Does carbon dioxide pneumoperitoneum affect the renal function in donors following laparoscopic donor nephrectomy? A prospective study

Abstract

CONTEXT:Although the technical feasibility of laparoscopic donor nephrectomy (LDN) has been established, concerns have been raised about the impaired renal function resulting from pneumoperitoneum and its short- and long-term effects.AIMS:We used urinary biomarkers of acute kidney injury including urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary N-acetyl-beta-D-glucosaminidase (uNAG) to study the injury caused to the donor's retained kidney by pneumoperitoneum.SETTINGS AND DESIGN:This was a prospective cohort study of thirty consecutive patients who underwent LDN at our hospital.SUBJECTS AND METHODS:We measured urinary creatinine, uNAG and uNGAL at the time of induction of anaesthesia, at 1 h after starting surgery, at 5 min after clamping the ureter, at the time of skin closure and then at 4, 8 and 24 h after the surgery.RESULTS:The uNAG level showed a gradual increase from the start of the surgery and reached the peak at the time of the closure. Thereafter, there was a gradual fall in the level and reached to pre-operative level at 24 h post-surgery. Similarly, the uNGAL also showed a similar trend although it did not reach pre-operative value by 24 h.CONCLUSIONS:We objectively confirm that although there is acute injury to the retained kidney in the donor after LDN due to the CO2 pneumoperitoneum, the renal function improves and reaches close to the pre-operative level within 24 h after surgery.

The learning curve for pure retroperitoneoscopic donor nephrectomy by using cumulative sum analysis

“…It is crucial to avoid making the assumption that a shorter operative time (ot) is not a significant factor in laparoscopic donor nephrectomies. The literature lacks clarity regarding the impact of pneumoperitoneum on both the donor's remaining kidney and graft function 16 . However, we believe that with a shorter ot and wit, it will be better to prevent both the donor's remnant kidney and the graft kidney from acute injury due to pneumoperitoneum in terms of functional outcomes.…”

Pneumoperitoneum and Acute Kidney Injury—An Integrative Clinical Concept Review

“…A significant part of clinical data comparing laparoscopic and open techniques is derived from the surgeries of the genitourinary system. 4,5,[32][33][34][35][36][37] The diagnosis of AKI may depend, however, on 1) the criteria used at the time of study (individual definition, RIFLE, AKIN, or KDIGO); 2) the method determining the baseline creatinine level; and 3) the anatomical loss of nephrons due to intervention itself (e.g., partial or full nephrectomy). [38][39][40][41][42][43] Accordingly, all of these factors can profoundly impact the case definition-whether AKI exists or not-and the perceived severity of AKI.…”

“…4 In an another single-center study, in patients undergoing laparoscopic donor nephrectomy, a transient rise of biomarkers was reported. 33 The zeniths of urine N-acetyl-β-d-gluconaminidase (NAG) and urine NGAL levels were observed at the completion of surgery and declined to preoperative levels at 24 hours following the operation. Serum creatinine levels showed a larger rise initially but remained elevated in the kidney of donor individual at 1 year after surgery compared to preintervention level.…”