Feasibility and safety of laparoscopic living donor nephrectomy in case of right kidney and multiple-renal artery kidney: a systematic review of the literature

Broudeur, L.; Karam, Georges; Chelghaf, I.; Vergie, S. De; Rigaud, J.; Verbe, M.A. Perrouin; Branchereau, J.

doi:10.1007/s00345-019-02821-8

Cited by 16 publications

(18 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…None of the DD studies reported on nephrectomy time; differences in which kidney is retrieved last may contribute to inferior outcomes as found by Heylen et al 59 Whilst this is the first meta-analysis comparing right and left DD kidneys, there are three other meta-analyses to our knowledge which attempt to compare right versus left LD kidneys. [21][22][23] All three focus primarily on donor outcomes rather than the recipient outcomes described in this study. These three previous LD meta-analyses observed similar rates of DGF, ischemic times and long term survival between LD kidney sides.…”

Section: Discussionmentioning

confidence: 99%

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Carolan

Tingle

Thompson

et al. 2021

Clinical Transplantation

View full text Add to dashboard Cite

Introduction: Transplantation of right kidneys can pose technical challenges due to the short right renal vein. Whether this results in inferior outcomes remains controversial.Method: Healthcare Database Advanced Search (HDAS) was used to identify relevant studies. Two authors independently reviewed each study. Statistical analyses were performed using random effects models and results expressed as HR or relative risk (RR) with 95% confidence intervals. Subgroup analyses were performed in kidneys from deceased donors (DD) and living donors (LD).Results: A total of 35 studies (257,429 participants) were identified. Both deceased and living donor right kidneys were at increased risk of delayed graft function (DGF; RR = 1.12[1.06-1.18] and RR = 1.33[1.21-1.46] respectively; both p < .0001). In absolute terms, for each 100 kidney pairs of DD kidneys transplanted there are 2.72 (1.67-3.78, p < .00001) excess episodes of DGF in right kidneys. Graft thromboses and graft loss due to technical failure was also significantly more likely in right kidneys, in both DD and LD settings. There was no evidence that laterality alters long term graft survival in LD or DD. Conclusion:Right kidneys have inferior early outcomes, with higher rates of DGF, technical failure and graft thrombosis. However, these differences are small in absolute terms, and long-term graft survival is equivalent.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Carolan

Tingle

Thompson

et al. 2021

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…14 During donor evaluation, both kidneys are screened, and the kidney ultimately chosen for donation should be the one with either decreased function in GFR and/or morphological abnormality (cysts, stones, lipomas, and number of vessels) with the intent of minimizing donor morbidity. 11 , 17 …”

Section: Discussionmentioning

confidence: 99%

Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization

Hiffa

Schulte

Saeed

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

Chylous ascites may result from a variety of pathological conditions, most of them from nontraumatic causes, such as congenital defects of the lymphatic system, infections, liver cirrhosis, and malignancy. Rarely, chylous ascites occurs as an iatrogenic complication after left-sided laparoscopic donor nephrectomy (LDN). Injury to the cisterna chyli and its main lymphatic tributaries around the para-aortic region intraoperatively can cause the lymphatic fluid to accumulate. There is currently no standardized treatment for chylous ascites as there have only been 54 cases documented to date. Most patients can be managed with conservative therapy. Recommended guidelines include high-protein and low-fat diet with medium-chain triglycerides. Paracentesis is often used as a diagnostic and therapeutic first-line measure with total parenteral nutrition (TPN), bowel rest, and somatostatin analogue as adjunct therapies. We present a case of massive chylous ascites refractory to conservative therapy. The patient had progressive abdominal distention and unintentional weight gain 2 weeks postoperatively warranting multiple paracenteses of >7 L of chylous fluid. Ultimately, the patient was successfully treated with lymphatic embolization using N-butyl cyanoacrylate glue.

show abstract

“…2 In addition, on the right side there is greater variability in the length of the renal artery (which increases the likelihood that the right renal artery is also short), mobilization of the right lobe of the liver is required for kidney removal, 3 and there also exists a greater likelihood of encountering multiple renal arteries. 4 The dissection and stapling of the right renal hilum is therefore a critical step during laparoscopic nephrectomy of the right donor kidney. Multiple maneuvers and surgical approaches for ligation of vessels have been developed to best handle the right renal hilum, including those for the right renal vein (RRV), [5][6][7][8] the right renal artery (RRA) 9,10 , and both renal vessels.…”

Section: Introductionmentioning

confidence: 99%

Midline Rotation of the Right Renal Hilum During Hand-Assisted Laparoscopic Living Donor Nephrectomy

Ciancio

Farag

Gaynor

et al. 2021

JSLS

View full text Add to dashboard Cite

Background/Objectives: Laparoscopic living donor nephrectomy (LLDN) of the right kidney is currently considered as part of standard of care; however, dealing with the renal hilum when performing ligation/division of its renal vessels is still a main concern. Here, we describe a simpleto-perform technique, i.e., flipping the fully mobilized right kidney to the midline so that the renal artery becomes anteriorly, which offers better visualization and easier dissection of the renal vessels (achieving maximized lengths) when performing hand-assisted LLDN of the right kidney.Methods: Living donors who underwent hand-assisted LLDN of the right kidney, along with their respective renal transplant recipients, were included in this report. Donor characteristics included renal artery and vein lengths; recipient characteristics included creatinine at months 12 -36. Graft vein and arterial anastomosis data were also reported.Results: Nineteen living donors and 19 recipients, with median donor and recipient ages being 39 (24 -60) and 53 (3 -81) years, respectively, were included. None of the 38 patients had intra-or postoperative complications. Donor renal vein was anastomosed to the right external iliac vein (n = 16), right common iliac vein (n = 2), and inferior vena cava (n = 1). Gonadal vein (n = 1) and deceased donor iliac vein (n = 2) were used to increase the right renal vein length in 3 cases. Four donor kidneys had 2 arteries reconstructed side by side. None of the recipients developed any vascular or urological complications. Conclusions:The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.

show abstract

Feasibility and safety of laparoscopic living donor nephrectomy in case of right kidney and multiple-renal artery kidney: a systematic review of the literature

Cited by 16 publications

References 38 publications

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization

Midline Rotation of the Right Renal Hilum During Hand-Assisted Laparoscopic Living Donor Nephrectomy

Contact Info

Product

Resources

About