LDN Group Research Articles

Comparison of laparoscopic and open donor nephrectomy: a randomized controlled trial

Authors from Iran compare various outcomes between laparoscopic and open donor nephrectomy in kidney transplantation; they carried out a large comparative trial, and found that laparoscopic donor nephrectomy gave better donor satisfaction and morbidity, with equivalent graft outcome. To compare the graft survival, donor and recipient outcome, donor satisfaction, and complications of laparoscopic (LDN) and open donor nephrectomy (ODN) in kidney transplantation. In a randomized controlled trial, 100 cases each of LDN and ODN were compared. We modified the standard LDN procedure to make it less expensive. The mean (sd) operative duration was 152.2 (33.9) min for ODN and 270.8 (58.5) min for LDN, and the mean duration of kidney warm ischaemia was 1.87 min for ODN and 8.7 min for LDN. Only one LDN required conversion to ODN because of bleeding. The mean follow-up in the LDN and ODN groups was not significantly different (406.1 vs 403.8 days). The mean (sd) score for donor satisfaction was 17.3 (3.5) for ODN and 19.6 (1.0) for LDN. The rate of ureteric complications was 2% for ODN and none for LDN. As determined by serum creatinine levels at 3, 21-30, 90, 180 and 365 days after surgery, graft function was not significantly different between ODN and LDN. Long-term graft survival was 93.8% for LDN and 92.7% for ODN. Compared to ODN, LDN was associated with greater donor satisfaction, less morbidity and equivalent graft outcome.

Open versus laparoscopic donor nephrectomy in live related renal transplantation

Background This analysis sought to evaluate the efficiency and safety of laparoscopic nephrectomy (LDN) for the donor, the recipient, and the graft. LDN seems to have advantages over the open donor nephrectomy (ODN) in length of hospital stay, postoperative comfort, and pain control. Methods The results of 40 patients who underwent LDN between October 2000 and September 2003 were compared to those of 40 ODN patients just preceding the LDN patients. Eight laparoscopy patients required conversion to an open procedure due to bleeding (4; two major and two minor), technical problems with the instrument ( n = 1) and difficulty in the dissection ( n = 3). Results The demographic data, percentages of right and left nephrectomy, number of vessels, rates of acute rejection episodes, as well as the rates of urologic and vascular complications were similar between the two groups. The time of hospital stay was shorter, and the duration of the operation and of the warm ischemia time were significantly longer for the LDN group. The postoperative decline in serum creatinine levels were similar for the two groups. Graft survival rates were 91.7% at both the first and third years in the LDN group; 92.5% and 87.0% for the ODN group, a difference that was not statistically significant. Conclusion LDN is as efficient and safe as ODN for donors, recipients, and grafts.

Live donor nephrectomy and return to work: does the operative technique matter?

Several studies report an earlier return to work after minimal invasive kidney donation compared to open donor nephrectomy. However, this variation in outcome might be influenced by other factors than the surgical technique used, such as the advice given by the physician regarding return to work. In this study, we compare the absence from work after open (ODN), laparoscopic (LDN), and hand-assisted donor nephrectomy (HA) performed in the Netherlands, in relation to the advice given. Questionnaires containing questions about return to work or return to daily activities were sent to 78 donors from three hospitals. In the HA and ODN hospitals, advice on full return to work was 3 months. In contrast, advice given in the LDN hospital was 6 weeks. After LDN, donors resumed their work after 6 weeks, 5 weeks faster compared to ODN (p = 0.002) and HA (p <0.001). Complete return to work occurred 9 weeks sooner in the LDN group compared to the ODN and HA groups (both p <0.001). In the unemployed group, there was no significant difference in length until full return to daily activities. Return to work is influenced by the advice on return to work given by the physician as well as the morbidity associated with the surgical approach.

Exposure to continuous light inhibits maturation in turbot (Scophthalmus maximus)

Abstract Individually tagged female turbot that had been kept in captivity for 6 years were reared in two 4 m 2 tanks at 12 °C. The fish had been reared under simulated natural photoperiod (LDN) from hatching (1991) and until the start of the experiment. In March 1997, the fish were exposed to two photoperiod regimes. One group remained on LDN, and one group was transferred to continuous light (LDN/LD24:0). Female turbot reared under natural photoperiod spawned in the period between June and August the following summer (1997). Exposure to continuous light reduced the proportion of maturing females, spawning was delayed for 4 weeks, individual spawning frequency was lower (2.6 compared to 5.3 in the LDN group) and egg production was reduced by 90% (545 g compared to 5645 g in the LDN group). Maturing females in both experimental groups had significantly lower growth compared to non-maturing females. It is concluded that exposure to continuous light around spring equinox can significantly decrease and delay maturation in adult turbot.

Laparoscopic Donor Nephrectomy: Impact on an Established Renal Transplant Program

The current disparity of viable organs and patients in need of a transplant has been an impetus for innovative measures. Live donor renal transplantation offers significant advantages compared with cadaveric donor transplantation: increased graft and patient survival, diminution in incidence of delayed graft function, acute tubular necrosis (ATN), and reduction in waiting time. Notwithstanding these gains live donors continue to be underutilized and account for only approximately one quarter of all renal transplants performed in the United States. It has been felt that inherent disincentives to live donation have slowed its growth. These include degree and duration of postoperative pain and convalescence, child care concerns, cosmetic concerns, and time until return to full activities and employment. In an attempt to curtail the disincentives to live donation, laparoscopic live donation (laparoscopic donor nephrectomy; LDN) was developed. The purpose of this study was to compare the results of our first 25 laparoscopic nephrectomies (performed over a 10-month period from September 1998 through July 1999) with the previous 25 standard open donor nephrectomies (ODNs) completed over the past 3 years. We conducted a retrospective review of all donor nephrectomies and recipient pairs performed over the past 3 years. End points included sex, operative time, length of stay, immediate and long-term renal function, and willingness to donate. There were no differences in demographics of the ODN versus the LDN group. The average length of stay was 2.48+/-0.72 days for the LDN versus 4.08+/-0.28 days for the ODN. ODN and LDN have comparable short- and long-term function with no delayed graft function and no complications. Growth of living donor transplant has increased from 16 per cent of all kidney transplants performed in 1995 to 23 per cent in 1999. We conclude that LDN is a viable alternative to the standard donor operation. LDN has had a positive impact on the donor pool by minimizing disincentives to live donation. With the initiation of our laparoscopic program the number of LDNs has increased. Presently the live donor pool is the most viable alternative to significantly increase the number of kidneys for transplantation.

Effects of exposure to extended photoperiods during the first winter on long-term growth and age at first maturity in turbot ( Scophthalmus maximus)

The effects of photoperiod on growth of juvenile turbot and the consequences of extended daylength on age at first maturation were investigated. Growth of individually tagged turbot (initial weight 34–44 g, n = 94) was monitored for 18 months. The fish were held under natural photoperiod from hatching (July) until the start of the experiment in December. From December 4, 1991 until May 26, 1992, the fish were reared under constant light (LD24:0, n = 27), 16-h light:8-h darkness (LD16:8, n = 35), or simulated natural photoperiod for 60 °25′N (LDN, n = 32). The fish were then reared together on LDN for 12 months until first maturation during summer 1993 (age 24 months). The fish were held at 16 °C from December 1991 onwards. A growth promoting effect of extended daylength was seen in the LD16:8 and LD24:0 groups, but the effect was not apparent in the LD24:0 group until 6 months after the fish had been transferred to LDN. The final mean weights of the female turbot were 1727 g and 1777 g in the LD16:8 and LD24:0 groups, respectively, whereas final mean weights of males in these groups were 1075 g and 1055 g. In the LDN group the final mean weights for females and males were 1290 g and 909 g, respectively. The results from the present study suggest that exposure to extended photoperiod alters the growth pattern of both maturing fish and immature fish resulting in increased overall growth. Fewer males matured in the LD16:8 (26%) and LD24:0 (17%) groups than in the LDN (56%) group, whereas there were no differences between the experimental groups in the proportion of females that matured (range = 60–63%). It is concluded that extended daylength

Growth, oxygen consumption and activity of juvenile turbot ( scophthalmus maximus L.) reared under different temperatures and photoperiods

Juvenile turbot (5–125 g) were reared under two experimental temperatures: 10°C and 16°C, and three experimental photoperiods: LDN (natural photoperiod), LD 16:8 (16 h light: 8 h darkness), LD24:0 (continuous light), to study effects of temperature and photoperiod on growth, activity and oxygen consumption. Growth was strongly affected by temperature and was higher at 16°C than at 10°C. Continuous light had a growth-promoting effect at 10°C from mid-December to late March, while at 16°C this effect was restricted to December and January. A seasonal change in the condition index was found. The groups reared in continuous light had higher condition indices in winter. The experimental groups held at 16°C had higher O 2 consumption than those at 10°C. The LD24:0 groups invariably had a higher overall O 2 consumption than did the LDN and LD16:8 groups, the differences being caused by reduced O 2 consumption in the latter groups during darkness. The LD24:0 groups displayed higher activity than the LDN groups, in which activity was very low at night.

Advancing smolting to autumn in age 0+ Atlantic salmon by photoperiod, and long-term performance in sea water

Smolting in autumn in age 0+ Salmo salar was improved by 2 months of short photoperiod in an otherwise constant long photoperiod regime. Four groups of fry were reared under either constantlong photoperiod (LD 17:7), or LD17:7 interrupted by LD7:17 for one (1mo-short; July 27–September 1) or 2 months (2mo-short; June 30–September 1), or simulated natural day length (LDN). Bimodality in size-frequency developed in all groups by August. Probability of an individual entering the upper-modal group (UMG) was related positively to fork length in late June. The LDN regime had the highest proportion of both lower-modal group fish (46% vs. 25–27%), and 0+ sexually mature males of the four groups (26% vs. 10–12%). Smolt development in autumn was highest in the 2mo-short group, but was inferior to normal spring smolts, as judged by hypoosmoregulatory ability and gill Na +K +ATPase activity. Following transfer of UMG fish to a sea-cage in November, the 2mo-short group exhibited best survival and growth over winter. From spring onwards all groups grew well, reaching harvest size (3–4 kg) in August after 20 months in sea water. Mortality in sea water was 24% and 28% in the 2mo- and 1mo-short groups, and 54% and 67% in the constant-long and LDN groups. The study indicated the feasibility of stabilising the undesirable seasonal fluctuation in commercial salmon production by producing ‘off-season’ smolts 6 months out-of-phase from regular spring smolts.

Acclimation of Atlantic salmon ( Salmo salar) parr to seawater in autumn: stimulatory effect of a long photoperiod

Starting on 29 September, 1+ year-old Atlantic salmon parr (ca. 70 g) were maintained under either a long (LD18:6) or simulated natural photoperiod (LDN; 45 °N) for a 40-day period during which groups were either acclimated to seawater (SW; ca. 32 pans per thousand, ppt) by increasing salinity by 5–10 ppt every 5 days, or remained in fresh water (control). The increase in salinity and photoperiod independently resulted in a significant increase in gill Na +K +ATPase activity and high salinity (37 ppt) tolerance, with a combination of the two treatments being additive. Parr maintained mean plasma osmolality between 291 and 319 mcsmol kg −1 during acclimation, indicating a maintenance of iono/osmotic balance. On 5 November SW acclimated parr from LD18:6 and LDN groups were individually tagged and then maintained for 11 months in a single tank supplied with SW under an LDN photoperiod. During winter (SW temperature = 1–2 °C) overall cumulative mortality of parr acclimated under LD18:6 and LDN was 10% and 60% respectively, with the number of sexually mature male mortalities being disproportionately high. Death appeared due to breakdown in hypoosmoregulatory ability. Parr surviving the winter in SW completed smoltification in spring as judged by a decline in condition factor and change in appearance. The results support the hypothesis that an increase in photoperiod during autumn can improve the acclimation of Atlantic salmon parr to SW, and indicate the feasibility of transferring such fish to commercial marine facilities in autumn.

Effects of Constant Day Length on Sexual Maturation and Growth of Atlantic Salmon (Salmo salar) Parr

Atlantic salmon (Salmo salar) were reared for 6 mo from first feeding under four photoperiod regimes: LD 12:12, LD 16:8, LD 24:0, and simulated natural (LDN). Water temperature followed seasonal changes but was adjusted so as not to exceed 16 °C in summer or to fall below 6 °C in winter. Growth rates were highest in the LD 24:0 group during the first 3 mo; subsequently, the LD 16:8 fish grew faster than all others. Length–frequency distributions were skewed towards smaller sized fish in January. Sexually mature males were mainly in the lower halves of the length–frequency distributions; females and immature males were distributed throughout. The incidence of mature males was highest in the LDN group (67% of males) but reached high levels (44–58%) in the other groups.