Abstract:Background
Living donor kidneys with multiple arteries (MA) are increasingly procured laparoscopically for transplant.
Methods
We compare long-term graft function and survival of kidneys with single arteries (SA) and MA over a 10-year period.
Results
There were a total of 218 grafts with SA and 60 grafts with MA. The MA group had longer operative and ischemic times than SA group. There was a small increase in ureteral complication (8.3% vs. 2.3% P=0.06) and a significantly higher incidence of rejection (23… Show more
“…In the other hand, Paramesh et al when analyzing 278 LDN during a 10-year period, showed in a multivariable logistic regression analysis that MA was an independent risk factor for acute rejection. The authors also showed that the graft function at 6 and 12 months was significantly lower in the MA group than SA group, and this trend persisted for 3 years after transplant (13). In the present study, the MA group had a higher rate of poor EGF when compared to the SA group (23% vs 12%, respectively).…”
Section: Discussionsupporting
confidence: 57%
“…Results from previous studies comparing renal function outcomes in patients with MA and SA have been variable (13,(16)(17)(18)(19)(20). Kuo et al. showed similar functional outcomes for patients with one, two or three renal arteries.…”
Section: Discussionmentioning
confidence: 54%
“…In patients with MA, there is an increased risk of injury from more extensive dissection (13). The requirement for complicated vascular reconstruction and more difficult anastomosis at the time of implantation impose additional ischemic injury and subsequent reperfusion injury (13). This extended dissection and the need for back-table reconstruction have been shown, by some authors, to be associated with an increased risk for urological and vascular complications (9,14,15).…”
Section: Discussionmentioning
confidence: 99%
“…However, this difference was not statistically significantly and was not associated with a higher recipient need for dialysis during the first postoperative week. In patients with MA, there is an increased risk of injury from more extensive dissection (13). The requirement for complicated vascular reconstruction and more difficult anastomosis at the time of implantation impose additional ischemic injury and subsequent reperfusion injury (13).…”
ARTIcLE INFO _________________________________________________________ ___________________Purpose: We evaluated our experience with laparoscopic donor nephrectomy in patients with multiple renal arteries, comparing operative outcomes and early graft function with patients with a single renal artery.
Materials and Methods:From January 2003 to February 2009, 130 patients underwent laparoscopic donor nephrectomy at our institution, 108 (83%) with a single renal artery and 22 (17%) with multiple arteries. Donor and recipient outcomes for single artery and multiple arteries allografts were compared. Results: The LDN operative time was similar between the single artery and multiple arteries groups (162 vs 163 min, respectively, p = 0.87). Allografts with multiple arteries had significantly longer warm ischemia time (3.9 vs 4.9 min, p = 0.05) and cold ischemia time (72 vs 94 min, p < 0.001) than those with single artery. The conversion rate was similar between single and multiple arteries groups (6% vs 4.5%, respectively, p = 0.7). Multiple arteries grafts had a non statistically significant higher rate of poor graft function when compared to single artery grafts (23% vs 12%, respectively, p = 0.18). Five patients in the single artery group (4.6%) and one patient in the multiple arteries group (4.5%) needed dialysis during the first postoperative week. Overall, recipient complication rates were similar between single and multiple arteries groups (12.9% vs 18.1%, respectively, p = 0.51). Conclusion: Laparoscopic donor nephrectomy with multiple arteries was associated with a non statistically significant higher rate of poor early graft function. The procedure appears to be safe in patients with multiple arteries, with similar complications rates. Multiple arteries should not be a contraindication for laparoscopic donor nephrectomy.
“…In the other hand, Paramesh et al when analyzing 278 LDN during a 10-year period, showed in a multivariable logistic regression analysis that MA was an independent risk factor for acute rejection. The authors also showed that the graft function at 6 and 12 months was significantly lower in the MA group than SA group, and this trend persisted for 3 years after transplant (13). In the present study, the MA group had a higher rate of poor EGF when compared to the SA group (23% vs 12%, respectively).…”
Section: Discussionsupporting
confidence: 57%
“…Results from previous studies comparing renal function outcomes in patients with MA and SA have been variable (13,(16)(17)(18)(19)(20). Kuo et al. showed similar functional outcomes for patients with one, two or three renal arteries.…”
Section: Discussionmentioning
confidence: 54%
“…In patients with MA, there is an increased risk of injury from more extensive dissection (13). The requirement for complicated vascular reconstruction and more difficult anastomosis at the time of implantation impose additional ischemic injury and subsequent reperfusion injury (13). This extended dissection and the need for back-table reconstruction have been shown, by some authors, to be associated with an increased risk for urological and vascular complications (9,14,15).…”
Section: Discussionmentioning
confidence: 99%
“…However, this difference was not statistically significantly and was not associated with a higher recipient need for dialysis during the first postoperative week. In patients with MA, there is an increased risk of injury from more extensive dissection (13). The requirement for complicated vascular reconstruction and more difficult anastomosis at the time of implantation impose additional ischemic injury and subsequent reperfusion injury (13).…”
ARTIcLE INFO _________________________________________________________ ___________________Purpose: We evaluated our experience with laparoscopic donor nephrectomy in patients with multiple renal arteries, comparing operative outcomes and early graft function with patients with a single renal artery.
Materials and Methods:From January 2003 to February 2009, 130 patients underwent laparoscopic donor nephrectomy at our institution, 108 (83%) with a single renal artery and 22 (17%) with multiple arteries. Donor and recipient outcomes for single artery and multiple arteries allografts were compared. Results: The LDN operative time was similar between the single artery and multiple arteries groups (162 vs 163 min, respectively, p = 0.87). Allografts with multiple arteries had significantly longer warm ischemia time (3.9 vs 4.9 min, p = 0.05) and cold ischemia time (72 vs 94 min, p < 0.001) than those with single artery. The conversion rate was similar between single and multiple arteries groups (6% vs 4.5%, respectively, p = 0.7). Multiple arteries grafts had a non statistically significant higher rate of poor graft function when compared to single artery grafts (23% vs 12%, respectively, p = 0.18). Five patients in the single artery group (4.6%) and one patient in the multiple arteries group (4.5%) needed dialysis during the first postoperative week. Overall, recipient complication rates were similar between single and multiple arteries groups (12.9% vs 18.1%, respectively, p = 0.51). Conclusion: Laparoscopic donor nephrectomy with multiple arteries was associated with a non statistically significant higher rate of poor early graft function. The procedure appears to be safe in patients with multiple arteries, with similar complications rates. Multiple arteries should not be a contraindication for laparoscopic donor nephrectomy.
“…The presence of multiple renal arteries, however, results in higher rates of ureteric complications in the recipient compared with kidneys with a single artery (16.7% vs 3.2%, P = 0.001) [46]. In addition, transplantation of kidneys with multiple arteries has been shown to produce higher rates of graft loss than in organs with single vessels (HR 2.30, 95% CI 1.05, 5.09, P = 0.038) [47]. As ‘pure’ and hand‐assisted right LDN have been shown to be feasible and safe [48,49], with shorter operative times than left LDN [50], right LDN is now regarded as an acceptable alternative to left LDN in the presence of multiple renal arteries supplying the left kidney but not the right [51].…”
Section: Anatomical and Technical Considerationsmentioning
What's known on the subject? and What does the study add?
Innovations in laparoscopic surgery have provided transplant surgeons with a range of techniques as well as a vast array of minimally invasive instruments. Whilst randomized control trials have compared open and laparoscopic donor nephrectomy, there is a paucity of high quality data comparing different laparoscopic approaches. This article summarizes the main techniques of laparoscopic donor nephrectomy currently in use and reviews the evidence available for each. In addition, controversial aspects of donor nephrectomy are examined, including the technological advances applicable to this operation.
Increasing numbers of living donor kidney transplants are being performed worldwide, and the majority of donor operations are now laparoscopic. Transperitoneal ‘pure’ and hand‐assisted laparoscopic donor nephrectomy are the two most commonly performed procedures, although retroperitoneal approaches are advocated by some centres. Controversy persists with respect to the technical aspects of donor nephrectomy, including both the approach and the method of ligation of the hilar vessels. More recently, robot‐assisted, laparo‐endoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) ‐assisted donor nephrectomy have also been performed, further increasing the number of options available, but creating uncertainty as to the ideal approach.
Hypothesis: Despite the overall acceptance of laparoscopic donor nephrectomy (LDNX), concern remains about the application of this technique in certain complex situations, such as right-sided nephrectomies and in donors with complex kidney anatomy and obese donors. This study was designed to determine if complication rates have remained stable as we have offered LDNX to all medically acceptable donors and to analyze the results of cases in each of the complex categories. We hypothesized that complication rates in the 3 complex categories would be equivalent to those among more straightforward cases.
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