Living Donor Nephrectomy Research Articles

Kidney transplantation: A new era of laparoscopic living donor nephrectomy in Indonesia

Since its introduction in 1995, laparoscopic living donor nephrectomy (LLDN) has been a standard procedure in many transplantation centers worldwide. In 2011, LLDN was performed for the first time in Indonesia and became a standard procedure at our institution. The aim of this study is to evaluate the first 250 cases of LLDN at our institution. Retrospective analyses were conducted of the first 250 cases of LLDN. All operations were performed between November 2011 and July 2015 at Cipto Mangunkusumo Hospital, Jakarta. We grouped each 100 consecutive cases and the last 50 cases (three groups) to evaluate operation-related parameters, and complications. Significant decreases in the first warm ischemic time, blood loss, length of stay, and number of complications were observed among the three groups. There was only one conversion to open case during LLDN surgery and no mortality case observed. Laparoscopic living donor nephrectomies had been performed successfully with improvement of surgical parameter in due time. Thus, laparoscopic approach has entered a new era for kidney procurement in Indonesia.

Association Between Overweight and Renal Transplant Outcomes: A Meta-Analysis.

As the demand for kidney transplant allografts has increased, many centers are expanding the upper limit of acceptable body mass index for kidney donors. However, obesity is a risk factor for developing renal disease. Our goal was to quantify body mass index trends in donor nephrectomy patients and to institute nutrition counseling to promote sustainable weight loss to reduce the risk of metabolic syndrome-derived renal dysfunction. Ninety patients who underwent donor nephrectomy between 2007 and 2012 consented to having height and weight data collected at multiple time points. After data collection, each patient underwent a standardized nutrition counseling session. One year later, body mass index was reassessed. Preoperatively, 52% of the patients were overweight or obese. The percentage of overweight and obese patients remained stable for 2 years after surgery. However, at 3, 4, and 5 years after surgery, these rates increased to 59%, 69%, and 91%. Each patient was counseled about obesity-related comorbidities and provided information about lifestyle modification. One year later, 94% of previously overweight patients and 82% of previously obese patients had a decrease in mean body mass index from 27.2 ± 4.0 kg/m2 to 25.1 ± 3.6 kg/m2. Living-donor nephrectomy patients are at risk of developing obesity, similar to the adult population. Nutrition counseling may be beneficial to help normalize body mass index in patients who have become overweight or obese to potentially prevent obesity-related comorbidities. All patients were evaluated by a nutrition specialist after surgery to review our donor nephrectomy nutrition brochure. Body mass index monitoring and primary care follow-up appear to be appropriate surveillance methods.

Host-related Risk Factors for Adherent Perinephric Fat in Healthy Individuals Undergoing Laparoscopic Living-donor Nephrectomy.

The purpose of this study is to assess the risk factors and characteristics of adherent perinephric fat (APF) in healthy individuals. Men who underwent laparoscopic donor nephrectomy were included. Video review was used to divide patients on the basis of APF severity. Relationship between APF scores and clinical and radiographic features was evaluated. Of the 92 patients, 43 (46.7%) and 8 (8.7%) were categorized as APF and severe APF, respectively. The median total operative time was significantly associated with APF severity. Sex, body mass index, and perinephric fat area, stranding, and thickness were significantly associated with severe APF. In the multivariate analysis, perinephric fat areas and stranding were independent risk factors for severe APF (HR, 1.189 and 14.450, respectively). In the 44 analyzed cytokines, levels of sIL-6R in the perinephric adipose tissue-conditioned medium were significantly higher for APF group than that for non-APF group (P=0.049). Host-related risk factors for APF could predict surgical difficulty in patients undergoing partial nephrectomy.

Impact of the Ratio of Visceral to Subcutaneous Adipose Tissue in Donor Nephrectomy Patients

ObjectiveIt was reported that a metabolic syndrome affected the remaining renal function after living donor nephrectomy. However, the measurement of waist circumference is unclear because it cannot distinguish between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). We investigate the clinical correlation between body adipose tissue and renal function recovery after living donor nephrectomy. MethodsFrom July 2013 to February 2015, 75 living kidney donors were enrolled. The VAT and SAT were measured by preoperative computed tomography (CT) scan. Body mass index (BMI), VAT, SAT, and VAT-to-SAT ratio were analyzed according to a postoperative renal function recovery. Receiver operating characteristic (ROC) was performed to predict estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 at postoperative 6 months for BMI, VAT, SAT, and VAT-to-SAT ratio. ResultsThe lowest value of eGFR (57.52 ± 11.20 mL/min/1.73 m2) was measured at postoperative day 7. There was no statistically significant difference in eGFR between 1 month and 3 months. BMI, VAT, SAT, and VAT-to-SAT ratio showed a statistically significant correlation with each other (Pearson correlation, P < .05). Also, the recovery time of eGFR was correlated with VAT-to-SAT ratio; it was significant at postoperative 1, 3, and 6 months. VAT-to-SAT ratio (0.654, 95% confidence interval 0.525–0.783, P = .024) had higher predictive value in ROC. ConclusionWe developed a new variable to predict the value of lower eGFR (less than 60 mL/min/1.73 m2) at a postoperative 6 months in living kidney donor. According to a CT scan, VAT-to-SAT ratio can predict renal function recovery.

Clinical Investigation Into Plasma Neutrophil Gelatinase-Associated Lipocalin and Body Adipose Tissue Associated With Remaining Renal Function in Living Kidney Donor

ObjectivePlasma neutrophil gelatinase-associated lipocalin (pNGAL) is known to increase in proportion to the degree and period of renal damage. This study aimed to evaluate the clinical relevance of pNGAL and body adipose tissue to remaining renal function in living kidney donors. MethodsBetween July 2013 and February 2015, 75 live kidney donors were enrolled. Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and VAT/SAT ratio were measured in preoperative CT scan which performed before surgery. We analyzed the correlation among the variables (VAT, SAT, and VAT/SAT ratio), eGFR and pNGAL. ΔpNGAL-max(=Maximum pNGAL-measures), ΔpNGAL-min(=Minimum pNGAL-measures), ΔeGFR-max(=Maximum eGFR-measures) and ΔeGFR-min(=Minimum eGFR-measures) were also analyzed. ResultsThe highest value of pNGAL (207.46 ± 76 ng/mL) was observed on postoperative day 7, and the lowest value of eGFR (57.52 ± 11.20 mL/min/1.73 m2) was also measured on postoperative day 7. A significant correlation was found between ΔpNGAL, VAT, and VAT-to-SAT ratio. Moreover, a significant correlation between ΔpNGALmin and ΔeGFRmin was revealed. Also, VAT-to-SAT ratio was correlated with ΔeGFRmin during the all of the follow-up periods, and it was also correlated with ΔpNGALmin until postoperative day 3. ConclusionThere was a correlation between the elevation of pNGAL until postoperative day 5 and the decrease of eGFR after living donor nephrectomy. VAT-to-SAT ratio had a significant correlation with both ΔpNGALmin and eGFRmin. Given the metabolism of pNGAL, the increase of pNGAL seemed to be affected as a consequence of body adipose tissue.

Selection Criteria for Kidney Laterality in Retroperitoneoscopic Living Donor Nephrectomy and the Usefulness of Pretransplant Intervention

ObjectivesTo evaluate the selection criteria for kidney laterality and the usefulness of pretransplant intervention in living donor nephrectomy. MethodsWe compared conventional and revised criteria. The conventional criteria were that left kidneys were chosen in preference and provided the kidney with the fewest structural abnormalities and lowest functional decline and that most renal arteries remained in the donor. From April 2013, we allowed the use of left kidneys with double renal arteries. Patient characteristics and surgical outcomes were retrospectively compared between right and left retroperitoneoscopic living donor nephrectomies. ResultsWe compared data for 30 right kidney and 222 left kidney nephrectomies. Right kidneys were selected because of multiple renal arteries (n = 18), structural abnormalities (n = 10) of the left kidney, or functional decline (n = 2) of the right kidney. Right retroperitoneoscopic nephrectomies were associated with significantly longer operating times (267 minutes vs 241 minutes), larger blood losses (240 g vs 55 g), and higher open conversion rates (10% vs 0.9%). Pretransplant intervention was necessary for structural abnormalities in right kidneys, but the amended selection criteria resulted in fewer right nephrectomies. Pretransplant intervention was still necessary by ex vivo arterial anastomosis for multiple left renal arteries, which increased the total ischemia time (94 minutes vs 64 minutes); however, post-transplantation renal function was not significantly different. ConclusionsPretransplant intervention was beneficial both for repairing structural abnormalities and for reducing the difficulties of retroperitoneoscopic living donor nephrectomy.

Living Donor Nephrectomy at the National Kidney and Transplant Institute: Surgical Techniques, Perioperative Complications and Outcomes

Living Donor Nephrectomy at the National Kidney and Transplant Institute: Surgical Techniques, Perioperative Complications and Outcomes

TORPEDO: Prospective, double blind, randomized clinical trial comparing the use of Ketorolac verse placebo during live donor nephrectomy for kidney transplant

The aim of this pilot study was to determine if the use of Ketorolac for donor nephrectomies could decrease the use of narcotics. Methods: This is a prospective, double blind, randomized trial involving patients undergoing nephrectomy for live donor kidney transplantation. Three arms: 1. Ketorolac 30mg IV×1 in the OR, then ketorolac 15mg IV every 6h for 7 doses. 2. Ketorolac 30mg IV×1 in the OR, then placebo IV every 6h for 7 doses. 3. Placebo IV×1 in the OR, then placebo IV every 6h for 7 doses. Outcomes: blood loss, mortality, renal function, cumulative narcotic use, length of hospital stay (LOS), and urinary retention. Results: There were no patient deaths, blood transfusions or renal dysfunction in any study arm. Arm 1 had less narcotic use, reduced length of stay, and reduced urinary retention than Arm 3. Conclusion: There was reduced LOS, less narcotic use and less urinary retention in the Ketorolac group (Arm 1) versus the placebo group (Arm 3). Based on these results we will proceed with a larger study to compare the use of non-opioid analgesics in donor nephrectomies.

MP74-17 RENAL ARTERY DIAMETER IS A SURROGATE MARKER FOR KIDNEY VOLUME IN LIVING KIDNEY DONORS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery III1 Apr 2017MP74-17 RENAL ARTERY DIAMETER IS A SURROGATE MARKER FOR KIDNEY VOLUME IN LIVING KIDNEY DONORS Arshvin Kesavan, Bee Choo Tai, Arun B, Benjamin Goh, Lata Raman, Vathsala Anantharaman, and Ho Yee Tiong Arshvin KesavanArshvin Kesavan More articles by this author , Bee Choo TaiBee Choo Tai More articles by this author , Arun BArun B More articles by this author , Benjamin GohBenjamin Goh More articles by this author , Lata RamanLata Raman More articles by this author , Vathsala AnantharamanVathsala Anantharaman More articles by this author , and Ho Yee TiongHo Yee Tiong More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2185AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Donor kidney volume (KV) is an increasingly important parameter evaluated before living kidney donation. It potentially enhances the estimation of glomerular filtration rate before surgery, measures split renal function for selection of the explantation side and prognosticates recipient function following transplantation. However, KV measurements on Computerised Tomographic (CT) scanning requires a manually intensive process of manual or semi-automatic segmentation of kidneys with inter-observer variation. Renal artery diameter (RAD) is an easier marker to measure and this study aims to investigate the relationship between donor RAD and KV. METHODS A retrospective review of consecutive patients who underwent living donor nephrectomy between 2010 and 2016 was conducted. In all patients, bilateral kidney volumes were measured based on contrast-enhanced CT scan imaging, using segmentation of functional nephron mass to exclude sinus fat, blood vessels and the pelvi-calyceal system. For the renal artery maximum diameter, we measured the RAD at the vessel cross section just distal to the aortic ostia. Measurements were taken between the tunica intima by direct visualisation on the arterial phase of transverse CT slices. Estimated Glomerular Filtration Rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation from serum creatinine levels collected before surgery. RESULTS 92 consecutive living donor nephrectomy patients were reviewed. After excluding 15 patients with multiple arteries, 77 patients (55.8% Female, 58.4% Chinese) were available for this study. The mean age of the donors was 44.4+/-12.7 years. Controlled hypertension, hyperlipidemia and smoking were present in 9(11.7%), 17 (22.1%) and 7 (9.2%) patients with no other significant co-morbidities. All patients had normal blood pressure (BP) measurements pre-operatively with a mean systolic and diastolic BP of 122.4+/-14.4 and 72.4+/-10.4 mmHg respectively. Mean right and left KVs were 132.8+/-25.9 and 138.9+/-24.8 cm3 respectively. Mean right and left RADs were 4.86+/-0.91 and 5.14+/-0.85 mm respectively On regression analysis, there was a significant association between the right and left RADs and their ipsilateral KVs with a regression coefficient of 7.9 (95% C.I. 1.3-14.5, P=0.019) and 9.8 (95% C.I. 3.3-16.3, P=0.004) respectively. Mean eGFR pre-operatively was 105.1+/-14.9 mL/min/1.73 m2. Mean total RAD (the sum of both left and right RAD) was 9.61+/-2.51mm. It was found to be correlated with pre-operative eGFR at 0.095. Patients with pre-operative eGFR of < 100 mL/min/1.73 m2 had a lower total RAD than those with eGFR>100 mL/min/1.73 m2 (9.38+/-3.44 mm vs 9.73+/-1.86 mm, p=n.s.) CONCLUSIONS This study demonstrates that renal artery size is positively associated with kidney volume and may be used as a more easily measured surrogate marker for kidney size with its attended implications in living donor transplantation. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1001-e1002 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Arshvin Kesavan More articles by this author Bee Choo Tai More articles by this author Arun B More articles by this author Benjamin Goh More articles by this author Lata Raman More articles by this author Vathsala Anantharaman More articles by this author Ho Yee Tiong More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Human adipose tissue accumulation is associated with pro-inflammatory changes in subcutaneous rather than visceral adipose tissue

The importance of the involvement of adipose tissue macrophage subpopulations in obesity-related disorders is well known from different animal models, but human data are scarcer. Subcutaneous (n=44) and visceral (n=52) adipose tissues of healthy living kidney donors were obtained during living donor nephrectomy. Stromal vascular fractions were isolated and analysed by flow cytometry using CD14, CD16, CD36 and CD163 antibodies. Total macrophage numbers in subcutaneous adipose tissue increased (P=0.02) with body mass index (BMI), with a similar increase seen in the proportion of phagocytic CD14+CD16+CD36high macrophages (P<0.01). On the other hand, there was an inverse correlation between anti-inflammatory CD14+CD16−CD163+ macrophages (P<0.05) and BMI. These correlations disappeared after excluding obese subjects (BMI ⩾30 kg m−2) from the analysis. Interestingly, none of these subpopulations were significantly related to BMI in visceral adipose tissue. Obesity per se is associated with distinct, highly phagocytic macrophage accumulation in human subcutaneous adipose tissue.

MP06-01 EVALUATION OF THE RELATIONSHIP BETWEEN THE DONOR AND RECIPIENT DURING KIDNEY TRANSPLANT

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2017MP06-01 EVALUATION OF THE RELATIONSHIP BETWEEN THE DONOR AND RECIPIENT DURING KIDNEY TRANSPLANT Christopher Dru, D. Joseph Thum, Devin Patel, Justin Houman, and Gerhard Fuchs Christopher DruChristopher Dru More articles by this author , D. Joseph ThumD. Joseph Thum More articles by this author , Devin PatelDevin Patel More articles by this author , Justin HoumanJustin Houman More articles by this author , and Gerhard FuchsGerhard Fuchs More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.246AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2014, approximately 6,100 people in the United States underwent living donor nephrectomy. Unlike other types of organ donation, this patient population has a longer-than-average life expectancy due to strict selection criteria. Greater than 99% of patients that donated a kidney at Cedars-Sinai Medical Center donated to an immediate family member, relative, or close friend. Our study seeks to qualify and quantify functional changes in the relationship between the donor and the recipient before and after surgery as well as to identify perioperative complications and stress to determine if patients are content with their decision to donate. METHODS From 2002-2012, 532 patients underwent donor nephrectomy for kidney transplant at Cedars-Sinai Medical Center. After IRB approval, a randomized subset of these patients were administered a standardized questionnaire regarding his or her experience. We assessed if each patient would undergo the donation process again, now having more intimate knowledge and appreciation of the pre- and post-operative surgical and medical course. RESULTS Of the fifty patients who participated in our survey, 92% stated that their relationship with the recipient improved after surgery. Of the 8% that noted a deterioration in the relationship, there was a distribution of dissatisfaction with relation to the sexual relationship (n=1), recipient personality changes (n=1), or divorce (n=2). Approximately 10% of patients experienced a complication related to surgery, all of which were clavian grade I-II. Examples of these included incisional hernia (n=3, upper midline incision, BMI>30 kg/m2) and urinary tract infection (n=2). Overall, 98% of patients were extremely satisfied with the donation process and would not hesitate to participate again. Only one patient stated that he would not donate again, as he developed an unanticipated glomerulonephropathy not related to surgery that required hemodialysis. CONCLUSIONS Our research demonstrates that the act of donating a kidney overwhelmingly enhances the bond between the donor and recipient. Even donors who noted a decline in their relationship with the recipient all stated that they would still donate if faced with the same decision again. This suggests that the relationship with the recipient is of highest importance and a crucial component of pre-operative counseling that should be emphasized. Our urology group has started to incorporate this practice in our management with great success. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e72 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christopher Dru More articles by this author D. Joseph Thum More articles by this author Devin Patel More articles by this author Justin Houman More articles by this author Gerhard Fuchs More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical Aspects of Kidney Transplantation

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. This review discusses the surgical aspects of kidney transplantation in detail, beginning with the important features of the preoperative evaluation of a potential transplant recipient. We then explain in detail the technical aspects of living donor nephrectomy and kidney transplantation and provide guidance for managing variability in donor organ anatomy. Immediate postoperative management of the kidney transplant patient is briefly discussed. Finally, this review addresses the important postoperative complications to be aware of in the kidney transplant patient and management strategies, as well as outcomes of kidney transplantation. Key words: chronic kidney disease, deceased donor transplantation, delayed graft function, kidney transplant, living donor nephrectomy, living donor transplantation, lymphocele, renal artery stenosis, transplant workup, urologic complications

Anatomic Diversity Encountered During Laparoscopic Hand-Assisted Transperitoneal Donor Nephrectomy: A Case Report of Complete Caval Duplication

IntroductionLaparoscopic donor nephrectomy is widely used to retrieve a kidney for transplantation. Preoperative evaluation of the donor is of crucial importance to the recipient. In particular, vascular anatomy should be assessed with the help of modern imaging modalities. We present a hand-assisted laparoscopic nephrectomy of a kidney donor with a complete duplex vena cava. Case ReportA 40-year-old male patient was admitted to our clinic as a kidney donor for his 20-year-old son. After the preliminary tests, further imaging with the use of computerized tomographic angiography showed a complete duplex vena cava. He had no morbidities or previous surgeries. A hand-assisted transperitoneal laparoscopic left nephrectomy was performed as the kidney removal technique commonly used in our center. There was minimal blood loss, and the warm ischemia time was 66 minutes. Operation time was 265 minutes. After transplantation had been performed, graft functions were good with normal urine output. Blood sample tests were in normal ranges. The live donor was discharged on the 7th day after the procedure without any complications. ConclusionsAlthough renal vascular anomalies are rarely seen, they have a significant impact on the outcomes of the renal transplantation. Knowing the vascular anatomy minimizes the complications risk and increases the success rate. Laparoscopic live-donor nephrectomy can be performed safely, even in patients with vascular anomalies.

Effectiveness of deep versus moderate muscle relaxation during laparoscopic donor nephrectomy in enhancing postoperative recovery: study protocol for a randomized controlled study

BackgroundPostoperative recovery after live donor nephrectomy is largely determined by the consequences of postoperative pain and analgesia consumptions. The use of deep neuromuscular blockade has been shown to reduce postoperative pain scores after laparoscopic surgery. In this study, we will investigate whether deep neuromuscular blockade also improves the early quality of recovery after live donor nephrectomy.MethodsThe RELAX-study is a phase IV, multicenter, double-blinded, randomized controlled trial, in which 96 patients, scheduled for living donor nephrectomy, will be randomized into two groups: one with deep and one with moderate neuromuscular blockade. Deep neuromuscular blockade is defined as a post-tetanic count of 1–2. Our primary outcome measurement will be the Quality of Recovery-40 questionnaire (overall score) at 24 h after extubation.DiscussionThis study is, to our knowledge, the first randomized study to assess the effectiveness of deep neuromuscular blockade during laparoscopic donor nephrectomy in enhancing postoperative recovery. The study findings may also be applicable for other laparoscopic procedures.Trial registrationclinicaltrials.gov, NCT02838134. Registered on 29 June 2016.

1007 - Effectiveness and safety of minimally invasive laparoscopic living donor nephrectomy in comparison with standard laparoscopic living donor nephrectomy

1007 - Effectiveness and safety of minimally invasive laparoscopic living donor nephrectomy in comparison with standard laparoscopic living donor nephrectomy

Learning Curve for Laparoendoscopic Single-Incision Live Donor Nephrectomy: Implications for Laparoendoscopic Practice and Training.

The learning curve for laparoendoscopic single-incision live donor nephrectomy, which is technically more complex than the multiport, conventional laparoendoscopic approach, is unknown. In a retrospective cohort study, we analyzed the learning curve of the initial 114 consecutive single-incision laparoendoscopic nephrectomies performed in nonselected live kidney donors. Median donor body mass index was 26 kg/m2 (range 20-34). In all, 92% of the nephrectomies were performed on the left side; 18% of the recovered kidneys had multiple renal arteries. Cumulative sum (CUSUM) analysis of operating time (OT) demonstrated that the learning curve was achieved after case 61. For the learning curve phase (Group 1 [cases 1-61]) vs the postlearning phase (Group 2 [cases 62-114]), the difference of the mean OT was 20 minutes (p = 0.05). Mean warm ischemic time in the donors was significantly longer during the learning phase (Group 1, 6 minutes; Group 2, 5 minutes; p = 0.04). Rates of conversions to multiport procedures and of donor complications were not significantly different between Groups 1 and 2. For the recipients, we observed delayed graft function in 2 (2%) cases, no technical graft losses; and 1-year death-censored graft survival was 100% (p = n.s. for all comparisons of Group 1 vs 2). Single-incision laparoendoscopic donor nephrectomy had a long learning curve (>60 cases), but resulted in excellent donor and recipient outcomes. The long learning curve has significant implications for the programs and surgeons who contemplate transitioning from multiport to single-incision nephrectomy. Furthermore, our observations are highly relevant for informing the development of training requirements for fellows to be trained in single-incision laparoendoscopic nephrectomy.

Long-Term Body Mass Index Trends After Living-Donor Nephrectomy.

As the demand for kidney transplant allografts has increased, many centers are expanding the upper limit of acceptable body mass index for kidney donors. However, obesity is a risk factor for developing renal disease. Our goal was to quantify body mass index trends in donor nephrectomy patients and to institute nutrition counseling to promote sustainable weight loss to reduce the risk of metabolic syndrome-derived renal dysfunction. Ninety patients who underwent donor nephrectomy between 2007 and 2012 consented to having height and weight data collected at multiple time points. After data collection, each patient underwent a standardized nutrition counseling session. One year later, body mass index was reassessed. Preoperatively, 52% of the patients were overweight or obese. The percentage of overweight and obese patients remained stable for 2 years after surgery. However, at 3, 4, and 5 years after surgery, these rates increased to 59%, 69%, and 91%. Each patient was counseled about obesity-related comorbidities and provided information about lifestyle modification. One year later, 94% of previously overweight patients and 82% of previously obese patients had a decrease in mean body mass index from 27.2 ± 4.0 kg/m2 to 25.1 ± 3.6 kg/m2. Living-donor nephrectomy patients are at risk of developing obesity, similar to the adult population. Nutrition counseling may be beneficial to help normalize body mass index in patients who have become overweight or obese to potentially prevent obesity-related comorbidities. All patients were evaluated by a nutrition specialist after surgery to review our donor nephrectomy nutrition brochure. Body mass index monitoring and primary care follow-up appear to be appropriate surveillance methods.

Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group.

Two recent matched cohort studies from the USA and Norway published in 2014 have raised some concerns related to the long-term safety of kidney living donation. Further studies on the long-term risks of living donation have since been published. In this position paper, Developing Education Science and Care for Renal Transplantation in European States (DESCARTES) board members critically review the literature in an effort to summarize the current knowledge concerning long-term risks of kidney living donation to help physicians for decision-making purposes and for providing information to the prospective live donors. Long-term risk of end-stage renal disease (ESRD) can be partially foreseen by trying to identify donors at risk of developing ‘de novo’ kidney diseases during life post-donation and by predicting lifetime ESRD risk. However, lifetime risk may be difficult to assess in young donors, especially in those having first-degree relatives with ESRD. The study from Norway also found an increased risk of death after living donor nephrectomy, which became visible only after >15 years of post-donation follow-up. However, these findings are likely to be largely the result of an overestimation due to the confounding effect related to a family history of renal disease. DESCARTES board members emphasize the importance of optimal risk–benefit assessment and proper information to the prospective donor, which should also include recommendations on health-promoting behaviour post-donation.

Laparoscopic vs open donor nephrectomy: Lessons learnt from single academic center experience.

AIMTo compare laparoscopic and open living donor nephrectomy, based on the results from a single center during a decade.METHODSThis is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy (LLDN) and 211 undergoing open donor nephrectomy (OLDN). Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular filtration rate and creatinine (Cr), donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTSOverall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time, donor preoperative renal function, donor and recipient postoperative kidney function, delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed, there was a statistically significant difference regarding operating time in favor of the LLDN, pointing out the importance of the learning curve. Furthermore, another significant difference between the two groups was the decreased length of stay for the LLDN (2.87 d for LLDN vs 3.6 d for OLDN).CONCLUSIONRecognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor.

Hand Assisted Laparoscopic Surgery: An Updated Overview

Introduction: Hand assisted laparoscopic surgery is an updated highly advanced version of laparoscopic technique. Such technique bridges the gap between traditional surgery and total laparoscopic surgery. Introduction of the hand intracorporeally enhanced the degree of freedom, hence, a remarkable degree of precision and safety in task performance.Clinical and experimental studies confirmed safe use of the hand with insufflation pressure enhancing dexterity as well as a steep learning curve. Therefore, the author made an overview analysis to the factors related to safety; efficiency; dexterity; instrumentation and cost-effectiveness for the use of hand assisted laparoscopic surgery; with an emphasis on live donor nephrectomy. Results and discussion: Prospective studies made by Kolvenbach on the use of hand assisted laparoscopic surgery in aortic aneurysm repair proved high degree of safety and efficiency as well as cost effectiveness. Several studies highlighted a multitude of factors significantly contributing into a high degree of precision and task performance; which reflected on uneventful enhanced recovery programme.The introduction of either hand intracorporeally enhanced the limited degree of freedom for the current laparoscopic tools. There are various hand port devices of which the pros and cons for each port will be discussed in detail. The author’s experimental studies confirmed that optimum safe insufflation pressure would be 10 mm Hg with no leak from the hand port and optimum dexterity and task performance. Conclusion: Hand assisted laparoscopic surgery is a safe and efficient technique. It significantly enhances concept of Enhanced Recovery programme. Raising public awareness can provide a high impact in enhancing live donor nephrectomy; hence reducing the inexorable renal transplant waiting list for patients with end stage renal disease. Such patients are at progressive rise of mortality risk with prolonged waiting list.