Living kidney donation and hypertension risk
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ABSTRACT: In Europe, the vast majority of transplant centres still performs open donor nephrectomy. This approach can therefore be considered the gold standard. At our institution, classic lumbotomy (CL) was replaced by a mini-incision anterior flank incision (MIDN) thereby preserving the integrity of the muscles. Data of 60 donors who underwent MIDN were compared with 86 historical controls who underwent CL without rib resection. Median incision length measured 10.5 and 20 cm (MIDN versus CL, P < 0.001). Median operation time was 158 and 144 min (P = 0.02). Blood loss was significantly less after MIDN (median 210 vs. 300 ml, P = 0.01). Intra-operatively, 4 (7%) and 1 (1%) bleeding episodes occurred. Postoperatively, complications occurred in 12% in both groups (P = 1.00). Hospital stay was 4 and 6 days (P < 0.001). In one (2%) and 11 (13%) donors (P = 0.02) late complications related to the incision occurred. After correction for baseline differences, recipient serum creatinine values were not significantly different during the first month following transplantation. In conclusion, MIDN is a safe approach, which reduces blood loss, hospital stay and the number of incision related complications when compared with CL with only a modest increase in operation time.Transplant International 06/2006; 19(6):500-5. DOI:10.1111/j.1432-2277.2006.00324.x · 3.16 Impact Factor
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ABSTRACT: The aim of the present study was to prospectively investigate how mini-incision donor nephrectomy (MIDN) and laparoscopic donor nephrectomy (LDN) affected the donor's quality of life and fatigue. Forty-five donors underwent MIDN and 55 donors underwent LDN. Quality of life and fatigue were recorded preoperatively and four times during one year follow-up on the Short-Form 36 (SF-36) and Multidimensional Fatigue Inventory-20 (MFI-20), respectively. One-year response rates were 89% and 95% following MIDN and LDN, respectively. After MIDN, all dimensions of the SF-36 significantly declined. Most dimensions returned to preoperative values at three months except for "vitality" (six months) and "bodily pain" (12 months). After LDN, the scores of the SF-36 dimensions returned to preoperative values at three months, except for "vitality" and "role physical" (both six months). Between-groups analysis revealed significantly better scores of the SF-36 dimensions "physical function" (P = 0.03) and "bodily pain" (P = 0.04) following LDN at one month postoperatively. Fatigue scores did not significantly differ between the groups at any point in time. General and physical fatigue (MFI-20) remained affected up to one year after either type of surgery. After MIDN, 4% of the donors had returned to work at four weeks postoperatively versus 28% after LDN (P = 0.04). Return to preoperative activity level was not significantly different between groups. Both procedures clearly impact quality of life and fatigue. The beneficial effect on the quality of life and the earlier return to work encourage us to advocate LDN as the surgical approach to be preferred.Transplantation 12/2006; 82(10):1291-7. DOI:10.1097/01.tp.0000239312.45050.05 · 3.78 Impact Factor
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ABSTRACT: In Chapter One we described the development of live kidney donation. Currently, live donor kidney transplantation is the best solution to attack the persistent organ shortage in the Western World. Because of this shortage live kidney donation is still interesting over fifty years after Joseph Murray and Rene Kuss performed the first live kidney donor transplantations. The revival of live kidney donation in the 1990s still continues. Developments in immunosuppressive therapy, crossing the blood barrier, intelligent logistic solutions, improvements of peri-operative care and last but not least less invasive surgical techniques all attribute to the successes of live kidney donor transplantations. In this thesis we focused on the latter aspect, but one have to keep in mind that improvements in surgical and peri-operative care of the donor can only exist within a solid system providing screening of potential donors, selection of transplant candidates and accurate medical treatment of the recipients. In the United States Ratner and colleagues introduced laparoscopic donor nephrectomy in 1995. This technique has greatly revolutionized live kidney donation. Presently the majority of live kidney donors is operated on using a (modified) laparoscopic approach. However, the introduction of minimally invasive surgery has also encouraged refinement of open techniques. Most studies up to now aimed to prove the feasibility of a new surgical technique for live kidney donation. In this thesis, we compared these novel techniques, therewith addressing short term surgical outcomes, quality of life, costs and transplant outcome.