A Comparison of Recipient Renal Outcomes With Laparoscopic Versus Open Live Donor Nephrectomy

Nogueira, Joseph M.; Cangro, Charles B.; Fink, Jeffrey C.; Schweitzer, Eugene J.; Wiland, Anne; Klassen, David K.; Gardner, James M.; Flowers, John L.; Jacobs, Stephen C.; Cho, E.; Philosophe, Benjamin; Bartlett, Stephen T.; Weir, Matthew R.

doi:10.1097/00005392-199909010-00111

Cited by 53 publications

(86 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6 It was hypothesized that these factors would lead to an increased rate of graft dysfunction and failure; however, the literature fails to corroborate this. [10][11][12] Hazebroek and colleagues showed that pneumoperitoneum during LDN does not adversely affect the renal function of donors or recipients. 7 London and colleagues reported that increased intraoperative fluid administration could overcome decreased renal blood flow during LDN and prevent renal ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 More recent studies have shown that the short-term outcomes of allograft performance following LDN are equivalent to the open flank procedure. [7][8][9] However, Nogueira and colleagues 10 and Ratners and colleagues 11 found lower mean serum creatinine levels at 1 year post-transplant after LDN compared to open flank renal procurement. In their series, LDN donor kidneys were slower to achieve a nadir serum creatinine, but this had no effect on long-term outcomes.…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Samarasekera

Kim

Wang

et al. 2013

CUAJ

View full text Add to dashboard Cite

Background: Flank incision (FL), dorsal lumbotomy (DL) and laparoscopic surgery have been effective approaches to donor nephrectomy. While laparoscopic donor nephrectomy (LDN) has become increasingly popular, there has yet to be a direct comparison of the three modalities. Methods: We performed a retrospective chart review of FL, DL and LDN operations between 2002 and 2010 within a single institution. Donor and recipient characteristics, as well as surgical outcomes, were assessed. Results: There were 496 donor nephrectomy operations available for analyses. Patients in the LDN group had the lowest estimated blood loss, compared to the DL and FL groups (p < 0.001), lowest rate of complications (p < 0.01), and shortest hospital stay (p < 0.0001). Donors who underwent DL used an average of 60.12 ± 5.0 mg of morphine, which was significantly less than that used by patients in the LDN (93.2 mg, p < 0.0001) and FL (111.82 mg, p < 0.001) groups. Mean serum creatinine of recipients at day 1 post-op was the highest in the FL group (p < 0.0001 FL vs. LDN, p < 0.001 FL vs. DL), but there were no significant differences between the three groups at 2 weeks, 6, 12, 18, and 24 months post-operation (p > 0.45). Conclusions: Although a lower pain experience of LDN was not indicated, the use of LDN should be favoured over DL and FL as it is associated with fewer complications, and shorter length of stay. Of note, DL appears to be associated with higher complications and is likely not a preferred option for donor nephrectomy. RésuméContexte : L'incision du flanc, la lombotomie dorsale et la laparoscopie sont des techniques efficaces pour une néphrectomie chez un donneur vivant. Même si la laparoscopie a connu une montée en popularité, aucune comparaison directe entre les trois modalités n'a été effectuée. Méthodologie : Nous avons procédé à un examen rétrospectif des dossiers de patients ayant subi une néphrectomie par incision du flanc, par lombotomie dorsale et par laparoscopie entre 2002 et 2010 dans un même établissement. Les caractéristiques des donneurs et des receveurs ainsi que les résultats de la chirurgie ont été évalués. Résultats : Les analyses ont porté sur 496 néphrectomies. En comparaison avec les donneurs ayant subi une incision du flanc ou une lombotomie dorsale, les donneurs ayant subi une laparoscopie présentaient la perte sanguine estimée la plus faible (p < 0,001), le taux le plus bas de complications (p < 0,01) et la plus courte durée du séjour en hôpital (p < 0,0001). Les donneurs qui ont subi une lombotomie dorsale ont utilisé en moyenne 60,12 ± 5,0 mg de morphine, soit une valeur significativement plus faible que celle notée chez les patients ayant subi une laparoscopie (93,2 mg, p < 0,0001) et une incision du flanc (111,82 mg, p < 0,001). Le taux moyen de créatinine sérique le lendemain de l'intervention était le plus élevé chez les patients ayant subi une incision du flanc (p < 0,0001 incision du flanc vs laparoscopie, p < 0,001 incision du flanc vs lombotomie dorsale), mais les différences entre...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Samarasekera

Kim

Wang

et al. 2013

CUAJ

View full text Add to dashboard Cite

show abstract

“…Firstly, without knowledge of the current surgical techniques, many people may overestimate the potential risk of complications after surgery, and they may not donate based on unrealistic fears regarding the donation process. Secondly, results suggest that the overwhelming majority of the public is not particularly concerned about the risk of recipient graft failure, and that most people would tolerate a level of recipient kidney failure over five to six times higher than that which actually occurs for both laparoscopic and open nephrectomy procedures (6-9 and 5-7% 1-year graft failure for laparoscopic and open nephrectomy, respectively) (3,32). Thus, offering live kidney donation as an important option for patients and their families more frequently, while emphasizing the low risk of complications to the donor and highlighting the likelihood that recipients will have positive clinical outcomes, may improve rates of donation considerably.…”

Section: Discussionmentioning

confidence: 99%

The General Public's Concerns about Clinical Risk in Live Kidney Donation

Boulware

Ratner²,

Sosa³

et al. 2002

American Journal of Transplantation

View full text Add to dashboard Cite

Difficulty in attracting live kidney donors may be related to fears regarding both the surgical procedure for kidney harvesting and future failure of the remaining kidney. We conducted a cross-sectional study of households in Maryland to identify public disincentives to living related kidney donation. In multivariate analyses, we assessed the independent effects of several factors on willingness to donate a kidney to a sibling. We also assessed thresholds for factors above which persons would not donate a kidney. Of 385 participants, 66% were extremely willing to donate to a sibling. After adjustment, those who considered the length of a hospital stay, out-of-pocket expenses, size and appearance of a scar, the time it takes to get to the transplant center, and the donor risk of developing kidney failure very important had 50-60% less odds of being extremely willing to donate. Median acceptable levels for risk of complications, hospital stay, compensated and uncompensated time from work, time requiring pain medications, and out-of-pocket expenses were greater than levels from clinical evidence regarding both laparoscopic and open nephrectomy. Unrealistic concerns among the general public regarding live donation may serve as potential disincentives to donation. Efforts to educate the public regarding live donation might help assuage fears and attract those who may not otherwise donate.

show abstract

“…But subsequent studies have demonstrated that with increasing surgical experience, low technical complication rates can also be achieved with laparoscopic kidneys, regardless whether left or right kidneys (8), or kidneys with anatomical variations, such as multiple renal arteries, are used (9). Second, several investigators have shown slower early post-transplant function for laparoscopic (vs. open) grafts, as measured by delayed function rates (10)(11)(12) and by the recipients' early post-transplant serum creatinine levels (10,13,14). These findings are a priori not surprising, because warm ischemia times in laparoscopic donors are longer (11), and the pneumoperitoneum created during the laparoscopic operation negatively affects renal hemodynamics (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic (vs. Open) Live Donor Nephrectomy: A UNOS Database Analysis of Early Graft Function and Survival

Troppmann

Ormond²,

Perez

2003

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

A Comparison of Recipient Renal Outcomes With Laparoscopic Versus Open Live Donor Nephrectomy

Cited by 53 publications

References 2 publications

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

The General Public's Concerns about Clinical Risk in Live Kidney Donation

Laparoscopic (vs. Open) Live Donor Nephrectomy: A UNOS Database Analysis of Early Graft Function and Survival

Contact Info

Product

Resources

About