Abstract
Aims We aimed to summarize available evidence about intraoperative and postoperative donors' and recipients' outcomes following stone surgery in renal grafts from living donors performed either before donation or as ex vivo bench surgery at the time of living-donor nephrectomy. Methods A systematic review of PubMed, ISI Web of Knowledge, and Scopus databases was performed in September 2020. We included full papers that met the following criteria: original research, English language, human studies, and describing the results of stone surgery in renal grafts from living donors performed either before transplantation or as ex vivo bench surgery. Results We identified 11 studies involving 106 patients aged between 22 and 72 years. Predonation and bench stone surgery was performed in 9 (8.5%) and 96 (90.6%) patients, respectively. Predonation stone surgery involved extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy in 8, 1, and 1 patient, respectively. The overall success rate of predonation stone surgery was 78%, and the complication rate was 0%. Bench stone surgery involved ureteroscopy, pyelolithotomy, or a combination of both in 79 (82.3%), 10 (10.4%), and 7 (7.3%) cases, respectively, with an overall success rate of 95.8% and an overall complication rate of 9.37%. Conclusions Predonation and bench stone surgery in grafts from living donors represents efficacious and safe procedures. Further studies on wider series with a longer follow-up are required.
Highlights
Renal transplantation (RT) from living donors provides significant advantages compared to transplantation from deceased donors including improved long-term survival, immediate functioning of the transplant, better transplant survival, and the possibility of transplanting preemptively [1,2,3,4,5]
The total number of kidney transplants has increased in the last years, the number of total living donations has remained stable with a subsequent decrease in the proportion of living donor transplant procedures [2]
Stones located in the upper urinary tract of kidney donors represent a relative contraindication to RT because of complications like oliguria, hematuria, or rising creatinine in the receiver [8]
Summary
Renal transplantation (RT) from living donors provides significant advantages compared to transplantation from deceased donors including improved long-term survival, immediate functioning of the transplant, better transplant survival, and the possibility of transplanting preemptively [1,2,3,4,5]. The donor is exposed to the risk of future stone formation in the remaining kidney, which could lead to obstruction, infections, and end-stage renal disease [9]. The asymptomatic potential donor with a current single stone might be considered suitable for kidney donation in selected cases [10,11,12]. The need to cope with the living graft shortage together with the development of minimally invasive surgery and ex vivo bench surgery stimulated research toward the treatment of stones either in the pretransplantation setting or during back-table procedures [10]. The present review is aimed at summarizing available clinical evidence about the outcomes of stone surgery performed either in the predonation setting or as ex vivo bench surgery at the time of living-donor nephrectomy
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