SUCCESSFUL LIVING UNRELATED KIDNEY DONATION - TRANSPLANTATION: A FOUR YEAR EXPERIENCE

Abstract

225 For 180 consecutive renal transplants performed from January, 1994, to December, 1997, 30 (16.6%) were from living unrelated donors (18 women, 12 men, aged 25 to 63 - mean 44- years). All donors had pretransplant imaging evaluation of renal anatomy following renal function assessment, (minimal creatinine clearance 75 cc's per minute). Admission to the hospital via ambulatory surgery the a.m. of donation preceded nephrectomy under general anesthesia using an anterior flank, extra-retroperitoneal approach (no rib resection). Postoperative epidural pain control was used for all but one donor. After the initial hospital night, self-care, progressive ambulation, and prescriptive pulmonary care was undertaken to facilitate early recovery and short hospital stay. The 30 kidney donors were hospitalized for two (N=1), three (N=14), four (N=8), or 5-8 (N=7) days. Average length of stay was 3.96 (range 2-8) days. The mean charge for the kidney donor hospitalization was $15,915 (range $10,808 - $29,579). There was no requirement for frequent outpatient follow-up because of any aspect of the kidney donor episode or length of hospital stay. One major intraoperative hemorrhage required transfusion; the donor has subsequently done well. One late neural-related pain syndrome required outpatient wound exploration. Two kidneys were lost: one husband recipient from repetitive acute rejections at three months; one friend recipient from chronic rejection and non-compliance at two and one-half years; both recipients now await cadaver transplant. The other 28 kidneys gained and maintained life sustaining renal function with a current average serum creatinine of 1.9 (range 1.0 - 2.5) with up to 48 months follow-up (patient survival 100%; graft survival 93%). Strategies important to successful living unrelated kidney donation and transplantation are early and through patient and family education, ambulatory preoperative testing, donor and recipient morning admission, and early discharge planning. While most donors were spouses (10 husbands and 13 wives), friends, distant cousins, in-laws, and adoptive relatives did well as donors and recipients. Excellent kidney function from living unrelated donors may be accomplished by a brief length of stay, epidural pain management to facilitate early recovery, and a willingness to consider nephrectomy in healthy unrelated living donors. Expansion of donor resources by 15% to 20% may be possible in renal transplant programs that support the concept of living unrelated kidney donation.