Systematic Review and Meta-Analysis of the Relation Between Body Mass Index and Outcome of Laparoscopic Donor Nephrectomy

Abstract

Background: In this era of organ donor shortage, live kidney donation has been proven to increase the donor pool. However, it is extremely important to make careful decisions in including and excluding possible live donors. A Body Mass Index (BMI) above 35 is generally considered as a relative contra-indication for donation. Whether this is justified or not is currently under debate. For this reason, a systematic review and meta-analysis was carried out to compare outcome of live donor nephrectomy (LDN) between high- and low BMI donors. Methods: A comprehensive literature search was performed in the Cochrane Central Register for Controlled Trials, the Cochrane Library, MEDLINE, PubMed and Embase. Reference lists were screened manually for relevant articles. A meta-analysis was performed by using Review Manager version 5.1 (The Nordic Cochrane Centre, Copenhagen, Denmark). Random-effects models were used. All aspects of the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) statement were followed. Results: Out of 529 publications, fourteen studies were selected and reviewed. Eight peri-operative outcome measures were meta-analyzed. Of these, the following demonstrated significant differences in favour of low BMI donors: the mean difference in operation duration was 16.91 minutes (confidence interval (CI) 9.06 to 24.76; P < 0.0001), the mean difference in rise in serum creatinine was 0.05 mg/dL (CI 0.01 to 0.09; P = 0.02) and the risk ratio for conversion was 1.69 (CI 1.12 to 2.56; P = 0.01). Differences in the other outcome parameters (warm ischemia time, estimated blood loss, length of stay, perioperative complications and decrease in glomerular filtration rate) were not significant. Conclusion: In five out of eight outcome measures no significant differences were found between BMI groups. The clinical relevance of the outcome measures that were significantly different is questionable. Based on these results we conclude that a high BMI alone is no contra-indication for live kidney donation.