Karel W J Klop

Publications (3)12.02 Total impact

• Article: Incision-related outcome after live donor nephrectomy: a single-center experience.

  Karel W J Klop, Farah Hussain, Oguzhan Karatepe, Niels F M Kok, Jan N M Ijzermans, Frank J M F Dor
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  ABSTRACT: BACKGROUND: Live donor nephrectomy is routinely performed. However, little is known regarding the incision-related outcome. The aim of the present study was to evaluate the prevalence of incisional hernias (IH) and to assess body image and cosmesis scores after donation. METHODS: Questionnaires on IH, body image, and cosmesis were sent to all donors who underwent laparoscopic donor nephrectomy or mini-incision donor nephrectomy between January 2000 and December 2009. RESULTS: In total, 444 replies were received (75 %). Seven donors (1.5 %) had undergone a surgical correction of an IH. Surgical site infection and steroid use appeared to be independent risk factors for the development of an IH (p = 0.001 and 0.021, respectively). Body image and cosmesis scores were excellent. Elderly donors had significantly higher cosmesis scores when compared with young donors (p < 0.001). Donor age of 60 years or higher, correction of an IH, and survival of the recipient appeared to be independent factors associated with a higher score on the cosmesis scale in multivariate analysis. CONCLUSIONS: This is the largest study describing the prevalence of IH and cosmetic outcome after donor nephrectomy. The prevalence of IH after live donor nephrectomy is very low, and body image and cosmesis scores are excellent. Consequently, incision-related outcomes pose no barrier to live donor nephrectomy.
  Surgical Endoscopy 02/2013; · 4.01 Impact Factor
• Article: Intravesical versus extravesical ureteroneocystostomy in kidney transplantation: a systematic review and meta-analysis.

  Inez K B Slagt, Karel W J Klop, Jan N M Ijzermans, Türkan Terkivatan
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  ABSTRACT: : Urological complications are still a major problem postoperatively with a reported incidence of up to 30%, associated with significant morbidity, mortality, prolonged hospital stay and high medical costs. To date, there is no evidence favouring either an extravesical or an intravesical approach. The purpose of this systematic review and meta-analysis is to determine if an intravesical or extravesical anastomosis in kidney transplantation is to be preferred. Comprehensive searches were conducted in PubMed, Embase and the Cochrane Library. Reference lists were searched manually. The methodology was in accordance with the PRISMA statement. Two randomized controlled trials and seventeen cohort studies were identified. Based on the meta-analysis, outcome was in favour of the extravesical anastomosis. A relative risk (RR) for stenosis of 0.67 (confidence interval (CI), 0.48-0.93; p = 0.02), for leakage 0.55 (CI 0.39-0.80; p = 0.001) for the total number of urological complications 0.56 (CI 0.41-0.76; p < 0.001) and for haematuria of 0.41 (CI 0.22-0.76; p = 0.005) was demonstrated. Based on our results, we conclude that there is evidence in favour of the extravesical ureteroneocystostomy for having a smaller amount of urological complications in kidney transplantation.
  Transplantation 12/2012; 94(12):1179-84. · 4.00 Impact Factor
• Article: Attitudes among surgeons towards live-donor nephrectomy: a European update.

  Karel W J Klop, Leonienke F C Dols, Niels F M Kok, Willem Weimar, Jan N M Ijzermans
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  ABSTRACT: The increasing number of living kidney donors in the last decade has led to the development of novel surgical techniques for live-donor nephrectomy. The aim of the present study was to evaluate the current status of the surgical approach in Europe. A survey was sent to 119 transplant centers in 12 European countries. Questions included the number of donors, the technique used, and the acceptance of donors with comorbidities. Ninety-six centers (81%) replied. The number of living donors per center ranged from 0 to 124. Thirty-one institutions (32%) harvested kidneys using open techniques only. Six centers (6%) applied both endoscopic and open techniques; 59 centers (61%) performed endoscopic donor nephrectomy only. Lack of evidence that endoscopic techniques provide superior results was the main reason for still performing open donor nephrectomy. In seven centers, a lumbotomy is still performed. Seventy-two centers (75%) accept donors with a body mass index of more than 30 kg/m, the median upper limit in these centers was 35 kg/m (range, 31-40). Donors with an American Society of Anesthesiologists classification higher than 1 were accepted in 55% of the centers. Live kidney donation in general and minimally invasive donor nephrectomy in particular are more commonly applied in Northern and Western Europe. However, a classic lumbotomy is still performed in a minority of centers. Because minimally invasive techniques have been proven superior, more attention should be given to educational programs in this field to let many kidney donors benefit.
  Transplantation 07/2012; 94(3):263-8. · 4.00 Impact Factor