children and adolescents based on patient and graft survival outcomes. In our center, surgery complications led to kidney loss in very few cases.
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Affiliation(s)
- Hamid Reza Gholamrezaie
- Department of Urology, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Ali Tabibi
- Department of Urology, Shahid Labbafinejad Hospital, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nadia Nikravesh
- Department of Urology, Shahid Labbafinejad Hospital, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Bagheri-Amiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mohsenirad
- Department of Urology, Imam Reza Hospital, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Baar W, Goebel U, Buerkle H, Jaenigen B, Kaufmann K, Heinrich S. Lower rate of delayed graft function is observed when epidural analgesia for living donor nephrectomy is administered. BMC Anesthesiol 2019; 19:38. [PMID: 30885139 PMCID: PMC6421667 DOI: 10.1186/s12871-019-0713-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/11/2019] [Indexed: 12/14/2022] Open
Abstract
Background The beneficial effects of epidural analgesia (EDA) in terms of pain control and postoperative convalescence are widely known and led to a frequent use for patients who underwent living donor kidney nephrectomy. The objective of this study was to determine whether general anesthesia (GA) plus EDA compared to GA only, administered for living donor nephrectomy has effects on postoperative graft function in recipients. Methods In this monocentric, retrospective cohort analysis we analyzed the closed files of all consecutive donor- recipient pairs who underwent living donor kidney transplantations from 2008 to 2017. The outcome variable was delayed graft function (DGF), defined as at least one hemodialysis within seven days postoperatively, once hyperacute rejection, vascular or urinary tract complications were ruled out. Statistical analyses of continuous variables were calculated using the two-tail Student’s t test and Fisher exact test for categorical variables with a significance level of p < 0.05, respectively. Results The study enclosed 291 consecutive living donor kidney transplantations. 99 kidney donors received epidural analgesia whereas 192 had no epidural analgesia. The groups showed balanced pretransplantational characteristics and comparable donors´ and recipients’ risk factors. 9 out of all 291 recipients needed renal replacement therapy (RRT) during the first 7 days due to delayed graft function; none of these donors received EDA. The observed rate of DGF in recipients whose kidney donors received epidural analgesia was significantly lower (0% vs. 4.6%; p = 0.031). Conclusions In our cohort we observed a significantly lower rate of DGF when epidural analgesia for donor nephrectomy was administered. Due to restrictions of the study design this observation needs further confirmation by prospective studies.
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Affiliation(s)
- Wolfgang Baar
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Hartmut Buerkle
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Bernd Jaenigen
- Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Kai Kaufmann
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Sebastian Heinrich
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
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Hirose T, Hotta K, Iwami D, Harada H, Morita K, Tanabe T, Sasaki H, Fukuzawa N, Seki T, Shinohara N. Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopic Living Donor Nephrectomy. J Endourol 2018; 32:1120-1124. [DOI: 10.1089/end.2018.0669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takayuki Hirose
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Daiki Iwami
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Harada
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hajime Sasaki
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuyuki Fukuzawa
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Toshimori Seki
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Broe MP, Galvin R, Keenan LG, Power RE. Laparoscopic and hand-assisted laparoscopic donor nephrectomy: A systematic review and meta-analysis. Arab J Urol 2018; 16:322-334. [PMID: 30140469 PMCID: PMC6104662 DOI: 10.1016/j.aju.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 01/11/2023] Open
Abstract
Objective To compare the perioperative outcomes of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure LDN, as HALDN and LDN are the two most widely used techniques of DN to treat end-stage renal disease. Methods In this systematic review and meta-analysis, we performed a literature search of PubMed, Embase, Web of Science, and Cochrane from 01/01/1995 to 31/12/2014. The primary outcome was conversion to an open procedure. Secondary outcomes were warm ischaemia time (WIT), operation time (OT), estimated blood loss (EBL), complications, and length of stay (LOS). Data analysed were presented as odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs), I2, and P values. Subgroup analysis was performed. Results There were 24 studies included in the meta-analysis; three randomised controlled trials (RCTs), one randomised pilot study, two prospective, and 18 retrospective cohort studies. There were no differences in conversion to an open procedure between the two techniques for both RCTs (OR 0.42, 95% CI 0.06, 2.90; I2 = 0%, P < 0.001) and cohort studies (OR 1.06, 95% CI 0.63, 1.78; I2 = 0%, P = 0.84). WIT was shorter for the HALDN (-41.79 s, 95% CI -71.85, -11.74; I2 = 96%, P = 0.006), as was the OT (-26.32 min, 95% CI -40.67, -11.97; I2 = 95%, P < 0.001). There was no statistically significant difference in EBL, complications or LOS. Conclusion There is little statistical evidence to recommend one technique. HALDN is associated with a shorter WIT and OT. LDN has equal safety to HALDN. Further studies are required.
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Key Words
- (L)DN, (laparoscopic) donor nephrectomy
- BMI, body mass index
- EBL, estimated blood loss
- FEM, fixed-effects model
- HALDN, hand-assisted laparoscopic donor nephrectomy
- HARPDN, hand-assisted retroperitoneal donor nephrectomy
- Hand-assisted donor nephrectomy
- LOS, length of stay
- Laparoscopic donor nephrectomy
- OR, odds ratio
- OT, operation time
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses
- RALDN, robot-assisted laparoscopic donor nephrectomy
- RCT, randomised controlled trial
- REM, random-effects model
- Renal transplantation
- WIT, warm ischaemia time
- WMD, weighted mean difference
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Affiliation(s)
- Mark P Broe
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Rose Galvin
- Department of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lorna G Keenan
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Richard E Power
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
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Sevinç C, Özkaptan O, Balaban M, Karadeniz T, As A, Çicek NSK, Sarıyar M, Şahin S, Tuğcu V. Hand-assisted laparoscopic and laparoscopic donor nephrectomy: A comparison of surgical outcomes from two centres. Turk J Urol 2018; 44:362-366. [PMID: 29932406 DOI: 10.5152/tud.2018.67424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 02/21/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study was to compare the different surgical approaches of two centers on outcomes of live donor laparoscopic nephrectomy. MATERIAL AND METHODS The first 98 patients of each centre who underwent laparoscopic donor nephrectomy (LDN) or hand-assisted laparoscopic donor nephrectomy (HALDN) were included in the study. The following data were used for analyses: donor age, weight, height, body mass index (BMI), transfusion requirement, operative time, ischemia time and postoperative complications. RESULTS Median age, BMI, operation time and estimated blood loss (EBL) was 47.29 years, 27.91 kg/m2, 110.73 minutes, and 78.95 mL, respectively. Operation time was significantly shorter in the HALDN group (t=-3.554, p<0.01). EBL was not significantly different between the two groups. The difference in hospitalization time and warm ischemia times (WIT) was not significant between the two surgical technique groups (t=-1.554, t=1.258; p>0.05). No statistically significant difference was detected in the intraoperative and postoperative complication rates between two groups (p>0.05). The postoperative complication rate was 7.14% (n=7) and 6.12% (n=6) in the LDN and HALDN groups, respectively. There were two patients with conversion to open surgery in the HALDN group because of lumbar vein injury. CONCLUSION The operative and postoperative outcomes for the two techniques were found to be similar. The HALDN technique preserves the benefits of minimally invasive surgery. In experienced urologic laparoscopy centres both techniques promise similar success rates.
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Affiliation(s)
- Cüneyd Sevinç
- Department of Urology, Medicana International Hospital, İstanbul, Turkey
| | - Orkunt Özkaptan
- Department of Urology, Medicana International Hospital, İstanbul, Turkey
| | - Muhsin Balaban
- Department of Urology, Medicana International Hospital, İstanbul, Turkey
| | - Tahir Karadeniz
- Department of Urology, Medicana International Hospital, İstanbul, Turkey
| | - Abdullah As
- Department of General Surgery, Medicana International, İstanbul, Turkey
| | | | - Muzaffar Sarıyar
- Department of General Surgery, Medicana International, İstanbul, Turkey
| | - Selçuk Şahin
- Department of Urology and Kidney Transplantation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Volkan Tuğcu
- Department of Urology and Kidney Transplantation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Wiborg MH, Toft A, Jahn H, Hansen LU, Lund L. Initial experience with hand-assisted laparoscopic donor nephrectomy: a single-centre experience over 5 years. Scand J Urol 2016; 51:73-77. [PMID: 27827004 DOI: 10.1080/21681805.2016.1249025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Anja Toft
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Henrik Jahn
- Department of Urology, Odense University Hospital, Odense, Denmark
| | | | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
- Clinical Institute, Southern University of Denmark, Odense, Denmark
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Nashan B, Abbud-Filho M, Citterio F. Prediction, prevention, and management of delayed graft function: where are we now? Clin Transplant 2016; 30:1198-1208. [PMID: 27543840 DOI: 10.1111/ctr.12832] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
Delayed graft function (DGF) remains a major barrier to improved outcomes after kidney transplantation. High-risk transplant recipients can be identified, but no definitive prediction model exists. Novel biomarkers to predict DGF in the first hours post-transplant, such as neutrophil gelatinase-associated lipocalin (NGAL), are under investigation. Donor management to minimize the profound physiological consequences of brain death is highly complex. A hormonal resuscitation package to manage the catecholamine "storm" that follows brain death is recommended. Donor pretreatment with dopamine prior to procurement lowers the rate of DGF. Hypothermic machine perfusion may offer a significant reduction in the rate of DGF vs simple cold storage, but costs need to be evaluated. Surgically, reducing warm ischemia time may be advantageous. Research into recipient preconditioning options has so far not generated clinically helpful interventions. Diagnostic criteria for DGF vary, but requirement for dialysis and/or persistent high serum creatinine is likely to remain key to diagnosis until current work on early biomarkers has progressed further. Management centers on close monitoring of graft (non)function and physiological parameters. With so many unanswered questions, substantial reductions in the toll of DGF in the near future seem unlikely but concentrated research on many levels offers long-term promise.
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Affiliation(s)
- Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mario Abbud-Filho
- Department of Nephrology, Medical School FAMERP, Director Organ Transplantation Center Foundation FUNFARME, São José do Rio Preto, SP, Brazil
| | - Franco Citterio
- Department of Surgery, Renal Transplantation, Catholic University, Rome, Italy
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Fabián JF, Mancilla E, Aburto JS, Kasep J, Lopez JO, Almaguer F, Basilio CI, García HB, Arcos AG. Hand-Assisted Laparoscopic Nephrectomy for Live Donor Kidney Transplantation. Transplant Proc 2016; 48:568-71. [PMID: 27110004 DOI: 10.1016/j.transproceed.2016.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The live donor nephrectomy is an unusual surgical procedure as it is performed on healthy individuals. It is important to make the procedure as safe as possible without compromising the health of the donor and graft function. JUSTIFICATION In Mexico during 2014, 2610 kidney transplantations performed, and 1862 grafts were from living donors. OBJECTIVE We describe our experience with hand-assisted laparoscopic nephrectomy on live donors for kidney transplantation. MATERIALS AND METHODS We present a descriptive and observational study in which all living donors who completed the study protocol for renal transplantation are included. RESULTS From September 2006 to July 2015, there were 238 hand-assisted laparoscopic nephrectomies with live donors; 227 (95.37%) were performed on the left side and 11 (4.63%) on the right side. Of donors, 54.1% were females. The average values for the variables analyzed were age 38.17 years, 25.94 BMI, creatinine 0.82-1.13 mg/dL pre- and postoperative month respectively, length of stay 4.95 (range 2-8), warm ischemia 5.07 (range 3-13) minutes, surgical time 168.85 minutes (range 90-306), and transsurgical bleeding 139 055 mL (range 25-650). One patient was reoperated for abdominal pain and bloating without evidence of pathology, attributing it to metabolic ileus. Two patients were converted to open surgery; 1 by technical problems with the laparoscopic equipment and the second by bleeding from the renal vein, both with good results. DISCUSSION AND CONCLUSIONS Laparoscopic nephrectomy is a safe method that allows kidney donors to have a speedy recovery without modifying the survivals of renal grafts.
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Affiliation(s)
- J F Fabián
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México.
| | - E Mancilla
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - J S Aburto
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México; Department of Urology, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - J Kasep
- Department of Urology, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - J O Lopez
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - F Almaguer
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - C I Basilio
- Department of Urology, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - H B García
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - A G Arcos
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
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You D, Lee C, Jeong IG, Han DJ, Hong B. Transition From Hand-Assisted to Pure Laparoscopic Donor Nephrectomy. JSLS 2016; 19:JSLS.2015.00044. [PMID: 26229420 PMCID: PMC4517067 DOI: 10.4293/jsls.2015.00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: We compared perioperative donor outcomes and early graft function of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure laparoscopic donor nephrectomy (PLDN) performed by a single surgeon, to define the feasibility of technical transition from HALDN to PLDN. Methods: From October 1, 2012, through June 30, 2014, 60 donor nephrectomies were performed by a single surgeon who lacked experience with laparoscopic renal surgery: the first 30 by HALDN and the last 30 by PLDN. Operative and convalescence parameters were compared, as were intra- and postoperative complications within 90 days according to the Satava and Clavien-Dindo classifications, respectively. Binary logistic regression analysis was used to estimate the association of baseline characteristics with complications. Results: Baseline characteristics were similar in the 2 groups, except for American Society of Anesthesiologists score II (10.0% vs 43.3%; P = .007). All procedures were completed as planned. All operative and convalescence parameters of donors and graft outcomes were similar in the 2 groups, as were overall rates of intraoperative (43.3% vs 36.7%, P = .598) and postoperative (86.7% vs 70.0%; P = .209) complications. No factor was significantly predictive of intraoperative complications, whereas sex (female vs male, odds ratio, 0.183; P = .029) and learning curve (odds ratio, 0.602; P = .036) were significant determinants of postoperative complication. Conclusion: The technical transition from HALDN to PLDN does not involve a steep learning curve for surgeons less experienced with laparoscopic renal surgery and maintains similar perioperative donor and graft outcomes.
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Affiliation(s)
| | | | | | - Duck Jong Han
- Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chaudhuri A, Gallo A, Grimm P. Pediatric deceased donor renal transplantation: An approach to decision making II. Acceptability of a deceased donor kidney for a child, a snap decision at 3 AM. Pediatr Transplant 2015; 19:785-91. [PMID: 26426405 DOI: 10.1111/petr.12582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Abstract
Allocation of deceased donor kidneys is based on several criteria; however, the final decision to accept or reject the offered kidney is made by the potential recipient's transplant team (surgeon/nephrologist). Several considerations including assessment of the donor quality, the HLA match between the donor and the recipient, several recipient factors, the geographical location of the recipient, and the organ all affect the decision of whether or not to finally accept the organ for a particular recipient. This decision needs to be made quickly, often on the spot. Maximizing the benefit from this scarce resource raises difficult ethical issues. The philosophies of equity and utility are often competing. This article will discuss the several considerations for the pediatric nephrologist while accepting a deceased donor kidney for a particular pediatric patient.
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Affiliation(s)
- Abanti Chaudhuri
- Department of Pediatric Nephrology, Stanford University, Stanford, CA, USA
| | - Amy Gallo
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Paul Grimm
- Department of Pediatric Nephrology, Stanford University, Stanford, CA, USA
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Chaudhuri A, James G, Grimm P. Whether or not to accept a deceased donor kidney offer for a pediatric patient. Pediatr Nephrol 2015; 30:1529-36. [PMID: 26130248 DOI: 10.1007/s00467-015-3139-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022]
Abstract
The expansion of the number of children on the deceased donor renal transplant waitlist has far outstripped the supply of organs in most countries, leading to numerous adjustments to increase supply and to maximize the utility of donor organs. The system for organ allocation varies by country based on local laws, priorities, and resources. Adjustments are made to optimize allocation, enhance post-transplant survival benefit, decrease unequal transplant access, and optimize utilization of donated kidneys. Allocation of deceased donor kidneys is based on several criteria; however, the final decision to accept or reject the offered kidney is made by the potential recipient's transplant team (surgeon/nephrologist). Several considerations including assessment of the donor quality, the human leukocyte antigen (HLA) match between the donor and the recipient, numerous recipient factors, the geographical location of the recipient, and the organ all affect the decision to accept the organ or not for a particular recipient. This decision must be made quickly, often on the spot. Maximizing the benefit from this scarce resource raises difficult ethical issues. The philosophies of equity and utility are often competing. In this manuscript, we highlight a representative case that helps to focus on important issues for the pediatric nephrologist to consider while making the decision to accept a deceased donor kidney offer for a particular pediatric patient.
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Affiliation(s)
- Abanti Chaudhuri
- Department of Pediatric Nephrology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5208, USA,
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A comparison of technique modifications in laparoscopic donor nephrectomy: a systematic review and meta-analysis. PLoS One 2015; 10:e0121131. [PMID: 25816148 PMCID: PMC4376908 DOI: 10.1371/journal.pone.0121131] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/28/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of different technique modifications in laparoscopic donor nephrectomy. DESIGN Systematic review and meta-analyses. DATA SOURCES Searches of PubMed, EMBASE, Web of Science and Central from January 1st 1997 until April 1st 2014. STUDY DESIGN All cohort studies and randomized clinical trials comparing fully laparoscopic donor nephrectomy with modifications of the standard technique including hand-assisted, retroperitoneoscopic and single port techniques, were included. DATA-EXTRACTION AND ANALYSIS The primary outcome measure was the number of complications. Secondary outcome measures included: conversion to open surgery, first warm ischemia time, estimated blood loss, graft function, operation time and length of hospital stay. Each technique modification was compared with standard laparoscopic donor nephrectomy. Data was pooled with a random effects meta-analysis using odds ratios, weighted mean differences and their corresponding 95% confidence intervals. To assess heterogeneity, the I2 statistic was used. First, randomized clinical trials and cohort studies were analyzed separately, when data was comparable, pooled analysis were performed. RESULTS 31 studies comparing laparoscopic donor nephrectomy with other technique modifications were identified, including 5 randomized clinical trials and 26 cohort studies. Since data of randomized clinical trials and cohort studies were comparable, these data were pooled. There were significantly less complications in the retroperitoneoscopic group as compared to transperitoneal group (OR 0.52, 95%CI 0.33-0.83, I2 = 0%). Hand-assisted techniques showed shorter first warm ischemia and operation times. CONCLUSIONS Hand-assistance reduces the operation and first warm ischemia times and may improve safety for surgeons with less experience in laparoscopic donor nephrectomy. The retroperitoneoscopic approach was significantly associated with less complications. However, given the, in general, poor to intermediate quality and considerable heterogeneity in the included studies, further high-quality studies are required. TRIAL REGISTRATION The review protocol was registered in the PROSPERO database before the start of the review process (CRD number 42013006565).
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Trasplante renal de donante vivo: “una mirada global”. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Comparison of the laparoscopic versus open live donor nephrectomy: an overview of surgical complications and outcome. Langenbecks Arch Surg 2014; 399:543-51. [DOI: 10.1007/s00423-014-1196-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/14/2014] [Indexed: 01/10/2023]
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Simforoosh N, Soltani MH, Basiri A, Tabibi A, Gooran S, Sharifi SHH, Shakibi MH. Evolution of laparoscopic live donor nephrectomy: a single-center experience with 1510 cases over 14 years. J Endourol 2013; 28:34-9. [PMID: 24074354 DOI: 10.1089/end.2013.0460] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study evaluated the outcomes of laparoscopic donor nephrectomy (LDN) and proposed modifications for kidney donation surgery. From February 1997 to February 2011, 1510 LDNs were performed. PATIENTS AND METHODS Surgical modifications included a modified open access technique for entry into the abdominal cavity, using vascular clips for safe and cost-effective control of the renal pedicle, control of the lumbar veins, and adrenal vein using bipolar cautery instead of clips, and leaving the gonadal vein intact with the ureter. Kidneys were extracted by hand through a Pfannenstiel incision. Heparin was not used after the first 300 cases to prevent potential hemorrhagic complications. RESULTS Although three major vascular injuries occurred using the closed access method that were managed successfully, no access-related complications occurred using the modified open access technique. Clip failure did not happen in any cases. Patient and graft survival at 1 year post-transplantation were 96.5% and 95.5%, respectively, and at 5 years post-transplantation were 95.3% and 89.5%, respectively. CONCLUSION The proposed surgical modifications are based on 14 years of experience and 1510 cases, and make LDN simple, safe, and cost-effective. The excellent recipient and graft outcomes with minimal morbidity obtained further confirm that LDN can be considered as the gold standard for kidney donation surgery.
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Affiliation(s)
- Nasser Simforoosh
- Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Islamic Republic of Iran
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