Are Concerns Over Right Laparoscopic Donor Nephrectomy Unwarranted?

Abstract

ObjectiveTo examine the ability of several large, experienced transplantation centers to perform right-sided laparoscopic donor nephrectomy safely with equivalent long-term renal allograft function. Summary Background DataEarly reports noted a higher incidence of renal vein thrombosis and eventual graft loss. However, exclusion of right-sided donors would deprive a significant proportion of donors a laparoscopically harvested graft. MethodsA retrospective review was performed among 97 patients from seven centers performing right-sided laparoscopic donor nephrectomy. Surgical and postoperative demographic factors were evaluated. Complications were identified and longterm renal allograft function was compared with historical leftsided laparoscopic donor nephrectomy cohorts. ResultsRight laparoscopic donor nephrectomy was performed for varying reasons, including multiple left renal arteries or veins, smaller right kidney, or cystic right renal mass. Mean surgical time was 235.0 Ϯ 66.7 minutes, with a mean blood loss of 139 Ϯ 165.8 mL. Conversion was required in three patients secondary to bleeding or anatomical anomalies. Mean warm ischemic time was limited at 238 Ϯ 112 seconds. Return to diet was achieved on average after 7.5 Ϯ 2.3 hours, with mean discharge at 54.6 Ϯ 22.8 hours. Two grafts were lost during the early experience of these centers to renal vein thrombosis. Both surgical and postoperative complications were limited, with few long-term adverse effects. Mean serum creatinine levels were higher than open and left laparoscopic donor nephrectomy on postoperative day 1, but at all remaining intervals the right laparoscopic donors had equivalent creatinine values. ConclusionsThese results confirm that right laparoscopic donor nephrectomy provides similar patient benefits, including early return to diet and discharge. Long-term creatinine values were no higher than in traditional open donor or left laparoscopic donor cohorts. These results establish that early concerns about high thrombosis rates are not supported by a multiinstitutional review of laparoscopic right donor nephrectomies.Laparoscopic donor nephrectomy has been a revolutionary approach used to address the increasing disparity between organ need and availability.

The Evolution of Laparoscopic Right Donor Nephrectomy: Progression to Single Site Surgery

“…Moreover, the intraoperative complication rates were similar between left and right donors, and the 3 right procurementtechniques. Our intraoperative complication rates are similar [5] if not better than others have reported [10,19]. We have not seen an increase in intraoperative complications despite the evolution of more technically challenging methods of procurement.…”

“…Dols et al reported 2 conversions in 159 R-LAP-DN [5]. In another series of 97 R-LAP-DN, 3 conversions occurred [19].…”

Laparoscopic right nephrectomy for live kidney donation: functional results

“…Using this modification, they achieved nine additional successful right-sided laparoscopic nephrectomies. More recently, a retrospective North American seven-centre review of 97 right laparoscopic nephrectomies [5] also indicated that successful transplantation are able to be achieved with grafts provided by right living-donor nephrectomy.…”

“…Such harvesting of a caval rim does not narrow the inferior vena cava. The implantation operation is also of importance [5]: tension-free anastomoses are best achieved by surgeons who master vascular reconstructions, as these are often more complex than in conventional cadaveric kidney transplantation.…”

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

“…First, initial reports suggested higher vascular (6) and ureteral (7) complication rates with laparoscopically procured kidney grafts. 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).…”