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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: Nov 2017. | This topic last updated: Oct 10, 2016.
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