Abstract
Most studies revealed that ischemic time has substantial role in occurrence of delayed graft function (DGF) after deceased donor kidney transplantation. However, less is known about the potential impact of surgical times on early outcomes following live donor kidney transplantation. A retrospective cohort of 189 consecutive laparoscopic live donor kidney transplant (LDKT) recipients from January 2006 to August 2012 was analyzed to reveal the impact of pneumoperitoneum time (PT) and anastomosis time (AT) on donor and recipient length of hospital stay and early graft function (EGF). DGF was observed in 13 (6.8%) patients while slow graft function (SGF) was seen in 27 (14%) of the recipients. The median AT was 28 minutes (interquartile range 23, 35 minutes). AT was associated with DGF (Odds Ratio [OR] 1.044, per minute, 95% CI 1.007, 1.082, p = 0.018). Median recipient length of hospital stay was 8 (interquartile range 7, 11) days. Every 13.5 minutes of longer AT was associated with 1 extra day in hospital. The median PT was 180 minutes (interquartile range 144, 234 minutes). PT was associated with both DGF (OR 1.013 per minute, 95% CI 1.005, 1.021, p = 0.001) and SGF (OR 1.009 per minute, 95% CI 1.002, 1.016, p = 0.016). Every extra hour of PT was associated with 0.42 more days in hospital for the donor. Surgical times may be underestimated variables in dictating use of hospital resources. The effect of surgical times on long term hard outcomes entails further study.
Highlights
Since its description in 1995 laparoscopic live donor nephrectomy has replaced open donor nephrectomy at many transplant centres [1]
The purpose of this study was to examine the effect of anastomosis time (AT) and pneumoperitoneum time (PT) on short term outcomes in laparoscopic live donor kidney transplant (LDKT)
AT was associated with delayed graft function (DGF), higher recipient POD5 serum Cr, and longer recipient stays in hospital
Summary
Since its description in 1995 laparoscopic live donor nephrectomy has replaced open donor nephrectomy at many transplant centres [1]. Some studies have shown that the pneumoperitoneum used during laparoscopic donor nephrectomy procedure might impair renal blood flow and prolonged pneumoperitoneum time (PT) can increase the oxidative stress and subsequently cause subtle renal tissue injury [4,5,6]. In line with this hypothesis, several investigators have reported slower early post-transplant function for laparoscopically retrieved (vs open) grafts as measured by poor early graft function (EGF) rates [7,8]. Studies investigating EGF after kidney transplant from living donors (regardless of the procurement technique) identified prolonged anastomosis time (AT) as another risk factor for the occurrence of poor EGF [10]
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