老年活体亲属供肾移植的安全性分析

目的 探讨老年活体亲属供肾移植供体、受体的围手术期并发症、疗效及安全性.方法 亲属活体供肾移植132例,分为老年供体组(≥55岁,43例)和中青年供体组(＜55岁,89例);对供受体的住院时间、手术前后血肌酐(SCr)、内生肌酐清除率(CCr)、肾小球滤过率(GFR)、并发症以及受体的急性排斥反应率、人/肾存活率等进行比较分析.结果 2组供者术前SCr分别为(77.67±15.21)、(83.09±15.98)μmol/L,术后7 d分别为(109.54±22.32)、(106.56±23.46)μmol/L,均在正常范围内,2组间各时间点比较差异均无统计学意义(P值均＞0.05).术后3个月2组供者SCr分别为(112.57±20.87)、(104.29±19.43)μmol/L,与术前比较分别上升44.93%和25.51%,老年供体组比中青年供体组供者scr升高更明显.差异有统计学意义(P=0.0268).2组术前CCr分别为(1.63±0.34)、(1.56±0.25)ml/s,术后10 d分别为(0.83±0.29)、(1.11±0.27)ml/s.老年供体组术后3个月CCr为(0.97±0.10)ml/s,中青年供体组为(1.16±0.17)ml/s.2组手术前后CCr变化差异无统计学意义(P＞0.05).老年供体组术后10 d的留存肾GFR为(36.58±13.26)ml/min,术后3个月增加至(52.31±12.74)ml/min,达到原双肾GFR[(73.01±20.96)ml/min]的71.65%.中青年供体组术后10 d GFR为(38.32±10.79)ml/min,术后3个月增至(56.31±12.95)m1/min,达到原双肾GFR[(78.34±20.98)ml/min]的71.88%.手术前后GFR变化差异均无统计学意义,P值均＞0.05.供者手术并发症包括术中脾脏包膜下血肿1例、降结肠破裂1例和切口脂肪液化5例.术前和术后各时间点2组受者SCr水平差异无统计学意义(P值均＞0.05).2组供者平均住院时间分别为(13.2±3.4)和(12.8±2.6)d,P=0.4563.2组受者平均住院时间分别为(23.1±11.9)和(22.3士11.4)d,P=0.6991.老年供体组受者6个月内急性排斥反应发生率为4.7%(2/43),中青年供体组为7.9%(7/89).术后1年内2组各死亡1例,中青年供体组因急性排斥反应移植肾失功1例.结论 老年活体亲属供肾可能存在一定危险性,应予以重视,但供体年龄并非独立风险因素.在严格控制老年供者的纳入标准、对供者进行全面系统评估的情况下,老年供体活体肾移植的供体和受体围手术期并发症/疗效及安全性与中青年供体比较无明显差异.     

50岁以上亲属活体肾移植供者安全性分析

目的 探讨50岁以上亲属活体供肾移植供者的安全性. 方法 1993年4月至2007年12月行年龄>50(51～78)岁亲属活体供肾移植45例,同期年龄≤50岁供者62例作为对照组.比较2组供者手术前后SCr、GFR变化,手术并发症及术后随访情况. 结果 供肾手术均获成功.2组供者术前SCr分别为(82.16±10.86)和(78.66±10.41)μmol/L,术后1周、1个月及12个月分别为(106.00±8.68)、(86.62±10.81)、(83.18±9.19)μmol/L和(103.89±9.29)、(85.65±7.42)、(80.32±8.89)μmol/L,组问比较差异均无统计学意义(P>0.05);2组术前GFR分别为(85.82±6.26)和(88.74±9.44)ml/min,术后1、12个月分别为(49.76±3.57)、(60.32±4.42)ml/min和(51.36±5.39)、(62.10±6.31)ml/min,组间比较差异均无统计学意义(P>0.05).2组供者术后平均住院时间分别为9及8 d.>50岁组术中发生胸膜损伤2例,术后切口疼痛、下腹部麻木感4例,切口脂肪液化1例;对照组发生胸膜损伤1例,术后切口疼痛、下腹部麻木感9例.>50岁组供者随访37(12～180)个月,肾功能正常.结论 高龄不是亲属活体供肾绝对禁忌证,术前全面系统评估及术中仔细操作是高龄供者术后安全性的重要保证.     

老年活体供肾移植术后供者安全性及受者移植效果的分析

目的 分析老年活体供肾移植术后供者的安全性及受者的移植效果.方法 回顾性分析251例亲属活体供肾移植的临床资料.根据供者年龄,将251例活体供肾移植分为老年供肾组(≥55岁)和中青年供肾组(<55岁),对手术前后两组供、受者的血清肌酐(Cr)、肾小球滤过率(GFR)、内生肌酐清除率(Ccr)、并发症、平均住院时间以及受者的人/肾存活率、急性排斥反应发生率进行比较和分析.结果 老年供肾组和中青年供肾组供者手术前后血Cr水平的差异无统计学意义(P>0.05),而Ccr的差异有统计学意义(P<0.05).老年供肾组与中青年供肾组供者比较,术前总GFR、留存肾GFR及术后10 d留存肾GFR比较,差异均无统计学意义(P>0.05);老年供肾组供者术后10 d与术前的留存肾GFR比较,差异无统计学意义(P>0.05);中青年供肾组供者术后10 d的留存肾GFR较术前明显上升,差异有统计学意义(P<0.05).老年供肾组与中青年供肾组受者比较,手术前后各相应时间点的血Cr水平差异无统计学意义(P>0.05).老年供肾组和中青年供肾组供者平均住院时间分别为(16.67±7.78)d和(16.11±5.89)d(P>0.05),受者平均住院时间分别为(29.61±24.28)d和(28.76±19.27)d(P>0.05).两组受者6个月内急性排斥反应发生率分别为6.50%和5.75%(P>0.05).老年供肾组受者术后死亡1例,中青年供肾组死亡3例,并有1例因急性排斥反应切除移植肾.结论 老年活体供肾移植术前应对供者进行严格的选择,在进行全面系统评估的前提下,可以保证供者术后的安全以及受者的移植效果.     

亲属活体供肾移植后近期及中长期供者和受者的安全性分析

目的 探讨亲属活体供肾移植术后近期及中长期供、受者的安全性.方法 对106名亲属活体供肾者及其受者进行随访.随访日分别为肾移植后2个月至7年,其中32名供者随访时处于术后3个月内,44名处于术后3个月至1年,30名处于术后1年以上(其中术后1～3年者14名,3～5年者11名,5年以上者5名).以GFR作为评估供、受者肾功能的主要指标,比较供、受者手术前后的肾功能以及血压和尿蛋白.GFR的计算采用同位素发射计算机辅助断层显像法(GFR-ECT法)、24 h尿肌酐(Cr)清除率法(GFR-24 h Urine法)及Cockcroft-Gault公式法(GFR-Cr法).结果 取肾前106名供者的GFR-ECT和GFR-Cr分别为(1.51±0.13)和(1.99±0.42)ml/s,GFR-ECT是GFR-Cr的75.8%;术后第5天,供者的GFR-Cr为(1.40±0.33)ml/s,为术前的70.5%;术后3个月内、3个月至1年和1年以上者的GFR-Cr分别为(1.47±0.28)、(1.36±0.24)和(1.37±0.23)ml/s,分别为取肾术前的73.7%、68.0%和68.6%;术后1～3年者、3～5年者及5年以上者的GFR-Cr与超过1年者整体的GFR-Cr比较,差异无统计学意义(P>0.05).4名供者术后尿蛋白为±,均为术后超过1年者;4名供者血压升高.术后3个月、1年及1年以上,受者的GFR-Cr分别为(1.09±0.26)、(1.20±0.31)和(1.07±0.29)ml/s.结论 术后近期供者的GFR会下降,并小幅波动,术后中长期其GFR接近术前70%的水平,并趋于稳定.亲属活体供肾移植术后供、受者具有良好的安全性.     

亲属活体肾移植供者的安全性分析

目的 分析亲属活体肾移植供者手术前后的相关指标变化,探讨活体供者的安全性.方法对132例亲属活体供肾者进行心理和生理分析,包括尿常规、血生化、肾小球滤过率(GFR)、内生肌酐清除率(CCr)和生活质量等指标.结果 132例供肾者的生活质量评分与正常人群比较差异无统计学意义(P＞0.05).供肾切取术前供者血肌酐(SCr)为(78.33±15.94)μmol/L,术后7 d为(108.49±19.88)μmol/L(P=0.000);术后6个月为(112.47±20.38)μmol/L,与术后7 d比较差异无统计学意义(P=0.109).供肾切取术前供者CCr为(95.80±20.92)ml/min,术后7 d为(57.36±14.92)ml/min,与术前比较P=0.017;术后6个月为(65.49±8.25)ml/min,与术后7 d比较差异无统计学意义(P=0.619).术前双肾GFR为(74.08±18.51)ml/min,右肾GFR为(38.43±10.33)ml/min,供肾切取术后6个月保留右肾GFR为(56.49±13.01)ml/min,与术前双肾GFR比较,P=0.000;保留右肾GFR与术前自身比较代偿性增加47.0%.手术并发症包括脾脏包膜下出血1例,降结肠破裂1例,切口脂肪液化5例. 结论 术前对供肾者进行充分系统的医学心理学和生理学评估,严格履行风险告知义务,供受者术中规范操作,围手术期合理管理和建立严密的随访制度,可以有效提高亲属活体移植供肾者的心理和生理安全性.     

99Tcm-DTPA肾动态显像评估活体供肾功能

目的 分析99Tcm-DTPA肾动态显像法在亲属活体肾移植供肾功能评价中的应用和影响因素,探讨其临床应用价值和判定标准. 方法对亲属活体肾移植供体在术前应用99Tcm-DTPA肾动态显像法测定双侧肾脏肾小球滤过率(GFR)和尿肌酐法计算24 h内生肌酐清除率(CCr)评估肾功能.手术前、后对2种方法的检测结果进行对比.对留存肾进行手术前、后的比较,观察其代偿性变化.结果 供者术前SCr为(79.87±17.63)μmol/L,术后为(99.93±20.63)μmol/L,与术前比较,升高25.12%(P=0.000),但仍在正常范围.术前CCr为(1.56±0.29)ml/s,术后为(1.07±0.29)ml/s,较术前降低31.41%(P=0.019).术前供者双肾GFR为(72.32±18.70)ml/min,较CCr低22.95%.术后留存肾GFR为(54.39±15.63)ml/min,较术前[(36.64±9.15)ml/min]增加48.44%(P=0.000),但与术前双肾GFR比较则下降24.79%(P=0.021).手术前后比较差异均有统计学意义(P值均＜0.05).术前BUN为(5.39±1.43)mmol/L,术后为(5.84±1.29)mmol/L,升高8.35%(P=0.076).结论 99Tcm-DTPA肾动态显像法测定GFR是观察肾功能比较灵敏的指标,能直观评估分肾的肾小球滤过功能,评估尿路排泄情况,并可以动态观察留存肾功能的代偿性变化.     

68例腹腔镜活体供肾切取术的临床研究

目的:总结68例腹腔镜活体供肾切取术(laparoscopic live donor nephrectomy,LDN)的临床经验。方法:回顾分析2004年5月至2008年4月我院施行的LDN68例的临床资料,对手术时间,供肾热缺血时间,术中失血量,肾动、静脉长度进行统计,并对数据按照取左、右肾进行分组比较。根据改良的Clavien分级系统对围手术期并发症情况进行分析。术后对供者血肌酐(SCr),肾小球滤过率(GFR),24h尿蛋白定量水平,血压水平以及受者的肾功能情况进行随访。结果:68例LDN手术均取得成功,手术时间为(87.5±7.8)min,供肾热缺血时间为(85.6±13.1)s,术中失血量为(56.8±8.5)ml,肾动脉长度为(3.0±0.3)cm,肾静脉长度为(2.3±0.3)cm,按照取左右肾手术时间分别为(89.5±8.4)min和(86.8±7.2)min(P>0.05),供肾热缺血时间为(86.7±12.3)s和(85.2±14.1)s(P>0.05),术中失血量为(58.2±10.2)ml和(55.4±9.4)ml,(P>0.05),肾动脉长度为(2.5±0.3)cm和(3.5±0.3)cm(P<0.0001),肾静脉长度为(3.2±0.4)cm和(1.6±0.3)cm(P<0.0001)。围手术期3例(4.4%)出现并发症,其中Grade2b级1例,Grade1级2例。肾移植手术均获成功,受者在1周内肾功恢复正常,1例受者术后6个月并发肺部感染死亡。供者术后SCr,24h尿蛋白定量水平,GFR值维持在正常范围内,无新发高血压患者出现。结论:LDN安全、微创,完善LDN操作技术,加强对供者术后随访十分重要。     

手助腹腔镜与开放手术活体供肾切取术的临床研究

目的比较手助腹腔镜活体供肾切取术（HLDN）和开放手术活体供肾切取术（ODN）的临床疗效,观察术后受者移植肾近期存活情况。方法回顾性分析中南大学湘雅三医院移植中心2004年1月至2013年11月完成的341例亲属活体肾移植供、受者资料。根据供者手术方式的不同,将其分为HLDN组（103例）和ODN组（238例）。比较两组受者手术时长、切口长度、供肾热缺血时间、肾动脉长度、肾静脉长度、术中失血量、围手术期芬太尼用量、术后非甾体抗炎药（NSAIDs）用量和术后恢复劳动天数。术后48h使用视觉模拟评分（VAS）法评估两组供者疼痛程度。术后随访供、受者恢复情况,并于术后7d、1个月复查受者肾功能。连续变量采用t检验进行比较,分类变量采用Fisher确切概率法进行比较。结果HLDN组和ODN组供者切口长度分别为（6．0±0．4）cm和（13．5±1．0）cm,术中失血量分别为（45±12）mL和（151±24）mL,差异均有统计学意义（t=73．56和42．56,P均〈0．05）。两组手术时长、供肾热缺血时间、肾动脉长度、肾静脉长度相比,差异均无统计学意义（t=1．39,1．70,0．00和1．85,P均〉0．05）。103例HLDN组供者中有102例顺利完成手术,1例主动中转开放,术后发生肺部感染1例,无术后切口感染及其他严重并发症。238例ODN组供者均成功完成手术,术后切口感染1例、脂肪液化2例,术后出血通过外科止血2例,无其他手术相关并发症。HLDN组和ODN组供者术后48hVAS分别为（2．3±0．6）分和（3．9±0．9）分,围手术期芬太尼用量分别为（1．7±0．2）mg和（1．9±0．2）mg,术后NSAIDs用量分别为（22±33）mg和（47±42）mg,术后恢复劳动天数分别为（23±10）d和（44±15）d,差异均有统计学意义（t=16．52,8．48,5．37和13．00,P均〈0．05）。两组供者术后7d、1个月血清肌酐水平相比,?     

活体肾移植供者安全性的随访观察

目的探讨活体肾移植对供者安全性的影响。方法研究对象为2003年4月至2007年4月在新疆医科大学第一附属医院完成活体供肾肾移植的62例供者。记录供者手术时间和住院时间,观察术后并发症发生情况和预后情况。术后随访,随访内容包括血清肌酐(Scr)、血尿素氮(BUN)、肾小球滤过率(GFR)、血浆白蛋白、血红蛋白及血压等指标,同时调查供肾对生活工作的影响。结果62例供者供肾手术均获成功。供者中1例开放取肾术中发生气胸,1例发生切口脂肪液化坏死,经对症治疗后痊愈。2例术后并发肺部感染,选用敏感抗生素及雾化吸入治疗后治愈,其余术后均恢复顺利。62例供者平均术后住院时间(8.2±2.6)d,随访时间为(3.2±1.1)年。所有供者均存活,家庭生活和日常工作也未受到明显影响。62例供者术前及术后7 d、3个月、1年、3年、5年的Scr、BUN、GFR、血浆白蛋白、血红蛋白及血压变化情况比较,差异无统计学意义(均为P0.05)。结论活体供肾肾切除手术安全可行。严格完善术前检查,术中仔细操作及术后严密随访对于保障供者的安全有十分重要的意义。     

超选择性肾分支动脉栓塞联合零缺血后LPN对T1期肾癌患者术后肾功能影响

目的探讨数字减影技术(DSA)超选择性肾分支动脉栓塞联合零缺血后腹腔镜肾部分切除术(LPN)治疗T1期肾癌的安全性及对患者肾功能的影响。方法选择2017年5月至2020年4月在本院因T1期肾癌行后LPN的39例患者, 术前1～12 h先在介入手术室行DSA超选择性肾肿瘤靶动脉栓塞, 然后再行后腹腔镜下零缺血肾部分切除术。对患者的手术时间、术中出血量、术后胃肠道功能恢复所需时间、术后住院时间等进行分析, 比较术前24 h和术后24 h、7 d、30 d的血尿素氮(BUN)、血肌酐(Scr)水平, 同时对患者术前及术后6个月的分肾小球滤过率(GFR)结果进行分析。结果所有手术均成功完成。患者手术时间为(123.2±7.6) min, 术中出血量为(108.5±66.3)mL, 术后胃肠道功能恢复时间为(2.5±0.6)d, 术后住院时间为(7.6±1.5)d。术前及术后的Scr、BUN水平比较, 差异均无统计学意义(均P>0.05);术后6个月患肾的GFR为(45.6±8.4)mL/min, 较术前的(59.0±9.5)mL/min降低(P<0.001), 而健侧肾的术后GFR...     

腹腔镜技术获取活体供肾的基础研究

目的探讨建立小猪腹腔镜活体供肾切取和原位肾移植模型的可行性以及CO2气腹对小猪移植肾功能恢复及组织形态的影响。方法 40头滇南小耳猪经配型分为CO2气腹腹腔镜活体供肾切取组（LDN组,n=20）和开放活体供肾切取组（ODN组,n=20）,每组供、受体均为10头;两组分别采用腹腔镜和开放手术经腹膜后入路切取供肾后行原位肾移植。术后监测尿量、血清肌酐（SCr）及血尿素氮（BUN）;术后30d切取移植肾组织制作石蜡切片用于组织病理检查。结果 LDN组和ODN组均成功建立6例小猪原位肾移植模型,移植成功率均为60%（6/10）。LDN组和ODN组热缺血时间分别为（89±6）s和（30±11）s,差异有统计学意义（t=11.53,P〈0.05）。术后第3天LDN组和ODN组SCr分别为（152±16）μmol/L和（126±8）μmol/L,BUN分别为（7.26±0.99）mmol/L和（2.87±0.39）mmol/L,差异均有统计学意义（F=11.003,P〈0.05;F=6.303,P〈0.05）;术后第7天LDN组和ODN组SCr分别为（121±5）μmol/L和（89±10）μmol/L,BUN分别为（2.87±0.39）mmol/L和（1.63±0.38）mmol/L,差异均有统计学意义（F=48.301,P〈0.05;F=31.719,P〈0.05）。移植肾组织病理检查结果：HE染色显示LDN组移植肾肾小管上皮细胞损伤、肾间质水肿及炎性细胞浸润较ODN组稍重,但差异无统计学意义（P〉0.05）;过碘酸-Schiff染色及Masson染色显示两组移植肾病理改变无特异性。结论腹腔镜活体供肾切取术可影响移植肾的早期恢复,但对术后晚期移植肾功能及病理改变的影响与开放活体供肾切取术比较无差异。建立小猪经腹膜后入路腹腔镜活体供肾切取和原位肾移植模型具有可行性。     

Comparison of changes in tissue oxidative-stress markers in experimental model of open, laparoscopic, and retroperitoneoscopic donor nephrectomy

PURPOSE: We evaluated the oxidative stress in renal tissue during three types of surgery: open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), and retroperitoneoscopic donor nephrectomy (RDN). The aim was to find out which is the appropriate procedure for harvesting a donor kidney. MATERIALS AND METHODS: Twenty-four New Zealand White rabbits were randomized to four groups, each consisting of six rabbits. Group I (control) was subjected to 180 minutes of anesthesia, and transperitoneal nephrectomy was performed without creation of warm ischemia. In group II (ODN), after 180 minutes of anesthesia, warm ischemia was created for 5 minutes, and nephrectomy was performed. Group III (LDN) was subjected to 5 minutes of warm ischemia after 180 minutes of pneumoperitoneum at 12 mm Hg, and the kidney was removed. In group IV (RDN), after pneumoretroperitoneum at 12 mm Hg for 180 minutes, warm ischemia was created for 5 minutes, and nephrectomy was performed. Renal tissues were analyzed to determine malondialdehyde (MDA) and reduced glutathione (GSH) as oxidative-stress markers. RESULTS: Renal tissue GSH levels were decreased, whereas MDA levels were increased in groups II through IV compared with the control group (p<0.05). There was no statistically significant difference between the ODN, LDN, and RDN groups in the renal oxidative-stress markers. CONCLUSION: No differences were detected in oxidative-stress markers in renal tissue samples between ODN, LDN, and RDN. Therefore, we believe LDN and RDN can be used for live donor kidney harvesting as effectively as ODN without creating greater oxidative stress, which can have deleterious effects on a donor kidney.     

The effect of laparoscopic and open donor nephrectomy on the long-term renal function in donor and recipient: a retrospective study

Pneumoperitoneum, as used in laparoscopic donor nephrectomy (LDN), may result in negative effects on renal function in donor and recipient. This study compares long-term serum creatinine in donor and recipient after laparoscopic and open donor nephrectomy (ODN). A retrospective analysis of 120 LDN and 100 ODN donors and their recipients was performed. Serum creatinine of donor and recipient was recorded and analyzed. The follow-up period posttransplantation was 3 years. Serum creatinine in the recipients was significantly higher in the LDN groups the first week after transplantation. Serum creatinine in the donor was significantly higher in the LDN group at 1 day, 3 months, and 1 year posttransplant. Finally, creatinine levels remained 40% higher compared to preoperative values in both donor groups. LDN results in higher short-term serum creatinine levels in donor and recipient. Long-term serum creatinine levels were comparable after LDN or ODN in donor and recipient.     

Cost effectiveness of laparoscopic versus mini-incision open donor nephrectomy: a randomized study

BACKGROUND: Cost-effectiveness remains an issue surrounding the introduction of laparoscopic donor nephrectomy (LDN). METHODS: In a randomized controlled trial the cost-effectiveness of LDN versus mini-incision open donor nephrectomy (ODN) was determined. Fifty donors were included in each group. All in-hospital costs were documented. Postoperatively, case record forms were sent to the donors during 1-year follow-up to record return-to-work and societal costs. To offset costs against quality of life, the Euroqol-5D questionnaire was administered preoperatively and 3, 7, 14, 28, 90, 180, and 365 days postoperatively. RESULTS: Mean total costs were euro6,090 (US$7,308) after LDN and euro4,818 ($5,782) after ODN (P<0.001). Disposables influenced the cost difference most. Mean productivity loss was 68 and 75 days after LDN and ODN respectively, corresponding to euro783 ($940) gained per donor after LDN. The main gain in quality of life in the LDN group was realized within 4 weeks postoperatively. LDN resulted in a mean gain of 0.03 quality-adjusted life years at mean costs of euro1,271 ($1,525) and euro488 ($586) from a healthcare perspective and a societal perspective, respectively. This implies that one additional Quality-Adjusted Life Year after LDN costs about euro16,000 ($19,200) from a societal point of view and about euro41,000 ($49,200) from a health-care perspective. Activities other than work were resumed significantly earlier after LDN (66 vs. 91 days, P=0.01). CONCLUSION: In addition to a clinically relevant donor-experienced benefit from LDN, this technique appeared, given a societal perspective, a cost-efficient procedure mainly due to less productivity losses.     

Live donor nephrectomy and return to work

Background: Several studies report an earlier return to work after minimal invasive kidney donation compared to open donor nephrectomy. However, this variation in outcome might be influenced by other factors than the surgical technique used, such as the advice given by the physician regarding return to work. In this study, we compare the absence from work after open (ODN), laparoscopic (LDN), and hand-assisted donor nephrectomy (HA) performed in the Netherlands, in relation to the advice given. Methods: Questionnaires containing questions about return to work or return to daily activities were sent to 78 donors from three hospitals. In the HA and ODN hospitals, advice on full return to work was 3 months. In contrast, advice given in the LDN hospital was 6 weeks. Results: After LDN, donors resumed their work after 6 weeks, 5 weeks faster compared to ODN (p = 0.002) and HA (p <0.001). Complete return to work occurred 9 weeks sooner in the LDN group compared to the ODN and HA groups (both p <0.001). In the unemployed group, there was no significant difference in length until full return to daily activities. Conclusion: Return to work is influenced by the advice on return to work given by the physician as well as the morbidity associated with the surgical approach.     

Laparoscopic vs open living donor nephrectomy: a contemporary series from one centre

OBJECTIVE: To report our experience of laparoscopic living donor nephrectomy (LDN) vs open donor nephrectomy (ODN), as LDN offers potential advantages to the donor and has become a routine procedure for live kidney procurement worldwide. PATIENTS AND METHODS: Between February 2000 and August 2005 we performed 183 donor-recipient operations at our institution (ODN, 83; LDN, 100). We prospectively collected information on all donors and recipients for the same period to audit our experience with the first 100 LDNs. Patients made their operative choice after discussions that included unit experience and published information. We present our findings with the emphasis on donor operative details and early recipient graft outcome. RESULTS: Donor and recipient age, gender, body mass index, human leukocyte antigen mismatches, and vascular anastomotic times did not differ significantly between the groups. There were two conversions to an open operation in the LND group; neither affected recipient-graft outcome. The mean (sd) operative duration was 178 (38) min for the LDN and 159 (34) min for the ODN (P < 0.05). The mean (sd) hospital stay was 4.7 (1.2) days in the LND group and 6.8 (1.5) days in the ODN group (P < 0.05). There was one case of delayed graft function in both groups. Serum creatinine levels at 1, 6 and 12 months after transplantation did not differ significantly between the groups. CONCLUSIONS: Our contemporaneous series shows the safe introduction of a laparoscopic living-donor programme without compromising donor patient safety or allograft outcome.     

Laparoscopic versus open donor nephrectomy: comparing ureteral complications in the recipients and improving the laparoscopic technique.

BACKGROUND: Laparoscopic live donor nephrectomy (LDN) is a recently developed procedure, the performance of which needs to be studied. Given the reported advantages in the donors, this study looks at graft outcome and ureteral complications in recipients of kidneys procured by open donor nephrectomy (ODN) versus LDN. METHODS: The LDN recipients consisted of 193 patients since 3/27/96. A total of 168 ODN recipients from 1991 to 1998 served as controls. Immunosuppression protocols were similar for both groups. RESULTS: Two-year graft survival for LDN and ODN was 98% and 96%, respectively. Two-year patient survival for LDN and ODN was 98% and 97%, respectively. The incidence of delayed graft function and mean serum creatinine at 3 and 12 months was similar in both groups. However, the number of ureteral complications that required operative repair was significantly higher for LDN recipients compared to ODN recipients, 7.7% (n=15) vs. 0.6% (n=1) respectively (P=0.03). Ureteral stenting was required in an additional 3.1% (n=6) of LDN and 2.4% (n=4) of ODN (P=NS). There was, however, a learning curve with time. For the first 130 LDN patients, a total of 20 ureteral complications were recorded, whereas only one occurred in the more recent 63 patients (P=0.03). CONCLUSIONS: The higher ureteral complication rate in LDN recipients has improved over time as technical causes have been identified. We have noted significant improvement in ureteral viability by using the endogastrointestinal anastomosis instrument on the ureter and peri-ureteral tissue. LDN is therefore an excellent alternative to ODN. Identification of hazards unique to this technique is critical before its broader application.     

Comparison of laparoscopic and open donor nephrectomy: UK experience

A comparison of laparoscopic and open donor nephrectomy is presented by authors from the UK. They found that the laparoscopic approach could safely be offered to patients treated in experienced units and after adequate training fo the surgeon, with no increase in complications or decrease in efficacy. OBJECTIVE: To compare our early experience of laparoscopic donor nephrectomy (LDN) with a contemporary cohort of conventional open donor nephrectomy (ODN). PATIENTS AND METHODS: Transperitoneal left-sided LDN was offered to carefully selected potential live kidney donors on the basis of vascular anatomy. The first 20 donors who underwent LDN were compared with a control group of 20 patients who had ODN. Donors and recipients were compared for demographics, intraoperative variables, postoperative complications and allograft function. RESULTS: There was no peri-operative mortality in either group. No laparoscopic procedure required open conversion. The operating time was comparable (165 vs 153 min); LDN was associated with significantly less intraoperative blood loss (200 vs 350 mL; Mann-Whitney U, P = 0.01) and hospital stay (3 vs 5 days; P < 0.001). The graft warm ischaemic time was significantly longer for LDN (5 vs 2 min; P < 0.001) but this did not appear to affect either the delayed graft function rate (5% vs 10%, not significant) or serum creatinine level at discharge (125 vs 126 micromol/L). CONCLUSIONS: UK centres with experience of advanced laparoscopy and ODN can safely offer LDN to potential live donors.     

Open versus laparoscopic donor nephrectomy in live related renal transplantation

BACKGROUND: This analysis sought to evaluate the efficiency and safety of laparoscopic nephrectomy (LDN) for the donor, the recipient, and the graft. LDN seems to have advantages over the open donor nephrectomy (ODN) in length of hospital stay, postoperative comfort, and pain control. METHODS: The results of 40 patients who underwent LDN between October 2000 and September 2003 were compared to those of 40 ODN patients just preceding the LDN patients. Eight laparoscopy patients required conversion to an open procedure due to bleeding (4; two major and two minor), technical problems with the instrument (n = 1) and difficulty in the dissection (n = 3). RESULTS: The demographic data, percentages of right and left nephrectomy, number of vessels, rates of acute rejection episodes, as well as the rates of urologic and vascular complications were similar between the two groups. The time of hospital stay was shorter, and the duration of the operation and of the warm ischemia time were significantly longer for the LDN group. The postoperative decline in serum creatinine levels were similar for the two groups. Graft survival rates were 91.7% at both the first and third years in the LDN group; 92.5% and 87.0% for the ODN group, a difference that was not statistically significant. CONCLUSION: LDN is as efficient and safe as ODN for donors, recipients, and grafts.     

Pure laparoscopic versus open live donor nephrectomy: evaluation of health survey and graft functions

Background

Laparoscopic donor nephrectomy (LDN) has become the gold standard in many kidney transplantation centers seeking to increase the number of potential live donors. This study was designed to compare the health surveys and graft functions between LDN and open donor nephrectomy (ODN).

Methods

We retrospectively analyzed all patients who underwent donor nephrectomy between December 2005 and September 2009 who had at least 1 year of follow-up. We reviewed demographic data, operative time, warm ischemia period, graft function, and quality of life.

Results

Among the 132 cases, 98 were pure LDN and 34 were ODN. Demographic data were similar in both groups. Operative times were significantly longer in the ODN group but warm ischemia times significantly longer in the LDN group. However, graft functions were similar in both groups. There was 1 graft loss due to arterial thrombosis of the transplanted kidney among the LDN group. Short-Form 36 health survey scores were similar except for the role-physical subscale.

Conclusion

Although we failed to observe a significant difference between ODN and LDN as far as the quality of life and graft functions were concerned, the previously documented advantages of laparoscopy with similar operative results suggest? LDN to be the gold standard for this procedure in our institution.