Living Donor Nephrectomy Research Articles

From Open to Laparoscopic Living-donor Nephrectomy: Changing the Paradigm in a High-volume Transplant Center

In 1995, Ratner et al reported the first laparoscopic living-donor nephrectomy, and since then this approach is gradually replacing traditional open surgery. The learning curve of the procedure is still unclear and lessons taken from initial experience series are of utmost importance. We retrospectively analyzed our initial 50 living-donor laparoscopic nephrectomies, of which 90% were performed on the left side. Renal vascular variation occurred in 28% of donors. The median age and body mass index of the donors were 50 years (IQR 39–55) and 24.65 kg/m2 (IQR 22.5–27.3), respectively. The median operative time and warm ischemia time were 160 minutes (IQR 141–178) and 240 seconds (IQR 210–280), respectively. Estimated blood loss was 60 mL (IQR 60–127.5). The serum creatinine of the receptors was 97.6 μmol/L (IQR 87.5–139.6) 1 month after transplant. Overall, there were 5 complications, including 2 (4%) open conversions, 1 (2%) incisional hernia, 1 (2%) graft loss, and 1 (2%) reintervention. The body mass index and the multiple arteries did not influence the operative time and warm ischemia time or the recipient's serum creatinine level. Along the series, there was a significant reduction in the operative time (Spearman ρ = −5.2; P < .001), but no significant differences were found for warm ischemia time, blood loss, or serum creatinine of the recipients (P > .05). Laparoscopic donor nephrectomy is a safe procedure in centers experienced in laparoscopic surgery; however, the learning curve plateau was not reached after the initial 50 cases.

Laparoscopic Live Donor Nephrectomy: Comparison of Left-sided and Right-sided Approach in Our First 50 Cases

Objectives: To compare the operative results and outcomes between right and left laparoscopic live donor nephrectomy (LLDN). Methods: We retrospectively analyzed the first 50 consecutive LLDN in Indonesia performed between November 2011 and February 2013. Of these patients, 6 underwent right LLDNs and 44 left LLDNs. All patients underwent LLDNs in Cipto Mangunkusumo Hospital. All LLDNs were done by the same surgical teams. Intraoperative, post-operative donor and recipient data results were compared.Results: There were no significant differences of intraoperative, post-operative and recipient data results in both groups. The first warm ischemic time (mean±SD, 6min 55sec±145sec vs 7min 37sec±177 sec, p&gt;0.05), the second warm ischemic time (41min 35sec ± 7min 45sec vs 48min 36sec ± 8min 41sec, p&gt;0.05), and the operative time (4hour 41min ± 31min vs 4hour 32min ± 49 min, p&gt;0.05) showed similar results in the right and left LLDN, respectively. Active mobilization on 72-hour post-operation was found in 83,3% in the right LLDN compared to 95,5% (p&gt;0.05). There were no delayed graft function and post-operative hemodialysis within one week in the recipients of right LLDN group. Conclusion: Right LLDN has equal operative results and outcomes compared to left LLDN. Right-sided LLDN may be a judicious approach for donors with unfavorable characteristics of the left kidney.

Renal vein extension during living-donor kidney transplantation in the era of hand-assisted laparoscopic living-donor nephrectomy.

To evaluate retrospectively the clinical outcomes of living-donor kidney transplantations (LDKTs) using renal vein extension (RVE) for donor kidneys with short renal veins. Between January 2007 and December 2010, a total of 576 LDKTs were performed with grafts generated by hand-assisted laparoscopic living-donor nephrectomy: 31 (5.4%) transplants with RVE and 545 (94.6%) without an additional vascular procedure for renal vein lengthening. Outcomes were compared in patients who did and did not undergo the RVE procedure during transplantation. The 31 transplantation patients that underwent RVE involved procured kidneys with short renal veins: 29 were right-sided kidneys (93.5%) and 2 were left-sided kidneys (6.5%) (P=0.00). The RVE grafts were obtained from allogenic gonadal veins from female donors (n=16, 51.6%) and iliac veins from deceased donors (n=15, 48.4%). There were no postoperative complications related to the RVE procedure. During a follow-up period of 45.6±15.9 months, there were one (3.2%) graft failure among the 31 patients with RVE and four (0.7%) among the 545 patients without RVE. Delayed graft function was noted in one (3.2%) of the RVE patients and 22 (4.0%) of the patients without RVE. There was no statistically significant difference in graft failure (P=0.24) or delayed graft function (P=1.00) between the two groups. During LDKT, donor kidneys with exceptionally short renal veins, which may result in unavoidable tension during renal vein anastomosis, may be modified by RVE, thus facilitating a secure anastomosis and reducing postoperative complications.

MP85-03 PROSPECTIVE MEASUREMENT OF PLASMA NEUTROPHIL GELATINASE-ASSOCIATED LIPOPROTEIN IN LIVING KIDNEY DONOR NEPHRECTOMY

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2015MP85-03 PROSPECTIVE MEASUREMENT OF PLASMA NEUTROPHIL GELATINASE-ASSOCIATED LIPOPROTEIN IN LIVING KIDNEY DONOR NEPHRECTOMY Young Eun Yoon, Kyung Hwa Choi, Kwang Hyun Kim, Seung Choul Yang, and Woong Kyu Han Young Eun YoonYoung Eun Yoon More articles by this author , Kyung Hwa ChoiKyung Hwa Choi More articles by this author , Kwang Hyun KimKwang Hyun Kim More articles by this author , Seung Choul YangSeung Choul Yang More articles by this author , and Woong Kyu HanWoong Kyu Han More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1857AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neutrophil gelatinase-associated lipocalin (NGAL) is a marker for acute kidney injury. This study was conducted to determine the clinical implications of perioperative plasma NGAL in relation to renal function after living donor nephrectomy. METHODS Between July 2013 and May 2014, 112 donors in our hospital underwent live donor nephrectomy. Donor plasma NGAL was measured perioperatively until 6 month, and changes in perioperative plasma NGAL was investigated. The relationships between perioperative plasma NGAL and recovery of renal function was analyzed. Renal function was estimated with the Modification of Diet in Renal Disease (MDRD) formula. RESULTS Mean preoperative NGAL was 62.1±29.5 ng/mL. Plasma NGAL was most elevated at 1 week postoperatively (218±95.5 ng/mL) and stabilized after 1 month (122.9±45.3 ng/mL, figure 1). Preoperative plasma NGAL was not correlated with donor age (r=0.061, p=0.524) and preoperative eGFR (r=-0.164, p=0.084), but correlated with 6-month eGFR (r=-0.458, p<0.001). During the observation period, plasma NGAL at 1 week was most correlated with 6-month eGFR (r=-0.554, p<0.001). An ROC curve analysis showed that age, preoperative eGFR, and 1-week postoperative plasma NGAL were highly predictive of developing of chronic kidney disease (CKD; eGFR<60 ml/min/1.73m2) at 6 month (AUC=0.91; p<0.001). One-week postoperative plasma NGAL was associated with CKD at 6 month (odds ratio: 1.13 for each 10 ng/ml increase; p=0.013). CONCLUSIONS Plasma NGAL becomes elevated after kidney donation and can provide information about acute kidney injury during the compensatory hyperfiltration period. Donors with a perioperatively increased plasma NGAL require close observation because there may be a greater possibility of CKD developing after donation. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1067-e1068 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young Eun Yoon More articles by this author Kyung Hwa Choi More articles by this author Kwang Hyun Kim More articles by this author Seung Choul Yang More articles by this author Woong Kyu Han More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

87 Compensatory hypertrophy after living donor nephrectomy

87 Compensatory hypertrophy after living donor nephrectomy

86 Comparison of the clinical outcome and systemic inflammatory marker levels between standard laparoscopic surgery and reduced port surgery for living donor nephrectomy

86 Comparison of the clinical outcome and systemic inflammatory marker levels between standard laparoscopic surgery and reduced port surgery for living donor nephrectomy

Laparoscopic-Assisted Live Donor Nephrectomy: A Comparison of Conventional and Transvaginal Routes for Kidney Extraction

Laparoscopic approach has become the standard procedure for living donor nephrectomy in many transplant centers. Because the conventional approach results in cosmetic problems and pain during laparoscopic live donor nephrectomy, transvaginal extraction of an intact kidney has been recently introduced as a minimally invasive technique. Here, we aimed to investigate whether transvaginal extraction of an intact kidney during laparoscopic live donor nephrectomy is associated with decreased postoperative pain, nausea and vomiting, and morphine consumption. This prospective data analysis included a total of 27 female donors who underwent laparoscopic removal of a single kidney for living donor nephrectomy through conventional or transvaginal route. Data collected included age, body mass index, ASA scores, histocompatibility, additional medical disorders, peri- and postoperative complications, postoperative pain scores with visual analogue pain scores (VAS), length of postoperative stay, morphine consumption, degree of nausea and vomiting, level of sedation, and pruritus. No significant differences between the transvaginal and conventional groups were observed in VAS scores and morphine consumption at postoperative 1, 3, 6, 12, and 24 hours. Although not reaching statistical significance, according to analysis of morphine consumption, there was a trend toward decreasing analgesic requirements in the transvaginal group at postoperative 12 and 24 hours. There were no significant differences between the groups in terms of degree of nausea or vomiting, or length of postoperative hospital stay. We suggest that with a more desirable cosmetic result, transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy (TVNALDN) is a suitable new minimally invasive laparoscopic technique associated with reduced postoperative pain and analgesic requirements in select women.

LESS living donor nephrectomy: Surgical technique and results.

Purpose:We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014.Materials and Methods:Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery.Results:LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3–15), mean procedure time was 233.2 min (172–300), and hospitalization stay was 3.94 days (3–7) with a visual analogue pain score at discharge of 1.32 (0–3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1–20) and final scar length was 4.06 cm (3–5). Each allograft was functional.Conclusion:Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity.

H shape renal vein anomaly encountered during living donor nephrectomy

Presence of renal vein anomalies can create technical difficulties especially during donor nephrectomy. Three common anomaly are described. These are supernumerary renal vein, retroaortic renal vein and circumaortic renal vein, but there is no literature depicting H-Shaped anomaly of renal vein. To the best of our knowledge, we present the first case report of H-Shaped renal vein anomaly found during open donor nephrectomy.

Seriously ill patients as living unspecified kidney donors: rationale and justification.

Between 2000 and December 2013, 106 live donor nephrectomies from anonymous living-donors were performed at the Erasmus MC Rotterdam; five of the donors (5.4%) had a life-threatening disease. The aim of the present report is to give the rational and justification for this procedure. All five donors underwent the national standard living-donor screening procedure. Additionally, motivation to donate and psychologic stability were assessed by a psychologist using in-depth interview techniques and a psychologic complaints questionnaire. Post-donor nephrectomy follow-up consisted of standard questionnaires and clinical check-ups. One patient had cerebral and caudal ependymomas, one had severe and progressive emphysema, two had Huntington's disease and one had a grade 2 oligodendroglioma. The psychologic screening revealed genuine motivation, adequate risk perception, and normal sense of reality. No contraindications for donation were found. The five donor nephrectomies made nine kidney transplantations possible. All donors were satisfied with the donation procedure. Three donors died during follow-up (0.6-4.9 years) as a result of their disease. In the absence of apparent additional health risks, medical, and psychologic contraindications, we consider it ethically justified to accept an offer from a cognitively competent patient with a life-threatening disease in view of their self-reported satisfaction during follow-up. Although based on a limited number of patients, we conclude that a stricter psychologic screening for seriously ill donors compared to healthy unspecified anonymous donors to unspecified patients is not necessary.

Outcome of laparoendoscopic single site living donor nephrectomy

Outcome of laparoendoscopic single site living donor nephrectomy

Prevalence of Renal Vasculature Anomalies in Asymptomatic Healthy Population

Abstract: An accurate preoperative knowledge of the anatomical vasculature variations is essential for the precise performance of complex operative procedures like partial nephrectomy, renal transplantation and treatment for renal artery stenosis. Anatomic vascular variations differ with ethnicity and population.Aims and Objective: The study was aimed to determine the variety and prevalence of incidental renal vascular anomalies in healthy and asymptomatic individuals.Materials and Methods: All prospective potential kidney donors for live related donor nephrectomy who attended Urology OP from July 2012 to December 2014 in Government Medical College Trivandrum underwent MDCT Angiogram to know the renal vasculature variation and these data were retrospectively analysed. Results: 86 individuals were included in the study and most of them belonged to the age group 40-50 years. In the present study single renal artery was seen in 125 (72.7%) cases and variations were seen in 47 (27.3%). Single renal vein was se3en in 160 (92%) cases and variations in 12 (8%). Conclusions: Incidental radiographic variations of the renal arteries are common. Vascular variations usually do not preclude kidney donation but definitely need more expertise to deal with.

The Need for a Standardized Informed Consent Procedure in Live Donor Nephrectomy

Informed consent in live donor nephrectomy is a topic of great interest. Safety and transparency are key items increasingly getting more attention from media and healthcare inspection. Because live donors are not patients, but healthy individuals undergoing elective interventions, they justly insist on optimal conditions and guaranteed safety. Although transplant professionals agree that consent should be voluntary, free of coercion, and fully informed, there is no consensus on which information should be provided, and how the donors' comprehension should be ascertained. Comprehensive searches were conducted in Embase, Medline OvidSP, Web-of-Science, PubMed, CENTRAL (The Cochrane Library 2014, issue 1) and Google Scholar, evaluating the informed consent procedure for live kidney donation. The methodology was in accordance with the Cochrane Handbook for Interventional Systematic Reviews and written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The initial search yielded 1,009 hits from which 21 articles fell within the scope of this study. Procedures vary greatly between centers, and transplant professionals vary in the information they disclose. Although research has demonstrated that donors often make their decision based on moral reasoning rather than balancing risks and benefits, providing them with accurate, uniform information remains crucial because donors report feeling misinformed about or unprepared for donation. Although a standardized procedure may not provide the ultimate solution, it is vital to minimize differences in live donor education between transplant centers. There is a definite need for a guideline on how to provide information and obtain informed consent from live kidney donors to assist the transplant community in optimally preparing potential donors.

Retroperitoneoscopic donor nephrectomy with multiple renal arteries does not affect graft survival and ureteral complications.

Outcomes of retroperitoneoscopic procurement of living kidneys with multiple renal arteries (MRA) in the recipients are largely unknown. Our aim is to access the effect of kidney allografts with MRA on donor and recipient outcomes after pure retroperitoneoscopic live donor nephrectomy (RPLDN). From July 2001 to August 2010, 533 patients underwent live donor kidney transplants with allografts procured by RPLDN at our center. Of these 533 transplants, 406, 105, and 22 patients had one, two, and three renal arteries, respectively. We compared the retrospectively collected clinical data of each donor with MRA and the recipient using those with single renal artery as controls. Significant differences were found among the one-renal artery and three-renal artery groups regarding operative time, estimated blood loss, warm and cold ischemic time, and incidence of slow graft function (SGF). However, there was no significant difference regarding patient and graft survival among the three groups. Major complications, such as open conversion, bleeding, and blood transfusion, were not found in patients with MRA. Five ureteral complications occurred. Of these, there was one patient with MRA. In univariate analysis, MRA patients had a risk factor of developing SGF (P=0.005) but not ureteral complications following RPLDN. Kidneys with MRA after RPLDN increase the risk of SGF in recipients. However, they provide similar outcomes as to long-term graft survival and complications compared with those of single renal artery. Renal artery multiplicity should not be a contraindication for live kidney donation and may not increase the risk of ureteral complications.

Chylous ascites after laparoscopic donor nephrectomy.

The aim of this study was to determine the incidence, presentation, management, and outcomes of chylous ascites following laparoscopic donor nephrectomy. An Internet-based, multi-institutional survey was performed using http://www.surveymonkey.com. An email invitation to the voluntary survey was sent to 30 transplant centers and posted on CenterSpan, an email forum for transplant surgeons. The number of living donor transplantations and the number of cases of chylous ascites with clinical information, treatment and outcomes were sought from the questionnaire. A total of 12 centers responded and reported 7683 cases of live donor nephrectomy. The reported incidence of postoperative chylous ascites was 0.013% (n = 12). Six centers reported 10 cases of chylous ascites following laparoscopic donor nephrectomy and 2 cases after open donor nephrectomy. Among the eight patients who developed chylous ascites following laparoscopic donor nephrectomy, presentation was typically 2 weeks after the date of initial surgery. Conservative therapy was successful in 50% of cases. Refractory ascites managed secondarily with surgical intervention had a success rate of 100%. Chylous ascites is a rare complication following laparoscopic donor nephrectomy. Initial treatment should be conservative, with surgical therapy reserved for refractory cases.

Evaluation of arterial stiffness indices and central hemodynamics in healthy normotensive volunteers and in treated or untreated hypertensive patients in ambulatory conditions

Results: As expected, eGFR fell from 85 18ml/min at baseline to 59 12ml/ min, 12 months post-donation (P<0.001). Clinic BP was 123 15/79 9mmHg at baseline and 126 14/75 9mmHg, 12 months post-donation (PZ0.09 and P<0.001 for systolic and diastolic BP, respectively). There was no change in aPWV from baseline, 12 months following donation (7.33 1.53m/s versus 7.35 1.1.58m/s, PZ0.8). Conclusion: These data demonstrate that it is feasible to recruit patients undergoing living-donor nephrectomy and to examine the effects on aortic stiffness up to 12 months following donation. Moreover, the results provide important data on which to base larger studies aimed at investigating longerterm effects of kidney donation on aortic stiffness and cardiovascular health.

Single-port live donor nephrectomy using a novel Curved Radius R2 Surgical System in an in vivo model

Objective: Single-port laparoscopic donor nephrectomy provides low morbidity and satisfactory cosmetic results for patients. The aim of this animal study was to establish a surgical technique of single-site (LESS) living donor nephrectomy using novel curved r2 CURVE manipulators specially designed for single-port access. Material and methods: A total of six LESS nephrectomies were performed in three female pigs. r2 CURVE-instruments (Tuebingen Scientific Medical GmbH) were used providing a curved rotatable shaft, endless tip rotation, as well as 90° tip deflection. A 10 mm 30° extra long laparoscope, r2-curved Grasper, Maryland dissector and bipolar scissors were used for mobilization and dissection. Results: All LESS nephrectomies were performed successfully. Average operative time was 80 min (range, 42–149 min). No technical problems were observed. Insertion and extraction of the instruments through the single-port were easy to conduct. The diameter of the used single-port was sufficient for safe manual organ harvesting. Potential conflict between the laparoscope and the instrument handles was avoided by using an extra long laparoscope. Conclusions: The new curved and deflectable instruments showed that single-port nephrectomy using the R2 manipulators is feasible. Single-port laparoscopic nephrectomy might be more patient-friendly and improve the willingness of potential donors to donate live organs.

Which a factors influence compensatory renal hypertrophy following live donor nephrectomy?

Which a factors influence compensatory renal hypertrophy following live donor nephrectomy?

Vascular management during live donor nephrectomy in Europe — An online survey among ESOT surgeons

Vascular management during live donor nephrectomy in Europe — An online survey among ESOT surgeons

Mini-laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope.

To analyze our preliminary outcomes on the use of 3mm instruments for laparoscopic live donor nephrectomy (LLDN). Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor's cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3months after the kidney transplantation. Furthermore, there were no major complications in the recipients. Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation.