Recovery In Donors Research Articles

Metabolic Matching and Morphofunctional Parameters of Deceased Donor Kidney Transplantation: A Study of Super-Rapid and Delayed Recovery in Asystole Donors

Metabolic Matching and Morphofunctional Parameters of Deceased Donor Kidney Transplantation: A Study of Super-Rapid and Delayed Recovery in Asystole Donors

Effect of embryo flushing technique, number of flushing attempts and previous experience of operator on embryo recovery

The aims of this study were 1) to determine the effect of operator experience and embryo flushing technique on embryo recovery (ER) in each flushing attempt; 2) to determine the percentage of unwanted pregnancies and endometritis following embryo uterine lavage without administration of PGF2α. Seven non-lactating mares were inseminated with the same semen in four cycles (n=28 cycles). Embryo flushing was performed 7-9 days after ovulation by two operators of different experiences: experienced (>500 flushes) and beginner (<5), using two different flushing techniques in a crossover design. Mares were flushed three times with Ringer's Lactate (RL) “in-and-out”: 1L during the first two attempts and 0.5L during the third attempt. The remaining 0.5L was used to flush the tubing system. The two flushing techniques were 1) uterine massage (UM): continuous ballottement and massage of the uterus per rectum during RL recovery in each attempt, 2) control: the RL was allowed to flow back without touching the uterus during the first two attempts, and during the third attempt (0.5L) the uterus was manipulated as in UM. In both groups, 20 IU of oxytocin were administered at the second attempt and the RL was allowed to remain in the uterus for 3 minutes before recovery. No PGF2α was administered at the end of the flushing procedure. The overall ER was13/28 (46.4%). Ten embryos (10/13,77%) were recovered in the first filter, and 3 in the third filter. The experienced operator obtained a higher (P<0.05) ER (10/14) than the beginner (3/14). The ER of controls (6/14) was similar (P>0.1) to the UM (7/14). More embryos (7/7, P=0.06) were recovered in the first filter in the UM compared with the control group (3/6). Two mares entered prolonged dioestrus following a positive ER. Two mares with a negative ER (13%, 2/15) were pregnant 14 days after ovulation: both were from the control group and flushed by the beginner. In these mares, horn expansion was incomplete after RL infusion in every attempt. The last 8 embryos recovered in the study were transferred using the Wilsher´s technique immediately after recovery in the same donors, but none became pregnant. The overall mean inter-ovulatory interval was 22.5d (16-29d). Six mares (21.4%) developed free-intrauterine fluid and early luteolysis, of which 4 mares had been transferred with their own embryos. In conclusion, the previous operator´s experience had the greatest effect on overall ER. The uterine massage influenced the flushing attempt´s number in which the embryo was recovered. Oxytocin had no effect on ER. The risk of unwanted pregnancies in donors flushed by a beginner with no PGF2α treatment, was considerable.

Iron supplementation and blood donation in Nigeria: Effect on Hemoglobin, red cell indices, and iron stores - The ranferon™ study.

Iron-deficiency anemia is an important limiting factor to a sustainable supply of blood units, especially in low- and middle-income countries. Blood transfusion practice in Nigeria is poorly developed and structured with paucity of voluntary nonremunerated blood donors and high rate of donor deferrals resulting from low hemoglobin (Hb) levels. This study aimed to assess the effect of daily supplementation of iron using Ranferon-12 on Hb level, red blood cell (RBC) indices, iron level, ferritin level, and Hb recovery in blood donors in Nigeria. This longitudinal study was conducted at a tertiary hospital blood transfusion center from March to July 2020. Blood samples of regular donors were collected at three points in the study for the measurement of Hb and hematocrit (HCT); RBC indices including mean cell volume (MCV), mean cell hemoglobin (MCH), and Mean cell haemoglobin concentration (MCHC); and iron stores including serum iron, serum ferritin, and serum transferrin. The first point was at recruitment before donation of one unit of blood; the second point after the blood donation; and the third point at 6 weeks post blood donation. Following donation, participants were placed on Ranferon capsules (iron fumarate - 100 mg elemental iron) and 100 mg of tablet Vitamin C, for 6 weeks. There was a moderate significant positive correlation between administration of Ranferon and change in the values of HCT, MCV, MCH, red cell distribution width, ferritin, and transferring (P < 0.05). Percentage recovery of Hb, red cell indices, and iron stores parameters after 6 weeks of daily Ranferon ranged between 89% and 100%. Iron supplementation using Ranferon capsule daily for 6 weeks enhances recovery of Hb, red cell indices, and iron stores with attainment of benchmark Hb levels for donation.

Acute kidney injury and the compensation of kidney function after nephrectomy in living donation.

Acute kidney injury (AKI) incidence is growing rapidly, and AKI is one of the predictors of inpatient mortality. After nephrectomy, all the patients have decreased kidney function with AKI and recover from AKI. However, the characteristic and behavior of AKI is different from usual AKI and compensatory kidney function has been well known in the postoperative setting, especially in living donors. In this review, we have focused on the compensation of kidney function after nephrectomy in living donors. We discuss factors that have been identified as being associated with kidney recovery in donors including age, sex, body mass index, remnant kidney volume, estimated glomerular filtration rate, and various comorbidities.

An Evaluation of the Effect of Catheter-Directed Continuous Infusion of Local Anesthetic by Elastomeric Pump on Opioid Usage Following Donor Kidney Nephrectomy.

Postoperative pain management following donor nephrectomy can prove challenging for immediate discharge on postoperative day 1 or 2. Although the standard for pain control is utilization of opioids, this increases the risk of postoperative ileus and, if continued inappropriately, increases excess opioids circulating in the community. One strategy that proposes to limit postoperative opioids in kidney donors is the continuous infusion of local anesthetics (CILA), though the effect on patient outcomes is unclear. The purpose of this study was to evaluate the effectiveness of postoperative CILA to decrease opioid usage in kidney donors who undergo laparoscopic nephrectomy. A retrospective analysis was conducted of kidney donors who underwent laparoscopic nephrectomy and received CILA (CILA group) compared with kidney donors who received standard-of-care (SOC) postoperative analgesia. The primary outcome was the mean total oral morphine equivalents (OMEs) administered following surgery. A total of 176 kidney donors were evaluated, 88 in each group. The mean OME administered in the CILA group was significantly higher than in the SOC group: 194.8 versus 133.5 mg (P = 0.003). Mean total postoperative administration of acetaminophen was also increased in the CILA group: 3736.9 versus 2611.6 mg (P = 0.0041). Mean length of stay following surgery was higher in the kidney donors who received CILA, whereas return to bowel function, time to ambulation, and pain scores were not significantly different. This report demonstrated that CILA is not an effective modality to reduce opioid utilization or improve recovery in kidney donors following laparoscopic nephrectomy.

Poor iron store recovery in voluntary blood donors in the northern zone of Ghana; a five-month three-centre cohort study

ObjectiveIn Ghana, although iron deficiency is endemic, post blood donation iron supplementation is not routine. We sought to determine whether at five months post-donation of a single unit of whole blood, donors were able to recover iron stores. Materials and methodsThis three-centre cohort study recruited 164 blood donors at the Lawra, Nandom, and Bimbila communities in the northern zone of Ghana. Venous blood samples were drawn at baseline to estimate full blood count (FBC), haemoglobin variants, qualitative G6PD status, and serum ferritin. Five months post-donation, venous blood samples were drawn for a repeat measurement of FBC and serum ferritin. Data were analysed using SPSS and GraphPad prism to assess recovery of iron stores. ResultsWhereas 26.8 % had inherited haemoglobin variants, 18.9 % of the donors had qualitative G6PD deficiency. Overall, mean difference between pre-donation and five months post donation iron stores significantly differed from zero (p < 0.001; one sample t-test). After five months post donation, 76.8 % of the blood donors could not achieve pre-donation iron stores. Whereas 6.1 % and 8.5 % blood donors had depleted iron stores and iron deficient erythropoiesis at baseline, these increased to 9.8 % and 21.3 % respectively at five-month post donation. Moreover, at five months post donation, 11 % of these blood donors would have been disqualified per haemoglobin screening cut off of 12.5 g/dl. ConclusionReliance on food intake to replenish iron store lost per blood donation may not adequately assure donor health in the study area; iron supplementation should be considered.

Fetal neurodevelopmental recovery in donors after laser surgery for twin‐twin transfusion syndrome

Fetal magnetic resonance imaging (MRI) and spectroscopy (MRS) provide a unique opportunity to non-invasively measure markers of neurodevelopment in survivors of twin-twin transfusion syndrome (TTTS). To characterize fetal brain maturation after laser surgery for TTTS by measuring brain volumes and cerebral metabolite concentrations using fetal MRI + MRS. Prospective study of dual surviving fetuses treated with laser surgery for TTTS. At 4-5 postoperative weeks, fetal MRI was used together with novel image analysis to automatically extract major brain tissue volumes. Fetal MRS was used to measure major metabolite concentrations in the fetal brain. Twenty-one twin pairs were studied. The average (±SD) gestational age at MRI was 25.89 (±2.37) weeks. Total brain volume (TBV) was lower in the donors, although cerebral volumes were not different between twin pairs. Recipients showed lower proportions of cortical and cerebellar volumes, normalized to TBV and cerebral volumes. MRS data showed that biochemical differences between twin brains were related to discrepancy in their brain volumes. Although donors have a smaller TBV compared to recipients, proportionality of brain tissue volumes are preserved in donors. MRS maturational markers of fetal brain development show that recovery in donors persists 4 weeks after surgery.

96: Fetal neurodevelopmental recovery in donors after laser surgery for twin-twin transfusion syndrome

96: Fetal neurodevelopmental recovery in donors after laser surgery for twin-twin transfusion syndrome

Clinical Factors Associated with Left Ventricular Recovery in Brain Dead Cardiac Donors

Purpose Donor left ventricular (LV) dysfunction remains a primary reason donor hearts are not utilized for transplant. Transient ventricular dysfunction often occurs after brain death, and recent work has shown that use of these donors may not be associated with poorer post-transplant outcomes. In order to identify the clinical factors associated with LV recovery in potential heart donors, we reviewed our experience using protocolized management of donors at an off-site organ diagnostic and recovery center at a single OPO. Methods Clinical data were obtained for all potential donors evaluated between 2012-2017. LV dysfunction was defined as an ejection fraction (LVEF) of ≤ 40% on the initial echocardiogram. LV recovery was defined as an LVEF ≥ 50% before procurement. Out of 815 donors, 176 had initial LV dysfunction. Of these, 113 had ≥2 echocardiograms performed. Non-recovered and recovered groups were compared using chi-square tests and Student's t-tests. Results Of the 113 donors analyzed, 43% did not recover (N=49) while 57% recovered (N=64). Those who recovered from LV dysfunction were more likely to be male, younger, receive pRBCs, and have longer OPO management time. Recovery was not associated with cause of death, BMI, or CPR performed before arrival. Those who recovered had a lower peak troponin I (2.78 vs 24.5 ng/mL, p = 0.035), but no significant difference was found regarding peak lactate, creatinine, or transaminases. At the time of the initial echocardiogram, there was no significant difference between vasoactive inotropic score (VIS) and norepinephrine dose between groups. However, at the time of the final echocardiogram, the recovery group had a lower VIS and norepinephrine dose. Conclusion Recovery of LV function is common after brain death. Several clinical factors are associated with LV recovery in potential heart donors and may be important in predicting LV recovery, extending donor management efforts, and ultimately increasing the number of hearts utilized for transplant.

A liver for a kidney: Ethics of trans-organ paired exchange.

Living donation provides important access to organ transplantation, which is the optimal therapy for patients with end-stage liver or kidney failure. Paired exchanges have facilitated thousands of kidney transplants and enable transplantation when the donor and recipient are incompatible. However, frequently willing and otherwise healthy donors have contraindications to the donation of the organ that their recipient needs. Trans-organ paired exchanges would enable a donor associated with a kidney recipient to donate a lobe of liver and a donor associated with a liver recipient to donate a kidney. This article explores some of the ethical concerns that trans-organ exchange might encounter including unbalanced donor risks, the validity of informed consent, and effects on deceased organ donation.

Kinetics of liver regeneration in donors after living donor liver transplantation: A retrospective analysis of "2/3rd partial hepatectomy" model at 3months.

Right lobe living donor (2/3rd partial hepatectomy) model is the best way to accurately study liver regeneration process in human beings. We aimed to study the kinetics of liver regeneration after 2/3rd partial hepatectomy in donors. Retrospective analysis of prospectively maintained volumetric recovery data in donors was performed in 23 donors, who underwent 29 contrast-enhanced computed tomography within 3months for various clinical indications. The absolute volumetric growth percentages were as follows: 37.60 ± 21.74 at 1st week, 92 ± 53.27 at 2nd week, 115.55 ± 59.65 at 4th week, and 110.79 ± 64.47 at 3months. On sub-group analysis of our cohort, we found that 4.3%, 17%, 30.4%, and 39% donors attended ≥ 90% volumetric recovery at 1st, 2nd, 4th week, and 3months, respectively. One patient at 4th week revealed 128% volumetric recovery. There was one more patient who exceeded original total liver volumes (TLV) (111% of TLV) at 2.5months. The serum bilirubin and INR values peaked at postoperative day (POD) 3rd and then started showing a downward trend from POD 5th onwards. Our study is the first to document complete volumetric recovery in donors as early as 3weeks. Two of the donors overshot their original TLV during the early regenerative phase.

Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy?

The partial liver's ability to regenerate both as a graft and remnant justifies right lobe (RL) living donor liver transplantation. We studied (using biochemical and radiological parameters) the rate, extent of, and predictors of functional and volumetric recovery of the remnant left liver (RLL) during the first year in 91 consecutive RL donors. Recovery of normal liver function (prothrombin time [PT] ≥70% of normal and total bilirubin [TB] ≤20 µmol/L), liver volumetric recovery, and percentage RLL growth were analyzed. Normal liver function was regained by postoperative day's 7, 30, and 365 in 52%, 86%, and 96% donors, respectively. Similarly, mean liver volumetric recovery was 64%, 71%, and 85%; whereas the percentage liver growth was 85%, 105%, and 146%, respectively. Preoperative PT value (p = 0.01), RLL/total liver volume (TLV) ratio (p = 0.03), middle hepatic vein harvesting (p = 0.02), and postoperative peak TB (p < 0.01) were predictors of early functional recovery, whereas donor age (p = 0.03), RLL/TLV ratio (p = 0.004), and TLV/ body weight ratio (p = 0.02) predicted early volumetric recuperation. One-year post-RL donor hepatectomy, though functional recovery occurs in almost all (96%), donors had incomplete restoration (85%) of preoperative total liver volume. Modifiable predictors of regeneration could help in better and safer donor selection, while continuing to ensure successful recipient outcomes.

Baseline Symptoms, Female Sex, and Younger Age Are Correlated with Higher Levels of Peri-Collection Pain, Symptoms, and Persistent Discomfort One Year after Related Donor BM and PBSC Donation: An Analysis of the Related Donor Safety Study (RDSafe)

Prospective data regarding donation related toxicities and time to recovery in related donors (RDs) of bone marrow (BM) and peripheral blood stem cells (PBSC) are limited, in contrast to significant data available regarding unrelated donor experiences. To address this lack of data in RDs, the NHLBI-funded Related Donor Safety Study (RDSafe; NCT00948636) prospectively enrolled RDs of all ages between 2010 and 2013 at 54 transplant centers in the United States. RDs were assessed for pre-donation comorbidities and health status, and then followed for 1 year after donation, collecting detailed information on adverse events, pain levels and 10 collection-related NCI-CTC symptoms. This report describes baseline, peri-donation, and through 1 year post pain/symptoms for RDs aged 18-60: 124 BM (38 centers, med age 33, 48% female) and 919 PBSC (42 centers, med age 49, 44% female).Results: About 20% of RDs reported pain and NCI-CTC symptoms at baseline, mostly grade 1, with females reporting pain/symptoms more often than males (see figures). Pain occurred in approximately 80% of donors surrounding collection with other symptoms occurring in 50-70% of donors. Pain and symptoms persisted in 10-20% of RDs at 1, 6, and 12 months; pain/symptoms returned to baseline in only a few categories assessed, but mostly remained elevated from baseline at 1 year. In addition, for both males and females, at 1 year grade 2-4 pain or symptoms were 2-3 times baseline rates. Multivariate analysis was performed on PBSC donors, where numbers were sufficient to look at key risk factors (see table). Females had more grade 3-4 pain at collection, and grade 2-4 pain and symptoms at 1 year. Age differences were noted, with RDs age 30-39 experiencing the highest amount of pain and symptoms and RDs age 50-60 experiencing less pain compared to donors aged 18-29. Pain or symptoms at baseline were important predictors of higher levels of reported pain/symptoms, respectively, during the collection and also higher risk of grade 2-4 pain at 1 year.Conclusions: One in 5 RDs have mild/moderate pain and/or symptoms at baseline, and the presence of pain/symptoms at baseline increases risk for experiencing higher levels of pain/symptoms during collection. Although the majority of RDs return to baseline status within a month of donation, >10-20% of RDs have lingering pain/symptoms 6-12 months after donation, and rates of grades 2-4 pain and symptoms at 1 year are more than double baseline. Females have higher grades of pain with collection and more grade 2-4 pain and symptoms at 1 year compared to males. RDs should be informed of the risk of mild/moderate pain/symptoms lingering through the first year after donation. Ongoing efforts to correlate baseline comorbidities of RDs with outcomes should allow RDs to be better informed of risk and potentially identify clinical risk profiles where RDs should be deferred.*Pain = max grade 2-4 or 3-4 2 days post-donation of BM or day+5 of PBSC collection (collection day 1).**Symptoms = fever, fatigue, rash, local site reactions, nausea, vomiting, anorexia, insomnia, dizziness, and syncopeTable 1MV Analysis of PBSC RDs for pain and donation-related symptoms: Odds Ratio (p-value).Pain*Symptoms**day+5 Grd 2-4day+5 Grd 3-41yr Grd 2-4day+5 Grd 2-41yr Grd 2-4Female1.667 (0.010)1.667 (0.016)1.887 (0.041)Age(0.001)(0.008)(<0.001)Age 18-291.01.01.0Age 30-390.76 (0.306)2.2 (0.036)2.48 (0.008)Age 40-490.68 (0.115)1.46 (0.283)1.49 (0.216)Age 50-600.45 (<0.001)0.93 (0.836)0.93 (0.830)Baseline pain overall(0.001)(0.004)(<0.001)Baseline pain Grd 01.01.01.0Baseline pain Grd 12.2 (<0.001)2.6 (0.06)2.95 (<0.001)Baseline pain Grd 2-44.73 (<0.001)4.4 (0.002)3.95 (<0.001)Baseline sx overall(<0.001)Baseline sx Grd 01.0Baseline sx Grd 1-42.16 (<0.001) [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Predonation Health-Related Quality of Life Scores Predict Time to Recovery in Hematopoietic Stem Cell Donors

The physical reactions to hematopoietic stem cell donation have been extensively studied, but less is known about factors that predict poorer donation experiences. The aim of this prospective study was to examine demographic and health-related quality of life (HRQOL) factors that might be associated with recovery and side effects. We also described the changes in HRQOL during the donation process. In total, 275 peripheral blood stem cell (PBSC) and 37 bone marrow (BM) consecutive donors completed the SF-36 questionnaire predonation and 4 weeks, and 3 months postdonation. Predonation HRQOL markers were the strongest predictors of time to recovery. Poorer predonation physical health was associated with longer recovery (P = .017) and certain side effects in PBSC donors. Poorer predonation mental health was associated with longer recovery in BM donors (P = .03) and pain after PBSC donation (P = .003). Physical HRQOL scores declined significantly from predonation to 4 weeks postdonation. This was shown both for PBSC and BM donors (P < .001 and P = .009, respectively), but the decline was much greater for BM donors. There was a return to predonation HRQOL values 3 months after donation in both groups with values well above the mean of the general population (P < .001).

Predictors of hemoglobin recovery or deferral in blood donors with an initial successful donation

Donation eligibility is based on hemoglobin (Hb) level among other factors. This study assesses factors that influence Hb levels among first-time (FT) donors returning for a second donation. Allogeneic FT donors who successfully donated a red blood cell (RBC)-containing donation on their index presentation and returned to donate at least once more between August 1, 2009, and July 31, 2012, were included. Interdonation intervals and delta Hb (subsequent donation - index donation value) were calculated. Multivariable logistic regression and survival analysis methods were used to determine factors associated with 1) Hb recovery to preindex donation value or 2) deferral at the second presentation. During the study, 135,040 FT donors returned to donate. Overall, 44% of donors returned with a Hb level at or above their index value (defined as recovery for this study), 48.1% for males and 39.9% for females. Logistic regression revealed that the factor most strongly associated with Hb recovery was index Hb, with lower Hb having much higher odds of recovery. Shorter interdonation intervals were associated with decreased likelihood of recovery. Certain demographic characteristics were also associated with higher odds of recovery. Factors associated with deferral were similar to the factors associated with recovery, except for donor sex. As early as the second blood donation, allogeneic donors can be differentiated into two subpopulations: those who recover to index Hb levels and those who do not. Current data routinely collected by US blood centers cannot reliably distinguish between the two groups.

The effect of arginine vasopressin on organ donor procurement and lung function

BackgroundHormone replacement therapy (HRT) is becoming more common when managing brain-dead donors. Arginine vasopressin (AVP) is associated with benefits but is not consistently used. We hypothesize that AVP is associated with the maintenance of lung function and successful recovery in donors and enhanced lung graft performance in recipients. MethodsThe Organ Procurement and Transplantation Network database was used. Study donors were those treated with HRT and procured from January 1, 2009 to June 30, 2011. AVP (+) and AVP (−) donors were compared. Donor lung function, the rate of successful lung procurement, and the incidence of graft failure in recipients were studied. ResultsThere were 12,322 donors included, of which 7686 received AVP (62.4%). Cerebrovascular accident (4722 [38.3%]) was the most common cause of donor death. There was a significant increase in high yield (≥4 organs) (51.0% versus 39.3%, <0.001), mean number of organs (3.75 versus 3.33, <0.001), and rate of successful lung recovery (26.3% versus 20.5%, <0.001) with AVP. Lung function was preserved to a greater degree in donors receiving AVP. Adjusting the significant factors, AVP was independently associated with lung procurement (1.220 [1.114–1.336], <0.001). The incidence of early graft failure was not changed. ConclusionsAVP with HRT is associated with the maintenance of lung function and a significant increase in successful organ recovery in donors without untoward effects in the recipient. AVP should be universally adopted as a component of HRT in the management of donors with neurologic death.

Padronização da técnica de plasmaférese automatizada em equinos

O presente artigo objetivou estudar a viabilidade da técnica de plasmaférese automatizada e padronizá-la em cinco equinos hígidos, bem como apresentar as complicações durante o procedimento, as adequações em relação aos procedimentos em humanos e avaliar a recuperação de volume globular e proteínas plasmáticas totais nos doadores. Os procedimentos foram realizados com o equipamento Fresenius AS104, com duração média de 1h46min, processamento de 5758mL de sangue total e colheita média de 3133mL de plasma. Não foram observadas alterações significativas do volume globular após a plasmaférese automatizada. A recuperação dos níveis plasmáticos de proteínas foi de 91,4% em 96 horas após o procedimento. A plasmaférese automatizada apresentou-se viável para a espécie equina, diminuindo o tempo de recuperação hematimétrica nos doadores.

Right Lobe Living-Donor Liver Transplantation With or Without Middle Hepatic Vein: A Meta-Analysis

Objective The purpose of this meta-analysis was to compare outcomes after right-lobe living-donor liver transplantation (LDLT) with or without the middle hepatic vein (MHV). Methods Studies were identified through a computerized search of Pubmed, Embase, Ovid, the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, the Cochrane Library database, and the Web of Science. Two reviewers independently assessed the quality of each study and abstracted outcome data. We extracted data for liver functional recovery in donors, donor hospital stay, donor complications and liver functional recovery in recipients. We synthesized published data using random-effects and fixed-effect models, expressing results as weighted mean differences (WMD) or relative risk (RR). Results The 11 included eligible studies came from medical centers worldwide. Significant differences between “with MHV” versus “without MHV” groups were not observed for liver functional recovery ( P = .08; WMD = −2.88), donor hospital stay ( P = .00; WMD = 0.00), or donor complications ( P = .90; RR = 1.02). However, our meta-analysis showed a significant benefit for recipients liver functional recovery favoring the MHV group ( P = .02; WMD = −33.06). Conclusions Our meta-analysis discovered that right lobes with MHV not only experienced better liver functional recovery in recipients, but also caused no greater harm or risk to donors.

Predictors of Kidney Volume Change and Delayed Kidney Function Recovery After Donor Nephrectomy

To our knowledge the effects of preoperative kidney volume in living donors on the post-donation change in size and function of the remaining kidney have not been investigated. We studied the association between preoperative kidney volume, and volume change and delayed kidney function recovery in donors. From 2007 to 2008 we investigated 222 living donors. Kidney volume before and 6 months after surgery was estimated using the voxel count method. We analyzed correlations of kidney volume with patient characteristics, kidney function and actual kidney weight. To identify predictors of the volume increase of the remaining kidney and predictors of delayed kidney function recovery we performed regression analysis. Mean +/- SD total kidney volume was 311.9 +/- 50.6 cc and it correlated with weight, body surface area and kidney function (p <0.001). The mean volume increase in the remaining kidney was 27.6% +/- 9.7% (range 4.5% to 66.1%). Younger age (p <0.001) and lower preoperative volume of the remaining kidney (p = 0.019) were significant predictors of a greater increase in kidney volume on multiple linear regression analysis. Older age (OR 1.07, p <0.001), higher body mass index (OR 1.20, p = 0.008), lower preoperative kidney volume of the remaining kidney (OR 0.98, p = 0.003) and a lower preoperative diethylenetetramine pentaacetic acid glomerular filtration rate in the remaining kidney (OR 0.95, p = 0.017) were significant predictors of delayed kidney function recovery on multiple regression analysis. Kidney volume measured by the voxel count method was accurate and correlated with kidney function. Preoperative kidney volume is an independent predictor of the volume increase and delayed kidney function recovery in donors that could be used clinically.

Renal Function Recovery in Donors and Recipients after Live Donor Nephrectomy: Hand-Assisted Laparoscopic vs. Open Procedures

PurposeLaparoscopic donor nephrectomy is associated with less postoperative pain and faster recovery times in living kidney donors. However, pneumoperitoneum, which is required in laparoscopic donor nephrectomy, can result in adverse effects on renal function in donors and recipients. We compared renal function in donors and recipients after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN).Materials and MethodsBetween January 1997 and January 2008, 241 live donor nephrectomies were performed by either HALDN (n=118) or ODN (n=123). Preoperative patient characteristics were not significantly different between the donors and recipients. We monitored the changes in serum creatinine levels of the donors and recipients preoperatively and on postoperative days 1, 5, 28, 84, and 365.ResultsThe mean operative times of HALDN and ODN were 171 and 163 minutes (p=0.284), and the mean warm ischemic times were 292 and 236 seconds (p=0.207), respectively. The mean serum creatinine level in the recipients on postoperative day 1 was significantly higher after HALDN than after ODN (3.48 vs. 2.62 mg/dl, p=0.003). However, from postoperative day 5 to 1 year, there was no significant difference between the two groups. The mean serum creatinine level in the donors was not significantly different between the HALDN and ODN groups throughout the study period.ConclusionsRenal function recovery in the donors was similar with both HALDN and ODN. Graft renal function recovery after HALDN was comparable with that after ODN, except immediately after surgery (postoperative day 1).