This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (38)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Surgery  • Surgical Interventions  • Endocrine Surgery  • Transplantation  • Transplantation, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Surgical Technique and Surgical and Nonsurgical Donor and Recipient Outcomes

Christoph Troppmann, MD; Kevin Wiesmann, MS; John P. McVicar, MD; Bruce M. Wolfe, MD; Richard V. Perez, MD

Arch Surg. 2001;136:897-907.

Background  For anatomical and technical reasons, many transplant centers restrict laparoscopic live donor nephrectomy (in contrast with open live donor nephrectomy) to left kidneys.

Hypothesis  This change in surgical practice increases procurement and transplantation rates of live donor kidneys with multiple renal arteries (RAs), without affecting donor and recipient outcomes.

Design and Setting  Retrospective review at an academic tertiary care referral center comparing laparoscopically procured single vs multiple-RA kidney grafts (April 1997 to October 2000).

Patients  Seventy-nine consecutive left laparoscopic live kidney donors and 78 transplant recipients.

Main Outcome Measures  Donor and recipient complications and postoperative length of stay; cold and warm ischemia time; operating time; short-term and long-term graft function; and survival.

Results  We noted multiple RAs in 21 (27%) of all kidneys. The proportion of donors with 1 or more perioperative complications was 19% in the single-RA group vs 10% in the multiple-RA group (P was not significant). For the recipients, we noted no significant differences between groups with respect to surgical complications, quality of early and late graft function, rejection rates, graft losses (all immunologic), and graft survival. Cold and warm ischemia time and length of stay were similar for donors and recipients in both groups. Median operating times were significantly longer for the multiple-RA vs single-RA group (difference, 41 minutes for donors and 45 minutes for recipients; P<.02).

Conclusions  While the introduction of laparoscopic live donor nephrectomy has significantly increased the number of grafts with multiple RAs (compared with historical open controls), this change in practice is safe for both donors and recipients from a patient outcome–based perspective. However, from an economic perspective, the longer operating time associated with multiple-RA grafts provides strong added rationale for optimization of surgical instruments and techniques to make right-sided laparoscopic nephrectomy a routine intervention.

From the Department of Surgery, University of California–Davis Medical Center, Sacramento.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of Surgery
Arch Surg. 2001;136(8):859.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Utility of 16-MDCT angiography for comprehensive preoperative vascular evaluation of laparoscopic renal donors.
Raman et al.
Am. J. Roentgenol. 2006;186:1630-1638.
ABSTRACT | FULL TEXT  

Laparoscopic live donor nephrectomy
Challacombe and Mamode
Nephrol Dial Transplant 2004;19:2961-2964.
FULL TEXT  

Early and Late Recipient Graft Function and Donor Outcome After Laparoscopic vs Open Adult Live Donor Nephrectomy for Pediatric Renal Transplantation
Troppmann et al.
Arch Surg 2002;137:908-916.
ABSTRACT | FULL TEXT  

Preferential Laparoscopic Live Donor Left Nephrectomy in Women of Childbearing Age
Ratner
Arch Surg 2002;137:225-225.
FULL TEXT