LAPAROSCOPIC LIVE DONOR NEPHRECTOMY: THE RECIPIENT

Abstract

428 Laparoscopic live donor nephrectomy (LapNx) has been shown to offer advantages to the donor in terms of decreased pain, and shorter recuperation. However, heretofore no detailed analysis of the recipient of laparoscopically procured kidneys has been performed. The purpose of this study is to determine whether LapNx has any deleterious effect on the recipient. A retrospective review was conducted of all live donor renal transplants performed from 1/95-12/97. The control group received kidneys procured via a standard flank approach. Rejection was diagnosed histologically. Creatinine clearance (CrCl) was calculated using the Cockroft-Gault formula. Pediatric recipients were excluded from both short and long term renal functional analysis. 87 (82 adult, 5 peds) patients received kidneys from laparoscopic donors(Lap). 48 (37 adult, 11 peds, p=0.007) individuals comprised the open cohort. The 2 groups were not significantly different in regard to donor and recipient age, gender, race, or degree of HLA mismatch. Overall recipient(97.7% vs 97.9%) and graft (90.8 vs 89.6%) survival rates were similar for the Lap and Open groups respectively. 3(3.4%) allografts in the Lap and 1(2.1%) in the Open groups were lost due to vascular thrombosis (p=NS). Those lost to vascular thrombosis in the Lap were all right kidneys. Ureteral complications occurred in 9 (10.3%) pts in the Lap and 3(6.3%) in the Open groups (p=NS). The incidence of acute rejection for months 0-3 was Lap 33.3% and Open 35.4% (p=NS). Rate of decline of serum creatinine in the early posttransplant period was initially greater in the Open group, but by POD#4 no significant difference existed. No difference was observed in allograft function longterm as defined by CrCl (ml/min)(seetable, p=NS for all time points ). Also, combined donor/recipient median length of hospital stay (LOS) (10 vs 12 days) was less in the Lap cohort (p=0.011). No difference was noted in the recipient LOS(median 7.0 days for both groups). We conclude that LapNx does not adversely effect recipient outcome. However, improvements in patient selection and surgical technique may improve overall results as our experience with this operation matures. In particular, modification of the laparoscopic procedure may be necessary when a right sided approach is indicated.