Maximizing the donor pool: use of right kidneys and kidneys with multiple arteries for live donor transplantation

Abstract

Studies have shown donor and recipient outcomes to be equivalent for laparoscopic donor nephrectomy (LDN) and open donor nephrectomy. In the past, LDN has been avoided in the procurement of the right kidney or organs with multiple arteries. This study compares procurement of right and left kidneys as well as procurement of single- and multiple artery organs. A review of all LDNs at a single institution between August 2000 and December 2007 was performed. The data included estimated blood loss (EBL), need for transfusion, operative time, warm ischemia time, length of hospital stay (LOS), and delayed graft function. Arterial supply was assessed using renal arteriogram or computed tomographic (CT) angiography. Outcomes for multiple versus single artery and left versus right LDN were compared. Student's t-test and chi-square test were used for statistical comparison. A total of 230 LDNs were performed. Multiple arteries were present in 37 donors. The right kidney was procured from 36 donors. No significant difference in EBL, transfusions, operative time, or LOS was noted between multiple and single or right and left LDNs. Warm ischemia time was significantly longer for multiple arteries (mean, 83 s) than for single arteries (mean, 63 s; p = 0.007), and for right kidneys (mean, 86 s) than for left kidneys (mean, 62 s; p = 0.001). No significant difference in delayed graft function was seen in the comparison of multiple (21.6%) and single (11.4%) artery organs (p = 0.11) or of right (13.9%) and left (12.9%) kidneys (p = 0.79). The presence of multiple arteries or the need to procure the right kidney does not affect the operative outcome of laparoscopic donor nephrectomy. Warm ischemia time may be greater for these groups, but this does not result in delayed allograft function. The laparoscopic approach should be the standard of care even when expansion of the donor pool includes organs with multiple arteries and procurement of the right kidney.