Comparative analysis of donor and recipient outcomes of laparoscopic vs. open donor nephrectomy for allografts with multiple renal vessels
Dinno Francis Mendiola1, Ernesto L. Gerial Jr.1, Jose Benito A. Abraham1.
1Urology, National Kidney and Transplant Institute, Quezon City, Philippines
Introduction and Objectives: Laparoscopic nephrectomy is the current standard for kidney donors. Many hesitate to utilize this on kidneys with multiple vessels because of the risks to the donor and the allograft. We compared donor and recipient outcomes between laparoscopic (LDN) and open nephrectomy (ODN) among donors with multiple vessels.
Materials and Methods: A chart review was done on all living donor nephrectomies with multiple vessels at our institution from January 2006 to December 2015. Patient demographics, operative time, length of stay, estimated blood loss, pre- and postoperative creatinine (1 day, 1 week, 1 month, 1 year), incidence of delayed graft function, and complications were analyzed.
Results: A total of 257 donors, 118 LDN and 139 ODN were included in the study. There was no significant difference in mean age in LDN 29.5(18-66) vs. ODN 32.4(19-53) and male to female ratio in LDN 1.8:1 vs ODN 1.5:1. LDN was applied more frequently on the left (7:1) while ODN was utilized more for right kidneys (1:3). There was no difference in the number of vessel anomalies between the two groups. There was no difference in operative time (minutes) in LDN (191.46±39.98) vs. ODN (182.37±40.39), warm ischemia time (minutes) in LDN (4.65±3.26) vs. ODN (5.53±4.49), delayed graft function in LDN 3/118(2%) vs. ODN 4/139(3%), mean donor and recipient post-operative creatinine (1 week, 1 month and 1 year), and the incidence of complications. There was neither conversion from LDN to open nor mortality in either groups. There was significantly shorter hospital stay (days) in LDN (3.41±0.83) vs. ODN (3.76±1.16), less blood loss (ml.) in LDN (138.73±156.91) vs. ODN (232.87±199.88) and less postoperative fever in LDN 32/118(27%) vs. ODN 65/139(47%).
Conclusion: LDN achieves equivalent recipient outcomes as ODN. Additional benefits in LDN include a shorter hospital stay, less blood loss and lower morbidity rates.
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