Benefits and complications of minimally invasive live-donor nephrectomy
- Ron Shapiro, MD
Ron Shapiro, MD
- Professor of Surgery
- Surgical Director, Kidney/Pancreas Transplant Program
- Mount Sinai Hospital - Recanati Miller Transplantation Institute
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
INTRODUCTION AND OVERVIEW
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 . 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 .
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 . 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 . 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 . 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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