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Benefits and complications of minimally invasive live-donor nephrectomy

Ron Shapiro, MD
Daniel C Brennan, MD, FACP
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD


With the improvements in outcomes after renal transplantation over the past decade, the limiting factor has continued to be the number of organs available for transplantation. Deceased-donor donation rates have remained relatively stable, and, as of mid-2010, over 90,000 patients are registered on the kidney transplant waiting list in the United States [1]. As a result, many programs have focused on trying to increase the rate of living-donor kidney transplantation.

Coincident with this renewed interest in living donation has been the development of laparoscopic-assisted donor nephrectomy [2-6]. This procedure has been adopted by a number of transplant programs around the country and accounts for >50 percent of donor nephrectomies [7].

A significant number of studies have been published concerning the relative effectiveness of this technique, although many are not well designed [8-15]. A 2008 meta-analysis evaluated 73 studies that included 3751 and 2843 patients who had undergone laparoscopic surgery and open nephrectomy, respectively [14]. Compared with open nephrectomy, the laparoscopic surgery group had a significantly shorter hospital stay and a quicker return to work (by 1.48 days and 2.58 weeks, respectively). Both groups had similar rates of delayed allograft function and allograft loss. Overall, a consistent reported observation is that laparoscopic donor nephrectomy (LDN), compared with open donor nephrectomy, is associated with less donor morbidity and similar allograft function and overall safety, but more expense.

A meta-analysis of 31 studies, including five randomized trials and 26 cohort studies, concluded that hand-assistance reduces the operation and first warm ischemia times and may improve safety for surgeons with less experience in LDN [16]. Further, the retroperitoneoscopic approach was significantly associated with fewer complications. Another meta-analysis of nine studies compared 461 of laparoendoscopic single-site (LESS) living-donor nephrectomy with 1006 laparoscopic living-donor nephrectomies [17]. There were more left-side cases in the LESS living-donor nephrectomy group (96.5 versus 88.6 percent), longer operative time, and a greater likelihood of conversion to an open procedure, but a lower analgesic requirement.

The technical aspects of laparoscopic-assisted donor nephrectomy are described separately; this topic review will assess the known risks and benefits associated with LDN and compare them with those seen with open donor nephrectomy.


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Literature review current through: Sep 2016. | This topic last updated: Oct 10, 2016.
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  1. optn.transplant.hrsa.gov (Accessed on June 10, 2010).
  2. Ratner LE, Ciseck LJ, Moore RG, et al. Laparoscopic live donor nephrectomy. Transplantation 1995; 60:1047.
  3. Flowers JL, Jacobs S, Cho E, et al. Comparison of open and laparoscopic live donor nephrectomy. Ann Surg 1997; 226:483.
  4. Jacobs SC, Cho E, Foster C, et al. Laparoscopic donor nephrectomy: the University of Maryland 6-year experience. J Urol 2004; 171:47.
  5. Challacombe B, Mamode N. Laparoscopic live donor nephrectomy. Nephrol Dial Transplant 2004; 19:2961.
  6. Feng S, Humar A, Pomfret E, et al. Surgical challenges in transplantation: the Fourth Annual American Society of Transplant Surgeons' State-of-the-Art Winter Symposium. Am J Transplant 2005; 5:428.
  7. Davis CL, Delmonico FL. Living-donor kidney transplantation: a review of the current practices for the live donor. J Am Soc Nephrol 2005; 16:2098.
  8. Handschin AE, Weber M, Demartines N, Clavien PA. Laparoscopic donor nephrectomy. Br J Surg 2003; 90:1323.
  9. Burrows L, Knight R, Edye M, Gagner M. Laparoscopic kidney donation. Are the recipient complications worth the advantages to the donor? XVIII International Congress of the Transplantation Society, Book of abstracts, 2000 Aug 27-Sept 1.
  10. Wolf JS Jr, Merion RM, Leichtman AB, et al. Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation 2001; 72:284.
  11. Kok NF, Lind MY, Hansson BM, et al. Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial. BMJ 2006; 333:221.
  12. Simforoosh N, Basiri A, Tabibi A, et al. Comparison of laparoscopic and open donor nephrectomy: a randomized controlled trial. BJU Int 2005; 95:851.
  13. Øyen O, Andersen M, Mathisen L, et al. Laparoscopic versus open living-donor nephrectomy: experiences from a prospective, randomized, single-center study focusing on donor safety. Transplantation 2005; 79:1236.
  14. Nanidis TG, Antcliffe D, Kokkinos C, et al. Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis. Ann Surg 2008; 247:58.
  15. Nicholson ML, Kaushik M, Lewis GR, et al. Randomized clinical trial of laparoscopic versus open donor nephrectomy. Br J Surg 2010; 97:21.
  16. Özdemir-van Brunschot DM, Koning GG, van Laarhoven KC, et al. A comparison of technique modifications in laparoscopic donor nephrectomy: a systematic review and meta-analysis. PLoS One 2015; 10:e0121131.
  17. Autorino R, Brandao LF, Sankari B, et al. Laparoendoscopic single-site (LESS) vs laparoscopic living-donor nephrectomy: a systematic review and meta-analysis. BJU Int 2015; 115:206.
  18. Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010; 303:959.
  19. Kortram K, Ijzermans JN, Dor FJ. Perioperative Events and Complications in Minimally Invasive Live Donor Nephrectomy: A Systematic Review and Meta-Analysis. Transplantation 2016.
  20. Ratner LE, Kavoussi LR, Sroka M, et al. Laparoscopic assisted live donor nephrectomy--a comparison with the open approach. Transplantation 1997; 63:229.
  21. Jacobs SC, Cho E, Dunkin BJ, et al. Laparoscopic live donor nephrectomy: the University of Maryland 3-year experience. J Urol 2000; 164:1494.
  22. Perry KT, Freedland SJ, Hu JC, et al. Quality of life, pain and return to normal activities following laparoscopic donor nephrectomy versus open mini-incision donor nephrectomy. J Urol 2003; 169:2018.
  23. Bachmann A, Wolff T, Giannini O, et al. How painful is donor nephrectomy? Retrospective analysis of early pain and pain management in open versus laparoscopic versus retroperitoneoscopic nephrectomy. Transplantation 2006; 81:1735.
  24. Breda A, Veale J, Liao J, Schulam PG. Complications of laparoscopic living donor nephrectomy and their management: the UCLA experience. Urology 2007; 69:49.
  25. Tooher RL, Rao MM, Scott DF, et al. A systematic review of laparoscopic live-donor nephrectomy. Transplantation 2004; 78:404.
  26. Simforoosh N, Bassiri A, Ziaee SA, et al. Laparoscopic versus open live donor nephrectomy: the first randomized clinical trial. Transplant Proc 2003; 35:2553.
  27. Andersen MH, Mathisen L, Oyen O, et al. Postoperative pain and convalescence in living kidney donors-laparoscopic versus open donor nephrectomy: a randomized study. Am J Transplant 2006; 6:1438.
  28. Hadjianastassiou VG, Johnson RJ, Rudge CJ, Mamode N. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery. Am J Transplant 2007; 7:2532.
  29. Matas AJ, Bartlett ST, Leichtman AB, Delmonico FL. Morbidity and mortality after living kidney donation, 1999-2001: survey of United States transplant centers. Am J Transplant 2003; 3:830.
  30. Philosophe B, Kuo PC, Schweitzer EJ, et al. Laparoscopic versus open donor nephrectomy: comparing ureteral complications in the recipients and improving the laparoscopic technique. Transplantation 1999; 68:497.
  31. Chan DY, Fabrizio MD, Ratner LE, Kavoussi LR. Complications of laparoscopic live donor nephrectomy: the first 175 cases. Transplant Proc 2000; 32:778.
  32. Troppmann C, Ormond DB, Perez RV. Laparoscopic (vs open) live donor nephrectomy: a UNOS database analysis of early graft function and survival. Am J Transplant 2003; 3:1295.
  33. Abreu SC, Goldfarb DA, Derweesh I, et al. Factors related to delayed graft function after laparoscopic live donor nephrectomy. J Urol 2004; 171:52.
  34. Derweesh IH, Goldfarb DA, Abreu SC, et al. Laparoscopic live donor nephrectomy has equivalent early and late renal function outcomes compared with open donor nephrectomy. Urology 2005; 65:862.
  35. Ratner LE, Montgomery RA, Maley WR, et al. Laparoscopic live donor nephrectomy: the recipient. Transplantation 2000; 69:2319.
  36. Nogueira JM, Cangro CB, Fink JC, et al. A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation 1999; 67:722.
  37. Carter JT, Freise CE, McTaggart RA, et al. Laparoscopic procurement of kidneys with multiple renal arteries is associated with increased ureteral complications in the recipient. Am J Transplant 2005; 5:1312.
  38. Troppmann C, McBride MA, Baker TJ, Perez RV. Laparoscopic live donor nephrectomy: a risk factor for delayed function and rejection in pediatric kidney recipients? A UNOS analysis. Am J Transplant 2005; 5:175.
  39. Singer JS, Ettenger RB, Gore JL, et al. Laparoscopic versus open renal procurement for pediatric recipients of living donor renal transplantation. Am J Transplant 2005; 5:2514.
  40. Horgan S, Vanuno D, Sileri P, et al. Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation 2002; 73:1474.
  41. Gorodner V, Horgan S, Galvani C, et al. Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies. Transpl Int 2006; 19:636.
  42. Hubert J, Renoult E, Mourey E, et al. Complete robotic-assistance during laparoscopic living donor nephrectomies: an evaluation of 38 procedures at a single site. Int J Urol 2007; 14:986.
  43. Liu XS, Narins HW, Maley WR, et al. Robotic-assistance does not enhance standard laparoscopic technique for right-sided donor nephrectomy. JSLS 2012; 16:202.
  44. Tzvetanov I, Bejarano-Pineda L, Giulianotti PC, et al. State of the art of robotic surgery in organ transplantation. World J Surg 2013; 37:2791.
  45. Ratner LE, Hiller J, Sroka M, et al. Laparoscopic live donor nephrectomy removes disincentives to live donation. Transplant Proc 1997; 29:3402.
  46. Simmons RG, Klein SD, Simmons RL. Gift of Life: The Social and Psychological Impact of Organ Transplantation, John Wiley and Sons, New York 1977.
  47. Simmons RG, Marine SK, Simmons RL. Gift of Life: The Effect of Organ Transplantation on Individual, Family, and Societal Dynamics, 2nd ed., Transaction Books, New Brunswick 1987.
  48. Aull MJ, Afaneh C, Charlton M, et al. A randomized, prospective, parallel group study of laparoscopic versus laparoendoscopic single site donor nephrectomy for kidney donation. Am J Transplant 2014; 14:1630.
  49. Shenoy S, Lowell JA, Ramachandran V, Jendrisak M. The ideal living donor nephrectomy "mini-nephrectomy" through a posterior transcostal approach. J Am Coll Surg 2002; 194:240.
  50. Kok NF, Alwayn IP, Lind MY, et al. Donor nephrectomy: mini-incision muscle-splitting open approach versus laparoscopy. Transplantation 2006; 81:881.
  51. Dols LF, Ijzermans JN, Wentink N, et al. Long-term follow-up of a randomized trial comparing laparoscopic and mini-incision open live donor nephrectomy. Am J Transplant 2010; 10:2481.