Comorbidity Burden and Perioperative Complications for Living Kidney Donors in the United States.
ABSTRACT Since 1998, 35% of kidney transplants in the United States have been derived from living donors. Research suggests minimal long-term health consequences after donation, but comprehensive studies are limited. The primary objective was to evaluate trends in comorbidity burden and complications among living donors.
The National Inpatient Sample (NIS) was used to identify donors from 1998 to 2010 (n=69,117). Comorbid conditions, complications, and length of stay during hospitalization were evaluated. Outcomes among cohorts undergoing appendectomies, cholecystectomies and nephrectomy for nonmetastatic carcinoma were compared, and sample characteristics were validated with the Scientific Registry of Transplant Recipients (SRTR). Survey regression models were used to identify risk factors for outcomes.
The NIS captured 89% (69,117 of 77,702) of living donors in the United States. Donor characteristics were relatively concordant with those noted in SRTR (mean age, 40.1 versus 40.3 years [P=0.18]; female donors, 59.0% versus 59.1% [P=0.13]; white donors, 68.4% versus 69.8% [P<0.001] for NIS versus SRTR). Incidence of perioperative complications was 7.9% and decreased from 1998 to 2010 (from 10.1% to 7.6%). Men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 1.20 to 1.56) and donors with hypertension (AOR, 3.35; 95% CI, 2.24 to 5.01) were more likely to have perioperative complications. Median length of stay declined over time (from 3.7 days to 2.5 days), with longer length of stay associated with obesity, depression, hypertension, and pulmonary disorders. Presence of depression (AOR, 1.08; 95% CI, 1.04 to 1.12), hypothyroidism (AOR, 1.07; 95% CI, 1.04 to 1.11), hypertension (AOR, 1.38; 95% CI, 1.27 to 1.49), and obesity (AOR, 1.07; 95% CI, 1.03 to 1.11) increased over time. Complication rates and length of stay were similar for patients undergoing appendectomies and cholecystectomies but were less than those with nephrectomies for carcinoma.
The NIS is a representative sample of living donors. Complications and length of stay after donation have declined over time, while presence of documented comorbid conditions has increased. Patients undergoing appendectomy and cholecystectomy have similar outcomes during hospitalization. Monitoring the health of living donors remains critically important.
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ABSTRACT: Background: Reports of surgeons performing robotic-assisted live donor nephrectomy have been emerging in the literature. We sought to examine the national incidence of robotic-assisted live donor nephrectomies to assess regional utilization and economic differences in robotic-assisted versus laparoscopic live donor nephrectomy. Methods: Data from the Nationwide Inpatient Sample were used to identify patients who underwent either laparoscopic or robotic-assisted live donor nephrectomy from 2009 to 2011. Descriptive analysis was performed to examine differences between the laparoscopic and robotic-assisted groups. Results: A total of 4,163 cases of live donor nephrectomy were performed using robotic-assistance or pure laparoscopic surgery between 2009 and 2011. 142 were classified as robotic-assistance. All robotic-assisted cases were from the West. There was no difference in the incidence of complications between the laparoscopic and robotic-assisted groups (p=0.206). Median (IQR) total charges for robotic-assisted live donor nephrectomy were $48,639 (42,380-53,050) versus $37,019 (28,715-48,816) for laparoscopic (p<0.001). Conclusions: The role of robotic-assistance in live donor nephrectomy remains to be determined; however, from our study, there were no identified benefits to robotic-assistance.Journal of endourology / Endourological Society 02/2014; · 1.75 Impact Factor
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ABSTRACT: Aim of this study is to provide a systematic review and meta-analysis of studies comparing laparoendoscopic single site (LESS) versus standard laparoscopic living donor nephrectomy (LDN). A systematic review of the literature was performed in September 2013 using PubMed, Scopus, Ovid and The Cochrane library databases. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Weighted mean difference was used to measure continuous variables and odds ratio to measure categorical ones. Nine publications meeting eligibility criteria were identified, including 461 LESS and 1006 laparoscopic LDN cases. There was a higher number of left side cases in the LESS group (96.5% vs 88.6%, p<0.001). Meta-analysis of extractable data showed that laparoscopy was associated with a shorter operative time (15.06 min; 4.9-25.1; p=0.003), without significant difference in terms of warm ischemia time (0.41 min, -0.02, 0.84; p = 0.06). EBL was lower for LESS (-22.09 ml; -29.5, -14.6; p<0.0001), this difference being however not clinically significant. A higher likelihood of conversion was detected for LESS (13.21; 4.65, 37.53; p<0.0001). Hospital stay was similar (-0.11 days; -0.33, 0.12; p=0.35) as well as visual analog pain score at discharge (-0.31; -0.96, 0.35; p=0.36), but the analgesic requirement was lower for LESS (-2.58; -5.01, -0.15; p=0.04). Moreover, no difference was found in terms of postoperative complication rate (1.00; 0.65, 1.54; p=0.99). Renal function of the recipient as based on creatinine levels at 1 month showed similar outcomes between groups (0.10 mg/dl; -0.09, 0.29; p=0.29). LESS LDN represents an emerging option for living kidney donation. This procedure offers comparable surgical and early functional outcomes to the conventional laparoscopic procedure, and a lower analgesic requirement. However, it is more technically challenging than its standard laparoscopic counterpart, as demonstrated by a higher likelihood of conversion. The role of LESS LDN remains to be defined.BJU International 03/2014; · 3.13 Impact Factor
Article: The marginal kidney donor.[Show abstract] [Hide abstract]
ABSTRACT: The current era of organ shortage has necessitated a widening of criteria for donation, considering donors who would have been considered unsuitable before. This review summarizes the recent advances in strategies to maximize the use of marginal kidneys without compromising the outcomes.Current Opinion in Organ Transplantation 06/2014; · 2.38 Impact Factor