MORBID OBESITY, AN INDICATION FOR LAPAROSCOPIC LIVING NEPHRECTOMY?

Abstract

P155 Aims: Obesity historically has been viewed as complicating factor for laparoscopic surgeons. In addition to the technical challenges of positioning and instrumentation, it is often felt these patients have a propensity for postoperative and anesthetic complications. The benefit and safety of the laparoscopic nephrectomy has been demonstrated in numerous studies over the last 5 years. With the improved operating times and post operative care paths the ability for a living donor to donate a kidney has become safer with an improved risk/benefit ratio. Even so, the mean waiting time for a recipient patient on the cadaveric transplant kidney list continues to grow due to a relative deficiency of donor organs. Because of this the donor pool has been opened to include marginal cadaveric kidneys and living patients who may not be ideal candidates for donation due to factors other than kidney function. Many transplant programs have decreased the weight restrictions that they once had on living donors to fill part of this void. The aim of this investigation evaluates the outcomes between obese and non-obese living kidney donors after a hand-assisted laparoscopic nephrectomy. Methods: Living related and un-related donors underwent a hand-assisted laparoscopic nephrectomy between 10/1998 and 9/2003 at a single transplant program. Data was collected retrospectively from chart review. A BMI>32 was defined as obese. Results: 224 living kidney donors underwent laparoscopic donor nephrectomy; 43 patients had a BMI <32 and 179 >32. No statistical differences were found between obese and non-obese patients in estimated blood loss, length of stay, time to oral intake or time to solid food intake, creatinine clearance at 1, 7, or 90 days, mean urine output, pain medicine requirements or complications. Similarly no differences in warm or cold ischemic times were noted between obese and non-obese donors. Conclusions: The hand-assisted donor nephrectomy has been shown to be equal to the open technique in regards to complication rate, infections, function of the donor kidney, rates of acute cellular rejection in the recipient and the graft survival long term. Benefits of the laparoscopic technique include decreases in hospital length of stay, bowel dysfunction, complication rates, pain control and overall patient satisfaction. The results in this study indicate that the obese patient with a BMI >32 has equal outcomes to their non-obese counterparts when donating a kidney for transplantation and obesity should be an INDICATION for the laparoscopic harvest of donor kidneys and not a contraindication.