Mp59-11 postoperative Pain Management With Ketamine and Ibuprofen in Living Donor Nephrectomies: Results From a Double-Blind Placebo-Controlled Randomized Control Trial

Abstract

INTRODUCTION AND OBJECTIVE:Previous studies suggested that live kidney donors do not have a higher risk of death or endstage kidney disease (ESKD) than the general population. However, recent studies have suggested that screened kidney donors have a higher risk of ESKD than matched healthy controls. Therefore, donor risk is controversial. Furthermore, only a few studies have evaluated long-term renal function after kidney donation. We aimed to evaluate the long-term outcomes including mortality and renal function in Japanese kidney donors.METHODS: We collected the data of 170 living kidney donors (65men, 115 women) who underwent nephrectomy from 1965 to 2012 in our hospital. Median age was 53 years (range, 26-75 years). We evaluated mortality, cause of death, ESKD incidence, and change in renal function. Donor survival rate was compared with the age-and gender-matched expected survival calculated using the mortality data of Japan provided by the National Cancer Center.RESULTS: Medianfollow-up period was 12.6 (2-41) years. Survival analysis showed that157 donors were still alive and 13 (7.6%) were dead. The median interval between donation and death was 9.4 (2.0e32.8) years; median age at death was 70 (41-87) years. The following causes of death were observed: malignancies, 8; cardiovascular disease, 1; pneumonia, 1; suicide, 1; gastrointestinal bleeding, 1; and sudden death 1. Actual donor survival rates at 5, 10, 20, and 30 years were 98.3%, 94.6%, 93.0%, and 82.5% respectively; these values were comparable to age-and gender-matched expected survival (Fig. 1). Only 1 (0.5%) donor developed ESKD 24 years after donation due to contrast-induced nephropathy after undergoing coronary angiography. Next, we evaluated the renal function in 130 donors. During follow-up, donors showed the following estimated glomerular filtration rates (eGFR): 127 (97.6%), eGFR > 30ml/min; 114 (87.7%), eGFR > 45 ml/min;and 41 (32%), eGFR > 60 ml/min. The percentage of donors with eGFR > 45 ml/minat 5, 10, 20, and 30 years were 98.4%, 95.9%, 80.0%, and 80.0% respectively (Fig. 2).CONCLUSIONS: Our data suggested that kidney donors did not have an increased long-term risk of death compared with the general population. However, some donors showed decreased kidney function 10 years after donation. Therefore, long-term follow up of kidney donors is crucial.

Evaluating a unique enhanced recovery protocol in laparoscopic donor nephrectomy: A single center experience

“…Other ERAS protocols have been associated with similar results: Brown et al 18 . noted a 37.8% reduction in opioid consumption in an ERAS cohort, while Forsyth et al 19 . observed a 29.7% decrement in the first 24 h after surgery.…”

“…Forsyth et al 19 observed a 29.7% decrement in the first 24 h after surgery. This reduction in OMEs is grossly consistent across subspecialties with enhanced recovery protocols and is even larger when applied to more invasive surgeries, as Schwartz et al described for elective gynecologic laparotomy.…”