Do multiple renal arteries restrict laparoscopic donor nephrectomy?

Laparoscopic donor nephrectomy is a new technique. For anatomical and technical reasons, many transplant centers restrict laparoscopic donor nephrectomy to kidneys with a single artery. However, we believe that with increased experience, laparoscopic donor nephrectomy in cases of multiple renal arteries does not affect donor or recipient outcomes. Among 115 living related renal transplantations performed between January 1996 and December 2002, 31 nephrectomies were performed via laparoscopy including eight with multiple arteries and 84 via an open approach, including nine with multiple arteries. The 17 patients with multiple arteries at the two procedures were compared in terms of donor and recipient outcomes. All the patients received the same immunosuppressive regimen. The demographic data were similar in the two groups. Mean durations of the donor operations (223 vs 247 minutes), side of nephrectomy (left/right, 5/4 vs 7/1), mean warm ischemia times (230 vs 432 seconds), mean serum creatinine levels at the end of 1 year follow-up, were statistically similar for the open versus the laparoscopy groups. Urological (11.1% vs 25%) and vascular complication rates (22.2% vs 25%), acute rejection rates (11.1% vs 12.5%) were also statistically similar for open versus laparoscopy groups, respectively. One-year patient and graft survival rates were 87.5% for both groups. Laparoscopic donor nephrectomy was as safe a procedure as open surgery even in the presence of multiple renal arteries in the hands of experienced transplants surgeons.     

Does video-assisted minilaparotomy surgical living donor nephrectomy satisfy donors?

Purpose

Video-assisted minilaparotomy surgical (VAMS) nephrectomy is believed to provide better cosmetic outcomes than open-donor nephrectomy in healthy donors. However, the results of a few studies have influenced the opinion of donors on their physical appearance. This study investigated the satisfaction of donors after a VAMS living donor nephrectomy.

Methods

Donors who underwent VAMS living donor nephrectomy between 2009 and 2011 were requested to fill out a body image questionnaire. This questionnaire consisted of three subscales: body image scale (BS), confidence in surgery scale (CS), and hospital experience scale (HS). A total of 20 VAMS living nephrectomy donors completed the questionnaire.

Results

The study included 3 male and 17 female donors of overall mean age of 38.7 ± 12.4 years. Eight donors were unmarried (40.0%), 11 were married (55.0%), and 1 was divorced. The mean follow-up was 7.9 ± 4.5 months. The mean BS, CS, and HS scores were 41.6 ± 5.3, 21.85 ± 8.3, and 13.9 ± 2.2, corresponding to perfect scores of 50, 30, and 20, respectively.

Conclusion

The results of this study showed that VAMS nephrectomy donors tended to be pleased with their body image, operation, and hospital experiences.     

Does stroke volume variation predict intraoperative blood loss in living right donor hepatectomy?

Background

Although stroke volume variation (SVV) is a valuable index of preload responsiveness, there is limited information about the association between low SVV and increased hepatectomy-related bleeding. We therefore evaluated whether SVV predicts blood loss during living donor hepatectomy.

Methods

We evaluated 93 adult liver donors undergoing right hepatectomy for transplantation. Arterial blood pressure, heart rate, body temperature, central venous pressure, SVV, cardiac output, and systemic vascular resistance were measured. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to determine independent factors and optimal cutoff values of hemodynamic parameters for predicting intraoperative blood loss ≥ 700 mL.

Results

Of these 93 donors, 36 (38.7%) had blood loss ≥ 700 mL. Univariate logistic regression analysis showed that factors associated with blood loss ≥ 700 mL included heart rate, SVV, cardiac output, and systemic vascular resistance. Multivariate logistic regression analysis revealed that only SVV was an independent predictor of blood loss ≥ 700 mL. ROC curve analysis showed that the optimal cutoff value for SVV predicting blood loss ≥ 700 mL was 6% (area under the curve = 0.64).

Conclusions

SVV is a significant independent predictor of blood loss ≥ 700 mL during donor hepatectomy, suggesting that low SVV may provide useful information on intraoperative bleeding in donors undergoing right hepatectomy.     

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

BACKGROUND: Living kidney donation helps to avoid or reduce the time period of dialysis and on waiting lists in patients requiring a new organ. Mini-incision donor nephrectomy (MIDN) shows to result in better clinical outcome in comparison with traditional open donor nephrectomy (ODN). This study was performed to evaluate the impact of different surgical procedures on the quality of life (QoL) in patients that underwent donor nephrectomy. METHODS: The aim of the study was to detect differences in QoL assessed with the Short Form-36 Version 2 (SF-36v2) questionnaire between MIDN (n = 34) and ODN (n = 36). Furthermore, the development of QoL from prior to surgery until one yr afterwards, as well as outcomes of QoL in comparison with norm-based scores was investigated. RESULTS: Sixty-one of 70 patients, which is 87% (MIDN: 86%, ODN: 88%) resent a whole set questionnaires. QoL was similar at all time-points (prior to surgery, one wk, three months and one yr) in both groups. A tendency of better QoL in MIDN (Bodily Pain) after one wk was detectable (p = 0.075). Physical Component Summaries (PCS) significantly decreased from prior to surgery until one wk after surgery (p = 0.001) and improved significantly until three months (MIDN: p = 0.006, ODN: p = 0.001) and also until one yr after surgery (p = 0.002). Mental Component Summaries (MCS) were stable throughout the whole investigated time period. In comparison with norm-based scores, MIDN (p = 0.005) and ODN (p = 0.001) showed significantly higher PCS prior to, lower scores one wk after (p = 0.001), similar scores three months after and better scores (MIDN: p = 0.023, ODN: 0.015) one yr after surgery. Mental Component Scores were similar in both prior to and one wk after surgery. After three months and one yr scores were significantly better in MIDN (three months: p = 0.049, one yr: p = 0.037) and ODN (three months: 0.020, one yr: 0.073). CONCLUSION: Quality of life after living donor nephrectomy is not influenced by the surgical technique. Nevertheless the standardized instrument of the SF-36v2 Health Survey is a useful, practicable and universally interpretable tool to gain and estimate recovery from surgical procedures in the perioperative period and its development thereafter.     

Is right laparoscopic donor nephrectomy right?

Introduction  Laparoscopic donor nephrectomy has become the standard of care in many renal transplant centers. Many centers are reluctant to perform right laparoscopic donor nephrectomies, primarily due to concerns about transplanting a kidney with a short renal vein. Methods  A retrospective review of 26 right and 24 left consecutive donor nephrectomies and their recipients was performed. Patient demographics, preoperative, perioperative, and postoperative data were recorded and compared. Results  Patient demographics were similar between groups. Multiple vessels were encountered more frequently on the right side (10 vs. 3, p = 0.04) and the donated kidney had lesser preoperative function in the right group as determined by nuclear medicine imaging (46.5% vs. 49.4%, p < 0.001). Donor operating times were less in the right group (198 vs. 226 min, p = 0.016). There was no difference in implantation difficulty as demonstrated by similar operative and warm ischemia times. Complication rates were similar between both groups of donors and recipients. Conclusions  Right laparoscopic donor nephrectomy requires less operating time than, and is associated with similar outcomes for donors and recipients as, left laparoscopic donor nephrectomy. Right laparoscopic donor nephrectomy may be preferable in general and should be considered when multiple renal vessels are present on the left side and/or when preoperative function of the left kidney is greater than the right.     

Is laparoscopic donor nephrectomy here to stay?

BACKGROUND: Open live donor nephrectomy is safe and provides kidneys of excellent quality. The complexity of the laparoscopic donor technique has raised considerable concerns. METHOD: Twenty-six laparoscopic live donor nephrectomies were done from October 1997 to October 1998. RESULTS: All kidneys had immediate function. All recipients except 1 had serum creatinines less than 2.0 mg at 2 months posttransplantation. Three complications (wound infection, neuroma, reoperation) occurred. There was no mortality. CONCLUSIONS: Proper surgical training and patient selection can result in a safe donor operation that provides kidneys of excellent quality.     

Can a living kidney donor become a kidney recipient?

The living kidney donor represents a good resource for kidney transplantation. These grafts display better function and long-term graft survival at 5 and 10 years of follow-up. Furthermore, living donors prefer the possibility to increase kidney donation for a large waiting list of patients with end-stage renal disease (ESRD). However, kidney donation is a major surgical procedure associated with benefits and risks. The risks of donation have been studied in large series of living donors to focus on morbidity and mortality rates associated with the surgical procedure. New surgical laparoscopic techniques promote living kidney donation. While the benefits to the recipient are obvious, those for the donor are subjective and not quantifiable. However, donors describe donation as a great experience in life. The risk of kidney donation may be divided into the perioperative and the long-term risks. The evaluate the long-term risks for kidney donors requires a long follow-up. The main source of kidney donors in our transplant center has been living-related and -unrelated donors, with a minor percentage of cadaveric donors. In this report we present four kidney donors who developed ESRD thereafter, three becoming kidney recipients.     

Are concerns over right laparoscopic donor nephrectomy unwarranted?

OBJECTIVE: To examine the ability of several large, experienced transplantation centers to perform right-sided laparoscopic donor nephrectomy safely with equivalent long-term renal allograft function. SUMMARY BACKGROUND DATA: Early reports noted a higher incidence of renal vein thrombosis and eventual graft loss. However, exclusion of right-sided donors would deprive a significant proportion of donors a laparoscopically harvested graft. METHODS: A retrospective review was performed among 97 patients from seven centers performing right-sided laparoscopic donor nephrectomy. Surgical and postoperative demographic factors were evaluated. Complications were identified and long-term renal allograft function was compared with historical left-sided laparoscopic donor nephrectomy cohorts. RESULTS: Right laparoscopic donor nephrectomy was performed for varying reasons, including multiple left renal arteries or veins, smaller right kidney, or cystic right renal mass. Mean surgical time was 235.0 +/- 66.7 minutes, with a mean blood loss of 139 +/- 165.8 mL. Conversion was required in three patients secondary to bleeding or anatomical anomalies. Mean warm ischemic time was limited at 238 +/- 112 seconds. Return to diet was achieved on average after 7.5 +/- 2.3 hours, with mean discharge at 54.6 +/- 22.8 hours. Two grafts were lost during the early experience of these centers to renal vein thrombosis. Both surgical and postoperative complications were limited, with few long-term adverse effects. Mean serum creatinine levels were higher than open and left laparoscopic donor nephrectomy on postoperative day 1, but at all remaining intervals the right laparoscopic donors had equivalent creatinine values. CONCLUSIONS: These results confirm that right laparoscopic donor nephrectomy provides similar patient benefits, including early return to diet and discharge. Long-term creatinine values were no higher than in traditional open donor or left laparoscopic donor cohorts. These results establish that early concerns about high thrombosis rates are not supported by a multiinstitutional review of laparoscopic right donor nephrectomies.     

Is laparoscopic donor nephrectomy the new criterion standard?

HYPOTHESIS: The posttransplantation renal function outcomes between consecutive open donor and laparoscopic donor nephrectomies (LDNs) are similar and affect living donation. DESIGN: Using the medical records of renal living donor-recipient pairs, 36 consecutive open donor nephrectomies were compared with the subsequent 100 LDNs. Data collected on donor characteristics included demographics (age, race, sex, weight, and height), renal vascular and ureteral anatomical features, surgical information (blood loss, number of blood transfusions, operating time, warm ischemia time, and renal injury), complications, and length of hospital stay. Recipients' data also included renal function information (serum creatinine level on postoperative days 7 and 30) and ureteral complications during the initial hospital stay. SETTING: A not-for-profit tertiary care teaching hospital in a metropolitan area. PATIENTS: Adults who had end-stage renal disease and received a living donation kidney. MAIN OUTCOME MEASURES: Operative time, warm ischemia time, blood loss, and posttransplantation serum creatinine level. RESULTS: Patient characteristics were not significantly different between the open donor nephrectomy and LDN groups. No right kidney LDNs were done because of the shortness of the right renal vein; and, after the initial experience, left kidneys with more than 2 arteries were excluded. Warm ischemia time was recorded only for LDN, and it was found that a warm ischemia time of 10 minutes or longer was associated with difficulty in extraction and was uniformly associated with elevated mean serum creatinine levels on postoperative day 7. CONCLUSIONS: The length of hospital stay was decreased and cosmetic result enhanced. The number of living donors has increased from 28 in 1997 to 53 in 1998 and to 63 in 1999 at our institution. The length of hospital stay, incidence of complications, and comparable kidney quality indicate that LDN should be the initiating procedure for most patients.     

Are there anatomical barriers to laparoscopic donor nephrectomy?

Background: The aim of this study was to analyse the effect of the right donor kidney and multiple arteries, on donor and recipient outcomes in the era of laparoscopic live donor nephrectomy (LLDN). Methods: We retrospectively analysed the 200 donors and recipients who underwent a planned laparoscopic nephrectomy at two hospitals between September 1998 and December 2006. The impact of donor right kidney and multiple donor renal arteries on operative time, hospital stay, graft function, and donor and recipient complications were analysed. Results: Of the total cohort (n = 200), 140 (70%) were classified as Simple LLDN (left live donor kidney with single renal artery). The Complex LLDN group (n = 60) contained all right‐sided kidney (n = 28) and left‐sided kidneys with multiple renal arteries (n = 32). Baseline characteristics, extraction time, conversion to open, length of admission, overall graft function and complication rates were similar between the simple and complex groups. The second warm ischaemic time in the Simple LLDN group was slightly shorter than the Complex LLDN group (32 versus 36 min P = 0.016). The 1‐month post‐operative recipient serum creatinine level was lower in the Simple LLDN group when compared with the Complex LLDN group (117 versus 125 µmol/L P = 0.025). There was no difference in post op dialysis, acute rejection within 3 months or graft survival between the Simple and Complex LLDN groups. Conclusion: Laparoscopic procurements of right kidneys and kidneys with multiple arteries were safe and yielded kidneys with excellent function comparable with those of laparoscopic left donor nephrectomy with single artery.     

Does urinalysis predict acute renal failure after heart surgery?

Acute renal failure (ARF) usually develops in 5% to 30% of patients undergoing heart surgery and is associated with a more complicated clinical evolution course and with an excessive mortality of up to 80%. The objective of this study was to verify the frequency of ARF in postoperative coronary artery bypass surgery with and without cardiopulmonary bypass, by the evaluation of renal function markers' performance [plasma creatinine, plasma urea, urinalysis, fractional excretion of sodium, creatinine clearance and Alpha-glutathione S-transferase (alpha-GST)], besides to verify possible relations between clinical variables involved in postoperative heart surgery and the occurrence of renal insufficiency.