Laparoscopic donor nephrectomy in unusual venous anatomy – donor and recepient implications

Abstract

Objectives Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate.Materials and methods Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data.Results Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies. Conclusion Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.

Nefrectomía laparoscópica en un programa de donante vivo en la Costa Caribe de Colombia

“…Por ello, se consideró relevante mostrar que en el 22% de las nefrectomías, los pacientes tuvieron arterias renales múltiples y en el 7,4% de los casos hubo más de una vena renal presente. Estas prevalencias son más valiosas al compararlas con las reportadas por diferentes grupos en las que la proporción de pacientes con arterias renales múltiples oscila entre el 8% y el 13%; y en las que se puede observar que la anatomía de la población estudiada localmente muestra una mayor cantidad de pacientes con dicha variante anatómica 20,22,23 . Adicionalmente y teniendo en cuenta hallazgos del metaanálisis realizado por Zorgdrager et al 24 .…”

Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy

“… 2 Additionally, our study described the presence of multiple veins, whereas the majority of studies analyzed the impact of multiple arteries. Only a few studies included donors with venous anomalies, 3 , 4 , 15 , 52 showing that laparoscopic donor nephrectomy is safe and feasible in patients with vein anomalies. Our cohort had only ten kidneys with simultaneous multiple arteries and veins and no negative impact on donor outcomes.…”

Protean Drainage Patterns of the Left Renal Vein: A Cadaveric and Retrospective Clinical Study on the Surgical Implications and Technical Feasibility

“…RLRV and CLRV incidence varies between less than 1% to 10% and below 1% to above 15%, respectively [ 6 ]. In cases of donor nephrectomy in renal transplant, “warm ischemia time” is a very critical factor that has a long-term prognostic impact on renal graft survival, and the presence of multiple vessels and small length of vessels may prolong the ischemia time due to technical difficulty in procurement and wastage of time in multiple vessel anastomosis during bench surgery [ 7 ]. The left side kidney, for its longer venous pedicle, is often preferred to the right kidney for the obvious convenience of anastomose, resulting in less ischemia time of renal graft.…”