Open Versus Laparoscopic Live Donor Nephrectomy: A Focus on the Safety of Donors and the Need for a Donor Registry

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
The Journal of Urology (Impact Factor: 4.47). 12/2007; 178(5):1860-6. DOI: 10.1016/j.juro.2007.07.008
Source: PubMed


A review of the existing literature showed that the subject of live donor nephrectomy is a seat of underreporting and underestimation of complications. We provide a systematic comparison between laparoscopic and open live donor nephrectomy with special emphasis on the safety of donors and grafts.
The PubMed literature database was searched from inception to October 2006. A comparison was made between laparoscopic and open live donor nephrectomy regarding donor safety and graft efficacy.
The review included 69 studies. There were 7 randomized controlled trials, 5 prospective nonrandomized studies, 22 retrospective controlled studies, 26 large (greater than 100 donors), retrospective, noncontrolled studies, 8 case reports and 1 experimental study. Most investigators concluded that, compared to open live donor nephrectomy, laparoscopic live donor nephrectomy provides equal graft function, an equal rejection rate, equal urological complications, and equal patient and graft survival. Analgesic requirements, pain data, hospital stay and time to return to work are significantly in favor of the laparoscopic procedure. On the other hand, laparoscopic live donor nephrectomy has the disadvantages of increased operative time, increased warm ischemia time and increased major complications requiring reoperation. In terms of donor safety at least 8 perioperative deaths were recorded after laparoscopic live donor nephrectomy. These perioperative deaths were not documented in recent review articles. Ten perioperative deaths were reported with open live donor nephrectomy by 1991. No perioperative mortalities have been recorded following open live donor nephrectomy since 1991. Regarding graft safety, at least 15 graft losses directly related to the surgical technique of laparoscopic live donor nephrectomy were found but none was emphasized in recent review articles. The incidence of graft loss due to technical reasons in the early reports of open live donor nephrectomy was not properly documented in the literature.
We are in need of a live organ donor registry to determine the combined experience of complications and long-term outcomes, rather than short-term reports from single institutions. Like all other new techniques, laparoscopic live donor nephrectomy should be developed and improved at a few centers of excellence to avoid the loss of a donor or a graft.

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    • "Anatomical peculiarities with the right kidney are that the renal vein is shorter and thin walled, and part of the course of the renal artery is behind the inferior vena cava (IVC). Although LDN is being performed at many centers, there are reservations on the routine use for transperitoneal laparoscopic harvesting of the right kidney due to a perception of technical complexity and increased incidence of allograft failure, renal vein thrombosis and the need for more back-table reconstruction along with increased operative time.[56] We routinely perform laparoscopic right donor nephrectomy when required and herein compare the outcomes of transperitoneal right versus left donor nephrectomy. "
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    ABSTRACT: Introduction: Although laparoscopic donor nephrectomy (LDN) is being performed at many centers, there are reservations on the routine use of laparoscopy for harvesting the right kidney due to a perception of technical complexity and increased incidence of allograft failure, renal vein thrombosis and the need for more back-table reconstruction along with increased operative time. Materials and Methods: We performed a prospective non-randomized comparison of transperitoneal laparoscopic left donor nephrectomy (LLDN) with laparoscopic right donor nephrectomy (RLDN) from August 2008 to May 2013. The operative time, warm ischemia time, intraoperative events, blood loss and post-operative parameters were recorded. The renal recipient parameters, including post-operative creatinine, episodes of acute tubular necrosis (ATN) and delayed graft function were also recorded. Results: A total of 188 LDN were performed between August 2008 and May 2013, including 164 LLDN and 24 RLDN. The demographic characteristics between the two groups were comparable. The operative duration was in favor of the right donor group, while warm ischemia time, estimated blood loss and mean length of hospital stay were similar between the two groups. Overall renal functional outcomes were comparable between the two donor groups, while the recipient outcomes including creatinine at discharge were also comparable. Conclusions: RLDN has a safety profile comparable with LLDN, even in those with complex vascular anatomy, and can be successfully performed by the transperitoneal route with no added morbidity. RLDN requires lesser operative time with comparable morbidity.
    Indian Journal of Urology 07/2014; 30(3):256-60. DOI:10.4103/0970-1591.134244
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    • "Advantages of the laparoscopic technique include a decrease in morbidity, recovery time and postoperative pain, and better cosmesis [8] [9] [10]. In laparoscopic donor nephrectomy , because of the limited field of view, it is crucial to have detailed information on the vascular anatomy before surgery to avoid inadvertent vascular injuries [11]. "
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    ABSTRACT: Objective To evaluate the accuracy of 16-section multi-detector row computed tomography (MDCT) angiography in the preoperative evaluation of renal transplant donors in comparison with intra-operative findings.Patients and methodsIn this prospective study 89 consecutive renal donors (69 men and 20 women) underwent 16-MDCT angiography followed by open surgical donor nephrectomy from January 2008 to March 2010. We reported the number and origin of renal arteries and the presence of early branching arteries. Renal venous anatomy was evaluated for the presence of major and minor venous anomalies. The renal calyces and ureters were assessed with delayed excretory phase images. On a 3D workstation, images were evaluated by the radiologist and the urologist. These CT angiography results were compared with surgical findings.ResultsThe mean age of the donors was 31 years. Open donor nephrectomy was performed on the left in 52 and on the right in 37 subjects. At surgery, accessory renal arteries were found in 14 kidneys (double arteries to 13 kidneys and triple arteries to one kidney). CT and surgical findings agreed in 92% of subjects. Seven small accessory renal arteries in seven donors were missed by radiology reviewers. Early branching of the renal arteries was shown in 5 arteries, and CT matched surgical findings in 88 cases (99%). Renal vein anomalies were present in six subjects, three of them were missed with the preoperative CT. The major shortcoming of MDCT angiography was noted in identifying minor venous anatomy. The presence of discrepancies between pre-operative MDCT and the findings at surgery did not affect the clinical outcome of transplantation, except in one case where intra-operative surgical distress was noted due to failure in identifying multiple major renal veins.Conclusions16-MDCT angiography is a good modality in the pre-operative evaluation of live renal donors. However, it provides suboptimal information on renal vascular anatomy, particularly complex venous patterns. Surgeons should not rely fully on pre-operative CT angiography while performing donor nephrectomy.
    African Journal of Urology 03/2013; 19(1):7–12. DOI:10.1016/j.afju.2012.10.007
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    • "Shokeir concluded that LLDN has the disadvantages of increased operative time, increased warm ischemia time, and increased major complications requiring reoperation. It was difficult to analyze the results about perioperative mortality and graft loss due to technical reasons because they were reported mainly in old series and not in the recent ones [11]. Moreover, there is probably an underreporting of the unfavorable results of LLDN. "
    European Urology 10/2010; 58(4):510-1; discussion 512-3. DOI:10.1016/j.eururo.2010.05.005 · 13.94 Impact Factor
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