LAPAROSCOPIC RIGHT DONOR NEPHRECTOMY

Abstract

P159 Aims: Laparoscopic donor nephrectomy preferentially involves the left kidney in order to optimize vessel length and safety of the operation. Occasionally right donor nephrectomy is preferred for a variety of reasons. Although right donor nephrectomy has been reported in the literature, no single study reports more than 20 operations. This retrospective study evaluates donor and organ outcome for right and left donor nephrectomy. Methods: All laparoscopic donor nephrectomies performed at a single transplant program from 2000 to 2004 were reviewed for pre-operative and post-operative outcome of the donor patient, the recipient patient and the renal allograft. Donor age, gender, race, body mass index (BMI), operative time, warm ischemia, cold ischemia, intra-operative urine output (UOP), estimated blood loss (EBL), vessel length and post-operative recipient creatinine were evaluated. Results: Of 253 laparoscopic donor nephrectomies performed between 2000-2004, 40 harvested the right kidney (16%). There was no difference in mean age (41 ± 11 years), gender (45% male), or BMI (27.5 ± 5.8) of donor patients. There was a difference in the number of Caucasian donors (80% of each group, p = 0.009). There was no difference in the number of vessels of the right donor kidney (30 of 40 single vessel) compared to the left kidney (164 of 213 single vessel). The right kidney selection was based on more numerous vessels in the left kidney (90%), early bifurcation of the left renal vessels (5%) or presence of a left renal cyst (5%). There was no difference in operative time or cold ischemia, although warm ischemia was longer for the right-sided operation (3:55 ± 1:22 min) than the left-sided operation (3:18 ± 1:06 min) (p = 0.004). There was no difference in the intra-operative UOP or EBL. The right renal artery length (2.7 ± 0.6 cm) differed significantly from the left renal artery length (3.2 ± 0.5 cm) (p = 0.003), as the right renal vein length (1.9 ± 0.3 cm) differed from the left renal vein length (3.8 ± 0.9 cm) (p = 0.001). There was no difference in the complication rate of 18%, the most common being hemorrhage (15%), resulting in only rare conversions to an open procedure (1%). Post-operative hospital length of stay was similar for both donor groups (45 ± 12 hours). Post-operative allograft function was similar for both groups at post-operative day one (creatinine 4.89 ± 3.41 for right kidney donor, 4.5 ± 2.7 for left kidney donor), post-operative day seven (creatinine 1.77 ± 1.21 for right kidney donor, 1.7 ± 1.5 for left kidney donor) and one year (creatinine 1.5 ± 0.4 for right kidney donor, 1.23 ± 0.28 for left kidney donor), with only one graft loss of the right kidney group due to chronic rejection (2.5%). Conclusions: Although right kidney donor nephrectomy is performed only rarely due to concerns about shortened vessel length, this operation can be performed safely. We report no significant differences in donor demographics or allograft function at one year. With experience, laparoscopic right donor nephrectomy can be performed safely for the donor and recipient producing equal long term results.