MP72-18 ASSESSING THE EFFECTS OF PREOPERATIVE VOLUME MEASUREMENT FOR KIDNEY SELECTION DURING LAPAROSCOPIC DONOR NEPHRECTOMY

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery II1 Apr 2014MP72-18 ASSESSING THE EFFECTS OF PREOPERATIVE VOLUME MEASUREMENT FOR KIDNEY SELECTION DURING LAPAROSCOPIC DONOR NEPHRECTOMY Joshua D. Roth, Alexander L. Schneider, Clinton D. Bahler, John A. Powelson, Asif A. Sharfuddin, and Chandru P. Sundaram Joshua D. RothJoshua D. Roth More articles by this author , Alexander L. SchneiderAlexander L. Schneider More articles by this author , Clinton D. BahlerClinton D. Bahler More articles by this author , John A. PowelsonJohn A. Powelson More articles by this author , Asif A. SharfuddinAsif A. Sharfuddin More articles by this author , and Chandru P. SundaramChandru P. Sundaram More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2257AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prior to 2008, the left kidney was preferentially selected for donor nephrectomies to provide a longer renal vein for the transplant anastomosis. More recently, significant cost and effort have been employed to analyze kidney volumes so that the donor retains the larger kidney. We evaluated whether donor renal function is improved by utilizing volume measurements. METHODS We retrospectively analyzed a single surgeon’s laparoscopic donor nephrectomies from 2002-2011 at Indiana University. Beginning in 2008, renal volumes were routinely calculated by the radiology department using a triphasic CT scan and a semiautomatic segmentation algorithm (Phillips Intellispace portal software). If a size discrepancy was seen, a nuclear medicine scan was obtained for confirmation. Using the same software, we retrospectively measured volumes in donors between 2002 and 2007. RESULTS Over a 10-year span, 268 donor nephrectomies were performed, of which volumes could be calculated for 223 patients. Since we began using volume data to preferentially remove the smaller kidney from donors, the right kidney donation rate increased from 17.5% to 42.6% (p= <0.0001). Patients whose kidney selection was based on volume measurements did not have an improved percent change in GFR from baseline compared to those whose donation occurred prior to volume measurements (-30.8% vs. -31.8%, p= 0.563). See table. During this time period, 67 (30%) of these 223 patients had a >10% discrepancy in renal volumes. The larger kidney was removed in 22 (33%) of these patients. Patients whose larger kidney was removed did not have a worse percent change in GFR than those whose smaller kidney was removed (-34.3% vs. -31.6%, p=0.333). Rejection and graft loss were no different in recipients who received a smaller kidney (22% vs. 18%, p= 0.702). CONCLUSIONS Volumetric measurements of donor kidneys have safely resulted in a higher utilization rate of right-sided kidneys, but no renal function benefit was observed. More research is needed to assess whether volume measurements are worth the increased cost of healthcare, surgical complexity, and potential radiation exposure. Also, more data is needed to analyze increasing right-sided donor nephrectomy as a means of expanding the supply of available donors. Donor volumes considered in selecting nephrectomy side No, 2002-2007 (n=160) Yes, 2008-2011 (n=108) p-value Age (Years) 39.8 39.3 0.718 BMI 27.5 26.7 0.292 Operative Time (Minutes) 213.5 170.0 < 0.0001 Pre-operative Cr 0.91 0.83 < 0.0001 %GFR Change -30.8 -31.8 0.563 Follow Up (Months) 20.3 21.8 0.978 Gender (% Female) 51.9 63.9 0.060 Race (% Caucasian) 88.1 89.8 0.667 Side (% Right) 17.5 42.6 < 0.0001 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e830 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Joshua D. Roth More articles by this author Alexander L. Schneider More articles by this author Clinton D. Bahler More articles by this author John A. Powelson More articles by this author Asif A. Sharfuddin More articles by this author Chandru P. Sundaram More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...