Does mini-incision donor nephrectomy improve quality of life in living kidney donors?

Long-term health-related quality of life of living kidney donors: a single-center experience

PURPOSE

Over the last few years, the evaluation of the health-related quality of life (HRQoL) of living kidney donors (LKD) has become of particular interest. The present study sought to evaluate the physical and mental HRQoL after kidney removal. The clinical and paraclinical course of these patients was examined, and the impact of preoperative donor evaluation, donor nephrectomy, and surgical recovery was evaluated. These data were compared with reference data of the general population.

METHODS

Between 1998 and 2010, 72 living kidney donations were performed at our institution. To assess the HRQoL, two questionnaires-the Short Form 36 (SF-36) and a special LKD questionnaire-were sent to all 72 living donors. The records of the follow-up examinations of all 72 donors were retrospectively analyzed in order to assess the clinical and paraclinical data after kidney donation.

RESULTS

Out of 72 donors, 55 (76.4 %) responded to the questionnaires. There was no change in systolic and diastolic blood pressure during the 7-year follow-up (p > 0.05). Mild proteinuria (>150 mg/l) was observed in six cases. Kidney donors had a higher HRQoL compared to the general population with mean values of the physical and mental summation scale (PCS and MCS, respectively) being 51.3 (SD = 7.6) and 50.6 (SD = 8.1). Peri- or postoperative complications were associated with lower values for physical function and physical component summary (PCS) (p < 0.05).

DISCUSSION

Living donor kidney transplantation appears to be safe for donors. The HRQoL is excellent. To ensure a positive outcome for donors, a good clinical evaluation of potential donors is essential.

Comparing Surgical Complications of Donors and Recipients in Retroperitoneoscopic versus Mini-Incision Donor Nephrectomy: A Single-Center Experience

Anterior vertical mini-incision donor nephrectomy (MIDN) has been used as the standard retrieval procedure in our center. Though the MIDN approach was tolerated very well with low complication rates, there were especially cosmetic reasons, to consider a change of procedure. Hence we switched to a total retroperitoneoscopic donor nephrectomy (RPDN) in 2011. We compared the outcome and surgical complications of donors and recipients of the first 30 RPDNs performed with 30 consecutive MIDN procedures. In both techniques, right and left nephrectomies were carried out. After a very short learning curve, the mean RPDN operation times were shorter compared to the MIDN (109 versus 171 min, P<0.01) and donors were discharged earlier. No major complications occurred in the RPDN group and complications were less frequent compared to MIDN (17% versus 40%). The renal function in the recipients was equivalent in both groups at the time of discharge and after one year. We conclude that RPDN is easy to learn for a surgical team experienced in open retroperitoneal donor nephrectomy. The change of the retrieval technique is safe for the donor and the recipient regarding surgical complications and recipients’ renal function. Donors benefit from RPDN due to earlier hospital discharge and faster recovery.

Donor quality of life after living donor liver transplantation: a prospective study

BACKGROUND/PURPOSE

It is important to determine the health-related quality of life of live donors in liver transplantation.

MATERIALS AND METHODS

We reviewed 35 live liver donors and prospectively and longitudinally evaluated their health-related quality for 1.5 years post-surgery based on the Short Form-36 version 2 questionnaire. Scores of the donors stratified by the clinical data were analyzed. The study was approved by the University of Tokyo Institutional Review Board (No. 1533).

RESULTS

There was no donor mortality in the donor population studied. The percentage of major complications greater than Clavien's classification grade III was 8.6%. The physical component summary score decreased to 42.9 (p < 0.01) at 3 months, but recovered within 6 months after the operation. The mental component summary scores did not change during the observation period. The stratification study revealed that age and postoperative complications remained significant factors among the high physical component summary scores 3 months after the operation.

CONCLUSIONS

The findings from this survey suggest that liver harvesting does not decrease the donor's quality of life during the 1.5 years following the surgery.