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Eric J. Hazebroek, MD; Robert de Vos tot Nederveen Cappel, MD; Diederik Gommers, MD, PhD; Teun van Gelder, MD, PhD; Willem Weimar, MD, PhD; Ewout W. Steyerberg, PhD; H. Jaap Bonjer, MD, PhD; Jan N. M. IJzermans, MD, PhD

Arch Surg. 2002;137:600-605.

Background  During laparoscopic procedures, increased intra-abdominal pressure may cause transient renal dysfunction due to impaired renal blood flow and induction of neurohormones. However, the relationship between antidiuretic hormone (ADH) secretion and increased intra-abdominal pressure is poorly understood.

Hypothesis  Laparoscopic donor nephrectomy (LDN) is associated with an increase in plasma ADH concentration, which influences renal function in both the donor and transplanted graft.

Objectives  To evaluate plasma ADH levels during LDN and to correlate ADH levels with graft function.

Design and Interventions  In 30 patients who underwent LDN, plasma ADH levels were collected before insufflation, during surgery, after desufflation, and 24 hours after the procedure. In 6 patients who had open donor nephrectomy, blood samples were obtained as controls. Furthermore, graft function, operative characteristics, and clinical outcome were compared.

Setting  University hospital.

Results  In the LDN group, mean ADH levels during pneumoperitoneum and 30 minutes postinsufflation were significantly higher compared with preinsufflation values (P<.001). Twenty-four hours after LDN, mean ADH levels had returned to normal values. There were no significant differences in ADH levels in the open donor nephrectomy group. No significant differences in either intraoperative diuresis, blood pressure readings, or postoperative graft function were documented among the 2 groups.

Conclusions  In this study, LDN was associated with an increase in plasma ADH that appeared to be related to increased intra-abdominal pressure. We conclude that the increased ADH concentrations during LDN are not associated with clinically significant changes in either the kidney donor or the transplanted graft.

From the Departments of Surgery (Drs Hazebroek, de Vos tot Nederveen Cappel, Bonjer, and IJzermans), Anesthesiology (Dr Gommers), Internal Medicine (Drs van Gelder and Weimar), and Public Health (Dr Steyerberg), Erasmus Medical Center, Rotterdam, the Netherlands.

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