Abstract
Living kidney donation with minimally invasive nephrectomy (MIN) was established as adequate procedures regarding transplant function and perioperative results. However, the specific beneficial effects of MIN for donor and recipient were not investigated so far. Aim of study was to analyze transplant function and long-term results in comparison to postmortal transplantation (TX), as well as individual acceptance of donors and recipients after lapaproscopic and open nephectomy for living donation. Between 1998 and 2011, 175 living donors and recipients were investigated regarding kidney function and transplant survival and compared with 710 postmortal TX patients without primary transplant dysfunction. Incidence of newly diagnosed hypertension and proteinuria were assessed. Additionally, standardized analysis of quality of life and patient's satisfaction were analyzed. Livinig donor recipients had a 10 year transplant survival of 94% compared to 72% after postmortal TX. 118 patients had laparoscopic nephrectomy, 57 patients had open nephrectomy. There were no significant differences regarding transplant function and survival and no differences in kidney function, proteinuria or hypertonia in the donors (Creatinine,15/1,12 mg/dl after 3 years). Hospitalization was substantially shortened after laparoscopic nephrectomy (9,8 vs. 13,0 days, p=0.01). The incidence of incisional hernia was higher after open nephrectomy (9,8 vs. 13,0 Tage, p=0.01). In the laparoscopic group, higher satisfaction and acceptance was observed (p=0.05). Living donor kidney transplantation is associated with excellent long-term results of transplant function and survival. Minimally invasive nephrectomy is superior to open technique due to decreased hospitalization, incidence of incisional hernia and higher acceptance and should be preferred after careful assessments of individual risks.
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