Retroperitoneoscopic Live Donor Nephrectomy Research Articles

Safety and Efficacy of Right Retroperitoneal Laparoscopic Live Donor Nephrectomy: A Retrospective Single-Center Study.

BackgroundThe aim of this study was to investigate the efficacy and safety of right retroperitoneal laparoscopic live donor nephrectomy (LDN) in 81 cases of living-related renal transplant.Material/MethodsWe retrospectively reviewed all living-related donors who underwent right retroperitoneoscopic living donor nephrectomy between June 2010 and December 2017 at the First Hospital of Jilin University and their corresponding recipients. Demographic and clinical data were collected from the hospital’s electronic clinical data system. Data on preoperative renal retention parameters, operative time, and donor kidney warm ischemia time, the trimmed length of the renal artery and vein of donor kidney, and the time to extubation were recorded. Complications in both donors and recipients were recorded.ResultsWe included 81 donors who underwent successful right-sided retroperitoneoscopic LDN, with 31 males and 50 females and a mean age of 47.1 years (range 21–63 years). There was no intraoperative conversion to open donor nephrectomy. The mean operative time was 120.68±29.8 min. The mean warm ischemic time was 49.26±3.86 s. The estimate blood loss was 54.32 mL (range 50–400 mL). The median length of hospital stay was 7 days (range 4–13 days). There was neither intraoperative complication such as hemorrhage or lymph fistula nor kidney graft injury. There was no graft renal vein thrombosis and ureteral stricture or other complications. No graft rejection occurred.ConclusionsRight retroperitoneal laparoscopic live donor nephrectomy is safe and effective for renal transplant in living-related renal transplant by laparoscopic excision and extraction of the right kidney with vena cava flap.

Response to Letter to the Editor RE: Hirose et al., Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopic Living Donor Nephrectomy by Hirose et al. (From: Goyal K, Singh AK, Kumar U, et al. J Endourol 2019;33:503; DOI: 10.1089/end.2019.0099).

Response to Letter to the Editor RE: Hirose et al., Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopic Living Donor Nephrectomy by Hirose et al. (From: Goyal K, Singh AK, Kumar U, et al. J Endourol 2019;33:503; DOI: 10.1089/end.2019.0099).

Letter to the Editor RE: Hirose et al., Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopy Living Donor Nephrectomy (From: Hirose T, Hotta K, Iwami D, et al. J Endourol 2018;32:1120-1124; DOI: 10.1089/end.2018.0669).

Letter to the Editor RE: Hirose et al., Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopy Living Donor Nephrectomy (From: Hirose T, Hotta K, Iwami D, et al. J Endourol 2018;32:1120-1124; DOI: 10.1089/end.2018.0669).

Pure versus hand-assisted retroperitoneoscopic live donor nephrectomy: a retrospective cohort study of 1508 transplants from two centers.

Although minimally invasive procedures have been established as the standard for a donor nephrectomy, there are many different surgical techniques described in the literature. The aim of this study is to compare the outcomes of kidney transplant procedures using the pure retroperitoneoscopic donor nephrectomy (PRDN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARDN) techniques. A retrospective study involving 1508 transplant procedures was conducted; 874 were PRDN procedures; and 634 were HARDN. We reviewed the outcomes of the PRDN and HARDN groups, which were performed at two different centers over an identical time period. Donors in the PRDN group had a longer operation time (P < 0.0001), reduced estimated blood loss (P < 0.0001), less open conversion (P = 0.0002), lower postoperative serum C-reactive protein levels (P < 0.0001), and a shorter postoperative hospital stay (P < 0.0001) than the HARDN group. Recipients in the PRDN group had lower serum creatinine levels at postoperative day 1-6 and the decreased incidence of slow graft function (P = 0.0017) than the HARDN group. The HARDN procedure was an independent risk factor for the incidence of acute rejection (P = 0.0211) and graft loss (P = 0.0193). Our study suggests that the PRDN procedure is less invasive for donors as it results in reduced blood loss, lower postoperative serum CRP levels, and a shorter postoperative stay than the HARDN procedure. Additionally, PRDN provides a better outcome for recipients as it lowers the incidence of acute rejection and improves graft survival compared to HARDN.

Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopic Living Donor Nephrectomy.

Laparoscopic surgery has been a standard procedure of living donor nephrectomy (LDN). Transperitoneal hand-assisted laparoscopic LDN (HALDN) has been commonly reported by many centers with excellent outcome. However, there are few studies reporting retroperitoneoscopic LDN (RPLDN). Four hundred four consecutive kidney donors (124 men, 280 women) were enrolled in this study. Age of the donors was 55.0 ± 10.7 years. RPLDN was performed for 294 donors, and HALDN for 110 donors. We compared perioperative donor outcome and early complication rates between RPLDN and HALDN to evaluate the safety and efficacy of RPLDN. Intraoperative blood loss was significantly less in RPLDN than in HALDN (p < 0.05). The conversion rate to open surgery was similar between the two groups. The intraoperative complication rate was 1.0% (two vascular injuries and one bowel injury) in RPLDN and 0.9% (one vascular injury) in HALDN. The postoperative complication rate was 3.4% (six surgical site infections, two postoperative bleeding, one colon perforation, one ileus, one rhabdomyolysis) in RPLDN and 1.8% (two surgical site infections) in HALDN. Although warm ischemic time was significantly longer in RPLDN than in HALDN (p < 0.01), the incidence of delayed graft function was similar between the two groups. Furthermore, there was no difference in 1-year graft survival between the two groups. Both RPLDN and HALDN procedures were well tolerated with minimal complication rates, and both procedures showed similar impact on recipient graft function. These results suggest that RPLDN could be a feasible option for LDN as well as HALDN.

Cumulative Sum Analysis of the Learning Curve for Modified Retroperitoneoscopic Living-Donor Nephrectomy

Objectives: To introduce our modified retroperitoneoscopic living-donor nephrectomy (RPLDN) techniques and estimate the learning curve. Methods: We retrospectively evaluated 121 consecutive donors who underwent modified RPLDN performed by a single surgeon. While the surgeon controlled the renal vessels, one hand was inserted through an abdominal incision for assistance. The kidney was manually retrieved through the abdominal incision. The learning curve was evaluated using the cumulative sum (CUSUM) method, which was a graphical method showing changes in individual surgical performance. Results: The mean operating time and warm ischemic time (WIT) were 129.4 min and 154.5 s, respectively. The mean estimated blood loss (EBL) was 44.4 mL. Regarding intraoperative complications, no open conversions or blood transfusions were required. The CUSUM learning curve included the following 3 unique phases: phase 1 (the initial 32 cases), representing the initial learning curve; phase 2 (the middle 38 cases), representing expert competence; and phase 3 (the final 51 cases), representing mastery. Conclusions: Our modified method has the advantages of a short operating time, an optimized WIT, a low EBL, and acceptable complication rates. The surgeon completed the initial learning phase of RPLDN after 32 cases and could effectively perform RPLDN after 70 cases.

Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy.

Laparoscopic donor nephrectomy has become the standard of care due to multiple benefits. Currently, there are various techniques employed with two different approaches: transperitoneal (TLDN) or retroperitoneoscopic (RLDN) approach. There is a lack of data to determine which technique is superior, although the RLDN offers an anatomical advantage by avoidance of manipulation of the intraperitoneal organs. The aims of this study were to explore the merits of RLDN to TLDN and assess the learning curve of transition from TLDN to RLDN. From January 2010 to February 2017, 106 live donor nephrectomies were performed: 56 by TLDN and 50 by RLDN. Data on patient demographics, perioperative parameters, analgesic consumption, pain scores, and kidney graft function were collected and analysed. Data were compared with a Student's t test or Mann-Whitney test. A CUSUM analysis was performed to investigate the learning curve. All live donor nephrectomies were successful with no conversion to open surgery. There was no blood transfusion, readmission, or mortality. No postoperative complications were graded over Clavien II. Kidney function was comparable in both groups. The follow-up period ranged from 3 to 78 months. Retroperitoneoscopic live donor nephrectomy is a safe approach with comparable results to TLDN. RLDN has an anatomical advantage as it avoids manipulating the intraperitoneal organs and retains a virgin abdomen and hence translates to a lower perioperative complication risk.

Right retroperitoneoscopic living donor nephrectomy does not increase surgical complications in the recipient and leads to excellent long-term outcome.

Right-sided retroperitoneoscopic living donor nephrectomy (LDN) has been shown to be safe for the donor but it is unknown whether the short renal vein is associated with complications or an impaired long-term outcome in the recipient. In this retrospective cohort study, consecutive transplant recipients after retroperitoneoscopic LDN were enrolled. Complications occurring within 1 year were classified according to the Clavien-Dindo Classification for Surgical Complications and analysed using multivariable logistic regression. Predictors of 1-year creatinine clearance were analysed with multivariable linear regression. Cox proportional hazard models were used to analyse graft survival. Of the 251 recipients, 193 (77%) received a left kidney and 58 (23%) a right kidney. Surgical complications of Clavien-Dindo grade 3 or higher were comparable in recipients of right and left kidneys (33% vs 29%, odds ratio 0.98, 95% confidence interval [CI] 0.50, 1.94). The occurrence of a surgical complication had a significant impact on creatinine clearance at 1 year (decrease of 6 ml/min/m2, p = 0.016). Vascular complications in right kidneys were more common but were all corrected without impact on graft survival. One-year graft-survival was similar in recipients of right (98.3%) and left (96.9%) kidneys, as was creatinine clearance one year after transplantation (mean difference 3.3 ml/min/m2, 95% CI -1.5, 8.1; p = 0.175). After a median follow-up of 5 years, neither the side (hazard ratio 1.56, 95% CI 0.67, 3.63) nor surgical complications (hazard ratio 1.44, 95% CI 0.65, 3.19) were associated with graft failure. Right retroperitoneoscopic LDN does not compromise the outcome of transplantation. Surgical complications, long-term graft function and graft survival were comparable in right and left kidneys.

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.

Pure retroperitoneoscopic donor nephrectomy in duplication of inferior vena cava: A series of four cases.

Aim:Complex vascular anatomy poses a major challenge to the donor surgeon. Here, we have described the technical nuances in retroperitoneoscopic living donor nephrectomy for the left kidney in the situations of a rare vascular anomaly of duplication of inferior vena.Materials and Methods:Between September 2005 and June 2016, 1460 retroperitoneoscopic living donor nephrectomy were carried out in single surgical unit of our institution. Out of these four donors were found to have duplication of inferior vena cava (IVC). We retrospectively analyzed the prospectively collected data of these donors and studied the operative details for managing the duplicated limb of the IVC.Results:The mean age of the donors was 42.5 (range 30–54) years. Mean body mass index was 26.9 (range 25.2–28.6) kg/m2. Mean operative time (defined as between giving skin incision to the skin closure [O. T]), was 230 (range 185–310 min). Mean Warm ischemia time (defined from clamping of the renal artery to the starting of the cold HTK perfusion, [WIT]) was 136 s (range 105–178 s). In two cases, the renal vein could be controlled distal to the duplicated limb. In one case, the duplicated limb was clipped while in another a stapler was used to take a cuff of IVC.Conclusion:Retroperitoneoscopic donor nephrectomy can be performed safely in cases of duplication of IVC. Preoperative computerized tomography angiography with vascular reconstruction and surgical expertise is desirable in carrying out the procedure.

RETROPERITONEOSCOPIC DONOR NEPHRECTOMY: EXPERIENCE WITH 5 YEARS

We modified the method of retroperitoneoscopic live donor nephrectomy and evaluated results of 5 years procedures. There were no conversions to open or hand-assisted surgery. All organs have been successfully transplanted. Retroperitoneoscopic live donor nephrectomy is safe and feasible. The method has three main advantages over conventional laparoscopic nephrectomy: the absence of contact with bowel, spleen, liver and other intra-abdominal structures, more comfortable access to the renal artery, absence of intraperitoneal pressure elevation.

Optimizing a living kidney donation program: transition to hand-assisted retroperitoneoscopic living donor nephrectomy and introduction of a passive polarizing three-dimensional display system.

Optimizing a living kidney donation program is important to guarantee a high grade of acceptance among potential donors. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP) is an alternative to the open anterior approach (AA) technique. Problems associated to the learning curve could hinder a transition. 3D display technique seems to ease minimally invasive surgery. Aim of this study was to evaluate the learning curve during the transition from AA to HARP and the influence of the 3D display system on the established technique. Observational study (n=207) during transition to HARP and introduction of 3D display technique. Operation time (OT), warm ischemia time (WIT) and blood loss (BL) of HARP decreased during transition. Pairwise group comparison for OT showed a significant learning effect for the first 30 out of 50 HARPs without influence on graft function. Between AA and HARP no significant difference in OT (133±24 vs. 127±19min, p=0.25) but for WIT (23±28 vs. 126±40s, p<0.005) and BL (328±207 vs. 54±35ml, p<0.005) was seen. There was neither a significant difference in donors' nor recipients' eGFR. OT (98±16 vs. 106±19min, p=0.036) and WIT (97±37 vs. 120±57s, p=0.023) were significantly shorter for the 3D technique compared to 2D. A transition to HARP is possible without additional risk for the donor or loss of quality for the recipient. The learning curve for HARP is steep and short. The introduction of 3D display technique after transition facilitates the surgical preparation and could further help to optimize HARP.

Postoperative Continuous Infusion of Local Anesthesia in Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy.

Postoperative pain management in living kidney donor nephrectomy plays a key role in donor comfort and is important for the further acceptance of living kidney donation in times of organ shortage. Standard pain treatment (SPT) based on opioids is limited due to related side effects. Continuous infusion of local anesthesia (CILA) into the operative field is a promising alternative. The aim of this study was to evaluate whether CILA could reduce the dose of opioids in living kidney donors operated with hand-assisted retroperitoneoscopic donor nephrectomy (HARP). An observational study on 30 living donors was performed. The primary outcome was the difference of morphine equivalents (MEQ) administered between CILA and SPT. On day 0 and 1, living donors with CILA received significant less MEQ compared to the SPT group, although on day 1 this effect was not statistically significant (day 0: 6.3 mg, interquartile range [IR] 4.2-11.2 vs 16.8 mg, IR 10.5-22.1, P= .009; day 1: 5.25 mg, IR 2.1-13.3 vs 13.3 mg, IR 6.7-23.8, P= .150). On days 2 and 3 there was no difference (day 2: 13.3 mg, IR 0.0-20.0 vs 13.3 mg, IR 6.7-13.3, P= .708; day 3: 13.3 mg, IR 0.0-26.7 vs 13.3 mg, IR 6.7-20, P= .825). Overall (days 0 to3) MEQ was also less for CILA without reaching statistical significance (39.6 mg, IR 10.9-70.5 vs 59.6 mg, IR 42.4-72.9, P= .187). CILA seems to be an effective instrument for donor pain management in the first 24 hours after HARP. Its effect abates by 48 hours after surgery, especially if highly potent nonopioids are given.

Modified Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy with a Mini-Open Muscle Splitting Gibson Incision

Background: We aimed to confirm the advantages of a modified hand-assisted retroperitoneoscopic living donor nephrectomy (HARPLDN) compared to the performance of standard retroperitoneoscopic living donor nephrectomy (RPLDN). Methods: One hundred twenty-eight consecutive surgical cases were categorized into 2 groups, one receiving standard RPLDN (group 1) and one receiving modified HARPLDN (group 2). Perioperative factors of both groups were evaluated retrospectively, including donors' demographics, overall operating time, warm ischemia time (WIT), graft vessel length, blood loss, complications, pain visual analogue scale (VAS) scores, hospital stay, and matched recipients' perioperative outcomes. One-year follow-up data were also examined. Results: The standard RPLDN group (n = 44) and modified HARPLDN group (n = 84) had comparable age, gender, and body mass index. The RPLDN group donors had longer operative time, shorter vein length and longer WIT than the modified HARPLDN (all p < 0.001). RPLDN had higher VAS scores (p < 0.001), longer carminative time (p = 0.002) and higher morphine requirement (p = 0.039) than the modified HARPLDN. No complications occurred in either group. All recipients and grafts had survived at 1-year follow-up. Conclusion: The modified HARPLDN technique is safe and effective for living donor nephrectomy and has shorter operating time, shorter WIT and better pain control. Further study is required to evaluate donors' long-term quality of life and recipients' long-term outcomes.

Dynamics of Urinary Calprotectin after Renal Ischaemia.

Background: Urinary calprotectin has been identified as a promising biomarker for acute kidney injury. To date, however, the time-dependent changes of this parameter during acute kidney injury remain elusive. The aim of the present work was to define the time-course of urinary calprotectin secretion after ischaemia/reperfusion-induced kidney injury in comparison to neutrophil gelatinase—associated lipocalin, thereby monitoring the extent of tubular damage in nephron sparing surgery for kidney tumours. Methods: The study population consisted of 42 patients. Thirty-two patients underwent either open or endoscopic nephron sparing surgery for kidney tumours. During the surgery, the renal arterial pedicle was clamped with a median ischaemic time of 13 minutes (interquartile range, 4.5–20.3 minutes) in 26 patients. Ten retro-peritoneoscopic living donor nephrectomy patients and 6 nephron sparing surgery patients in whom the renal artery was not clamped served as controls. Urinary calprotectin and neutrophil gelatinase—associated lipocalin concentrations were repeatedly measured by enzyme-linked immunosorbent assay and assessed according to renal function parameters. Results: Urinary concentrations of calprotectin and neutrophil gelatinase—associated lipocalin increased significantly after ischaemia/reperfusion injury, whereas concentrations remained unchanged after nephron sparing surgery without ischaemia/reperfusion injury and after kidney donation. Calprotectin and neutrophil gelatinase—associated lipocalin levels were significantly increased 2 and 8 hours, respectively, post-ischaemia. Both proteins reached maximal concentrations after 48 hours, followed by a subsequent persistent decrease. Maximal neutrophil gelatinase—associated lipocalin and calprotectin concentrations were 9-fold and 69-fold higher than their respective baseline values. The glomerular filtration rate was only transiently impaired at the first post-operative day after ischaemia/reperfusion injury (p = 0.049). Conclusion: Calprotectin and neutrophil gelatinase—associated lipocalin can be used to monitor clinical and sub-clinical tubular damage after nephron sparing surgery for kidney tumours. Urinary calprotectin concentrations start rising within 2 hours after ischaemia/reperfusion-induced kidney injury.

Laparoscopic cholecystectomy performed simultaneously with retroperitoneoscopic live donor nephrectomy

Aim: To evaluate safety of simultaneous Laparoscopic cholecystectomy (LC) and Retroperitoneoscopic live donor nephrectomy (RPLDN). Materials and Methods: We have retrospectively reviewed 400 patients who have undergone RPLDN. Ten patients underwent a combination of RPLDN and LC. Ten patients underwent a combination of RPLDN and LC. Results: Mean operative time was 141.1 ± 27.47 min (range 95-170 min), with a mean estimated blood loss (EBL) of 61.1 ± 18.33 mL (range 30-80 mL). No blood transfusions were required. No short- or long-term complications were found. Mean hospital stay was 2.6 ± 0.84 days (range 2-4 days). Mean follow-up period was 1.8 ± 0.71 years (range 1-3 years). Conclusion: From our results, we conclude that simultaneous RPLDN and LC are safe.

Successful technical tradition of retroperitoneoscopic living donor nephrectomy to the next generation

Successful technical tradition of retroperitoneoscopic living donor nephrectomy to the next generation

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.

Outcomes of Retroperitoneoscopic Live Donor Nephrectomy in Patients With Renal Artery Aneurysm.

INTRODUCTION: Kidney transplantation with renal artery aneurysm (RAA) requires skilled technique for vascular reconstruction in bench surgery. Some cases are highly complicated and affect graft survival. We have been trying to establish a procedure of pure retroperitoneoscopic live donor nephrectomy (RPLDN). The outcomes of RPLDN in patients with RAA are not yet fully understood. In this study, we examine the outcome of recipient and donors with RAA using RPLDN at our institute. METHODS:Seven hundred sixty-four patients underwent live donor renal transplants with allografts procured by RPLDN at our institute between 2001 to 2013. Of these, 8 (1.0%) patients had renal artery aneurysms. Study variables included operative time, blood loss, warm ischemic time (WIT), total ischemic time (TIT), hospital stay, and early graft function. Surgical renovascular reconstructions were performed in all patients with RAA. RESULTS: Mean size of RAAs was 1.4 ± 0.7 cm (range: 0.9 - 2.8 cm). No significant differences were found between aneurysm and non-aneurysm groups regarding operative time, time to retrieval of the kidney, mean blood loss, hospital stay, or early graft function (Table 1). Post-operative bleeding and ureter stenosis that required reconstruction of the ureter were found in the aneurysm group. Univariate analysis showed RAA to have a risk factor of developing ureteral complications in recipients (p < 0.001) following RPLDN. CONCLUSIONS: RPLDN in patients with RAA could be an option for laparoscopic live donor nephrectomy because of excellent outcomes. On the other hand, post-operative ureteral complications should be carefully followed up following RPLDN.Table: No Caption available.

Retroperitoneoscopic Procurement of Kidneys With Multiple Renal Arteries Does Not Affect Graft Survival and Ureteral Complications.

Objective: To assess the effect of kidney allografts with multiple renal arteries (MRA) on donor and recipient outcomes after retroperitoneoscopic live donor nephrectomy (RPLDN). Patients and Methods: From July 2001 to August 2010, 533 patientsunderwent live donor kidney transplants with allografts procured by RPLDN at our center. Of these, 406, 105, and 22 patients had one, two, and three renal arteries, respectively. We compared retrospectively the collected clinical data of each donor with MRA and the recipient with those with single renal artery (SRA) as controls. Results: Significant differences were found between the one and three renal artery groups regarding operative time, estimated blood loss, warm and cold ischemic time, and incidence of slow graft function (SGF). There were no significant differences 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, one patient with MRA had ureteral complications. In univariate analysis, MRA patients had a risk factor of developing SGF (p = 0.005) but not ureteral complications following RPDN. Conclusions: Kidneys with MRAafter RPLDN increasethe risk of SGF in recipients. However, they provide similar outcomes regarding long-term graft survival and complications compared with those of SRA. Renal artery multiplicity may not increase the risk of ureteral complications.