Does the Side Matter? A Retrospective Cohort Study Comparing Left and Right Pure Laparoscopic Donor Nephrectomies

Abstract

<b><i>Objectives:</i></b> Right laparoscopic donor nephrectomy (RLDN) is no longer regarded inferior to left LDN (LLDN). However, this knowledge is based on many studies suffering from inherent learning curves, center-specific imbalances, and different laparoscopic techniques. <b><i>Methods:</i></b> Pure LDNs at a high-volume referral center from 2011 to 2016 were retrospectively analyzed. Patient, graft characteristics, outcomes of LDNs, and corresponding open kidney transplantations were compared between LLDN and RLDN including a follow-up. <b><i>Results:</i></b> 160 (78.4%) LLDNs and 44 (21.6%) RLDNs only differed regarding graft characteristics, as more right grafts had multiple veins (34.1 vs. 6.9%, <i>p</i> < 0.001) and worse scintigraphic function (44 vs. 51%, <i>p</i> < 0.001). RLDNs were shorter (201 vs. 220 min, <i>p</i> = 0.032) with longer warm ischemia time (165 vs. 140 s, <i>p</i> < 0.001), but left grafts were transplanted faster (160 vs. 171 min, <i>p</i> = 0.048). Recipients of right kidneys had more postoperative complications (grade 3: 25.6 vs. 11.3%, <i>p</i> = 0.020). At a follow-up of 45 (range 6–79) months, neither the kidney function, nor death-censored graft (5-year: LLDN 89 vs. 92%, <i>p</i> = 0.969) and patient survival (5-year: LLDN 95 vs. 98%, <i>p</i> = 0.747) differed. <b><i>Conclusions:</i></b> Pure LLDN and RLDN can have different outcomes at high-volume centers, especially higher complications for recipients of right grafts. However, long-term function and graft survival are the same irrespective of the chosen side.

Nefrectomía totalmente laparoscópica para donante vivo de riñón: características y desenlaces en una institución de alta complejidad en Colombia. Serie de casos

“…La primera es la lateralidad escogida para la nefrectomía (izquierda o derecha) y la decisión está determinada por las características anatómicas y funcionales del donante, siendo la nefrectomía derecha técnicamente más compleja debido a que la presencia del hígado dificulta la disección. Sin embargo, con una adecuada curva de aprendizaje por parte del cirujano, los resultados para el donante en cuanto a complicaciones, tiempo quirúrgico y tiempo de isquemia en caliente son comparables 11,12 . En nuestro caso, de los 3 donantes llevados a nefrectomía derecha, ninguno tuvo complicaciones asociadas al procedimiento ni a los 30 días del posoperatorio.…”