Risk Factors Associated with Decreased Renal Function after Hand-Assisted Laparoscopic Donor Nephrectomy: A Multivariate Analysis of a Single Surgeon Experience

Abstract

Background: Hand-assisted laparoscopic donor nephrectomy is a minimally invasive procedure for living kidney donation. The surgeon operative volume is associated with postoperative morbidity and mortality. We evaluated the risk factors associated with decreased renal function after hand-assisted laparoscopic donor nephrectomy performed by a single experienced surgeon.Methods: We included living renal donors who underwent hand-assisted laparoscopic donor nephrectomy by a single experienced surgeon between 2006 and 2013. Decreased renal function was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 on postoperative day 4. The donors were categorized into groups with postoperative eGFR < 60 mL/min/1.73 m2 or ≥ 60 mL/min/1.73 m2. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors associated with decreased renal function after hand-assisted laparoscopic donor nephrectomy. The hospital stay duration, intensive care unit admission rate, and eGFR at postoperative year 1 were evaluated.Results: Of 643 patients, 166 (25.8%) exhibited a postoperative eGFR of < 60 mL/min/1.73 m2. Multivariate logistic regression analysis demonstrated that the risk factors for decreased renal function were age [odds ratio (95% confidence interval), 1.062 (1.035-1.089), P < 0.001], male sex [odds ratio (95% confidence interval), 3.436 (2.123-5.561), P < 0.001], body mass index (BMI) [odds ratio (95% confidence interval), 1.093 (1.016-1.177), P = 0.018], and preoperative eGFR [odds ratio (95% confidence interval), 0.902 (0.881-0.924), P < 0.001]. There were no significant differences in postoperative hospital stay duration and intensive care unit admission rate between the two groups. In addition, 383 of 643 donors were analyzed at postoperative year 1. Sixty donors consisting of 14 (5.0%) from the group of 279 donors in eGFR ≥ 60 mL/min/1.73 m2, and 46 (44.2%) from the group of 104 donors in eGFR < 60 mL/min/1.73 m2 had eGFR < 60 mL/min/1.73 m2 at postoperative year 1 (P < 0.001).Conclusions: Increased age, male sex, higher BMI, and decreased preoperative eGFR were risk factors for decreased renal function after hand-assisted laparoscopic donor nephrectomy by a single experienced surgeon. These results provide important evidence for the safe perioperative management of living renal donors.

Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy

“…Part of that workup includes an analysis of the patient's BMI. There have been conflicting studies regarding the association between donor BMI and postoperative renal compromise [1][2][3][4][5][6][7][8]. Motivated by these conflicting studies, we examine the association of kidney MAP score with postoperative renal function in healthy donors.…”

“…Recent studies have evaluated the impact of various preoperative patient-specific and imaging-derived characteristics on postoperative renal function following donor nephrectomy. Examinations of large cohorts of patients suggest that age, male sex, and body mass index (BMI) are predictive of decreased postoperative renal function in patients undergoing donor nephrectomy [1][2][3][4]. However, other studies have shown that BMI has no effect on long term glomerular filtration rate (eGFR) in the donor nephrectomy population [5][6][7][8].…”

Clinical predictors of the estimated glomerular filtration rate 1 year after radical nephrectomy in Japanese patients

“…Men are reported to show a significant decline in the GFR and effective renal plasma flow between the ages of 20 and 50 years; this result is not seen in women, who are probably protected by estrogens in the premenopausal period [ 23 ]. Some studies have indicated that male sex is risk factor of decreased renal function after donor nephrectomy [ 24 25 26 27 ], Lim et al [ 26 ] pointed out sex hormones are involved in the reduction of kidney function after donor nephrectomy in their study. Ibrahim et al [ 20 ] reported that, through long-term follow-up after kidney donation, albuminuria was less likely to develop in females.…”

The lymphocyte/monocyte ratio and red blood cell transfusion during radical retropubic prostatectomy

“…Heart failure was defined as an ejection fraction of < 40%. The GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation [21,22].…”