Purpose: Living donor nephrectomy is a high-stake procedure involving healthy individuals, therefore every effort should be made to define each patient's individualized risk and improve potential donors' information. The aim of this study was to evaluate the interest of the Mayo Adhesive Probability (MAP) score, an imaging-based score initially designed to estimate the risk of adherent perinephric fat in partial nephrectomy, to predict intra-and postoperative complications of living donor nephrectomy. Materials and methods: We retrospectively reviewed the imaging, clinical, and follow-up data of 452 kidney donors who underwent laparoscopic donor nephrectomy in two academic centers. Results: Imaging and follow-up data were available for 307 kidney donors, among which 44 (14%) had a high MAP score (³3). Intraoperative difficulties were encountered in 50 patients (16%), including difficult dissection (n=35) and bleeding (n=17). Conversion to open surgery was required for 13 patients (4.2%). On multivariate analysis, a MAP score ³3 was significantly associated with the risk of intraoperative difficulty (OR 14.12 (5.58-35.7), p<0.001) or conversion to open surgery (OR 18.96 (3.42-105.14), p=0.0042). Postoperative complications were noted in 99 patients (32%), including 12 patients (3.9%) with Clavien-Dindo grade III-IV complications. On multivariate analysis, a high MAP score was also associated with the risk of postoperative complications (OR 2.55 (1.20-5.40), p=0.01). Conclusions: In this retrospective bicentric study, a high MAP score was associated with the risk of intra-and postoperative complications of laparoscopic donor nephrectomy. The MAP score appears of interest in the living donor evaluation process to help improve donors' information and outcomes.

The present study is the longest series to date of renal transplantation on continent urinary diversions. The long-term outcome shows that the presence of a continent urinary diversion does not reduce transplant survival.

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