Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Related articles included with a subscription

Preview Available
(subscription required for full access)

Benefits and complications of laparoscopic donor nephrectomy

INTRODUCTION

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 late 2008, over 76,000 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 greater than 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 [8-14]. 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, compared with open donor nephrectomy, is associated with less donor morbidity and similar allograft function and overall safety, but more expense.

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

A discussion of the different surgical techniques is presented separately. (See "Deceased and living donor renal allograft recovery".)
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. optn.transplant.hrsa.gov, accessed 6/09.
  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, Liao, P. 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. Oyen, 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. Najarian, JS, Chavers, BM, McHugh, LE, Matas, AJ. 20 years or more of follow-up of living kidney donors. Lancet 1992; 340:807.
  16. Bay, WH, Hebert, LA. The living donor in kidney transplantation. Ann Intern Med 1987; 106:719.
  17. 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.
  18. Ratner, LE, Kavoussi, LR, Sroka, M, et al. Laparoscopic assisted live donor nephrectomy – A comparison with the open approach. Transplantation 1997; 63:229.
  19. Jacobs, SC, Cho, E, Dunkin, BJ, et al. Laparoscopic live donor nephrectomy: the University of Maryland 3-year experience. J Urol 2000; 164:1494.
  20. Perry, KT, Freedland, SJ, Hu, JC, Phelan, MW. Quality of life, pain and return to normal activities following laparoscopic donor nephrectomy versus open mini-incision donor nephrectomy. J Urol 2003; 169:2018.
  21. 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.
  22. Breda, A, Veale, J, Liao, J, Schulam, PG. Complications of laparoscopic living donor nephrectomy and their management: The UCLA experience. Urology 2007; 69:49.
  23. Tooher, RL, Rao, MM, Scott, DF, et al. A systematic review of laparoscopic live-donor nephrectomy. Transplantation 2004; 78:404.
  24. Simfornoosh, N, Bassiri, A, Ziaee, SA, et al. Laparoscopic versus open live donor nephrectomy: the fist randomized clinical trial. Trans Proceed 2003; 35:2553.
  25. 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.
  26. 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.
  27. Hsu, TH, Su, LM, Ratner, LE, Kavoussi, LR. Renovascular complications of laparoscopic donor nephrectomy. Urology 2002; 60:811.
  28. 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.
  29. Chan, DY, Fabrizio, MD, Ratner, LE, Kavoussi, LR. Complications of laparoscopic live donor nephrectomy: the first 175 cases. Transplant Proc 2000; 32:778.
  30. Knoepp, L, Smith, M, Huey, J, et al. Complication after laparoscopic donor nephrectomy: a case report and review. Transplantation 1999; 68:449.
  31. Sandford, R, Nicholson, ML. Genito-femoral nerve entrapment: a complication of stapling the ureter during laparoscopic live donor nephrectomy. Nephrol Dial Transplant 2001; 16:2090.
  32. Blohme, I, Fehrman, I, Norden, G. Living donor nephrectomy. Complication rates in 490 consecutive cases. Scand J Urol Nephrol 1992; 26:149.
  33. Duraj, F, Tyden, G, Blom, B. Living-donor nephrectomy: how safe is it? Transplant Proc 1995; 27:803.
  34. Johnson, EM, Remucal, MJ, Gillingham, KJ, et al. Complications and risks of living donor nephrectomy. Transplantation 1997; 64:1124.
  35. Johnson, EM, Najarian, JS, Matas, AJ. Living kidney donation: donor risks and quality of life. Clin Transpl 1997; :231.
  36. 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.
  37. Abreu, SC, Goldfarb, DA, Derweesh, I, et al. Factors related to delayed graft function after laparoscopic live donor nephrectomy. J Urol 2004; 171:52.
  38. 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.
  39. Ratner, LE, Montgomery, RA, Maley, WR, et al. Laparoscopic live donor nephrectomy: the recipient. Transplantation 2000; 69:2319.
  40. 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.
  41. 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.
  42. 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.
  43. 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.
  44. Ratner, LE, Hiller, J, Sroka, M, et al. Laparoscopic live donor nephrectomy removes disincentives to live donation. Transplant Proc 1997; 29:3402.
  45. Simmons, RG, Klein, SD, Simmons, RL. Gift of life: The social and psychological impact of organ transplantation, John Wiley and Sons, New York 1977.
  46. 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.
  47. 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.
  48. Kok, NF, Alwayn, IP, Lind, MY, et al. Donor nephrectomy: mini-incision muscle-splitting open approach versus laparoscopy. Transplantation 2006; 81:881.
white circle LOG IN
white circle DEMO