Kidney Laterality and the Safety of Hand-assisted Live Donor Nephrectomy: Review of 1000 Consecutive Cases at a Single Center

Song, Geehyun; Jeong, In Gab; Kim, Young Hoon; Han, Duck‐Jong; Kim, Choung‐Soo; Ahn, Hanjong; Ahn, Tai Young; Hong, Bumsik

doi:10.1016/j.urology.2014.12.072

Cited by 10 publications

(26 citation statements)

References 36 publications

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“…The remaining 7 LD studies reported graft survival between left and right kidneys to be similar. 11,36,38,43,45,47,48 None of the LD studies reported adjusted graft survival.…”

Section: Living Donor Graft Survivalmentioning

confidence: 99%

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Carolan

Tingle

Thompson

et al. 2021

Clinical Transplantation

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Introduction: Transplantation of right kidneys can pose technical challenges due to the short right renal vein. Whether this results in inferior outcomes remains controversial.Method: Healthcare Database Advanced Search (HDAS) was used to identify relevant studies. Two authors independently reviewed each study. Statistical analyses were performed using random effects models and results expressed as HR or relative risk (RR) with 95% confidence intervals. Subgroup analyses were performed in kidneys from deceased donors (DD) and living donors (LD).Results: A total of 35 studies (257,429 participants) were identified. Both deceased and living donor right kidneys were at increased risk of delayed graft function (DGF; RR = 1.12[1.06-1.18] and RR = 1.33[1.21-1.46] respectively; both p < .0001). In absolute terms, for each 100 kidney pairs of DD kidneys transplanted there are 2.72 (1.67-3.78, p < .00001) excess episodes of DGF in right kidneys. Graft thromboses and graft loss due to technical failure was also significantly more likely in right kidneys, in both DD and LD settings. There was no evidence that laterality alters long term graft survival in LD or DD. Conclusion:Right kidneys have inferior early outcomes, with higher rates of DGF, technical failure and graft thrombosis. However, these differences are small in absolute terms, and long-term graft survival is equivalent.

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“…The remaining 7 LD studies reported graft survival between left and right kidneys to be similar. 11,36,38,43,45,47,48 None of the LD studies reported adjusted graft survival.…”

Section: Living Donor Graft Survivalmentioning

confidence: 99%

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Carolan

Tingle

Thompson

et al. 2021

Clinical Transplantation

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“…[ 26 ] In contrast, some centers have performed a large number of right-sided donor nephrectomies, albeit using hand-assisted techniques, and reported no significant difference in graft function. [ 27 ] Considering that MRA is not an uncommon variant, the very nature of preferentially selecting left-sided donor grafts regardless of arterial anatomy means that a higher number of MRA will be encountered. [ 24 ] This is reflected in our study, where 23% of donors had MRA grafts.…”

Section: Discussionmentioning

confidence: 99%

Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels

et al. 2020

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Introduction: In kidney transplantation, total laparoscopic live donor nephrectomy (TLLDN) in the presence of multiple renal arteries (MRA) is technically challenging and has traditionally been associated with higher complication rates. We report our experience of using MRA grafts procured by TLLDN. Materials and Methods: Patients undergoing TLLDN at our center (2004–2014) was identified from a prospectively maintained database and divided into single renal arteries (SRA) or MRA groups. Recipient perioperative parameters, postoperative complications, and long-term graft survival were analyzed. Results: Of 465 patients, 106 had MRA and 359 had an SRA. There were six vascular complications in the SRA group and two in the MRA group (1.7% vs. 1.8%). There were eight ureteric complications requiring intervention in the SRA group compared to three in the MRA group (4% vs. 3%; P = 0.45). Acute rejection was observed in 12% of the SRA group compared to 9% in the MRA group ( P = 0.23). One-, 5- and 10-year graft survivals were 98.2%, 91.3%, and 89.8% in the MRA group versus 98.0%, 90.4%, and 77.5% in the SRA group (log-rank P = 0.13). Conclusion: The use of MRA grafts procured by TLLDN has comparable complication rates to SRA grafts and should not preclude selection for renal transplantation.

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“…Among the various types of living donor nephrectomy, hand-assisted laparoscopic donor nephrectomy is easy to learn and has a relatively flat learning curve 14 . The safety outcomes in living donors show no significant differences between hand-assisted laparoscopic donor nephrectomy and open donor nephrectomy or laparoscopic procedures 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative predictors, including the anesthetic used, anesthesia time, warm ischemic time, nephrectomy side (right or left), use of vasopressors, volume of crystalloid administered, and urine output were also evaluated. Warm ischemic time was defined as the time between renal arterial division and graft perfusion with cold preservation solution 14 . If the mean arterial blood pressure was < 65 mmHg during the donor surgical procedure, vasopressors such as ephedrine or phenylephrine were administered.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors Associated with Decreased Renal Function after Hand-Assisted Laparoscopic Donor Nephrectomy: A Multivariate Analysis of a Single Surgeon Experience

Lim¹,

Kong²,

Kim³

et al. 2017

Int. J. Med. Sci.

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Background: Hand-assisted laparoscopic donor nephrectomy is a minimally invasive procedure for living kidney donation. The surgeon operative volume is associated with postoperative morbidity and mortality. We evaluated the risk factors associated with decreased renal function after hand-assisted laparoscopic donor nephrectomy performed by a single experienced surgeon.Methods: We included living renal donors who underwent hand-assisted laparoscopic donor nephrectomy by a single experienced surgeon between 2006 and 2013. Decreased renal function was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m2 on postoperative day 4. The donors were categorized into groups with postoperative eGFR < 60 mL/min/1.73 m2 or ≥ 60 mL/min/1.73 m2. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors associated with decreased renal function after hand-assisted laparoscopic donor nephrectomy. The hospital stay duration, intensive care unit admission rate, and eGFR at postoperative year 1 were evaluated.Results: Of 643 patients, 166 (25.8%) exhibited a postoperative eGFR of < 60 mL/min/1.73 m2. Multivariate logistic regression analysis demonstrated that the risk factors for decreased renal function were age [odds ratio (95% confidence interval), 1.062 (1.035-1.089), P < 0.001], male sex [odds ratio (95% confidence interval), 3.436 (2.123-5.561), P < 0.001], body mass index (BMI) [odds ratio (95% confidence interval), 1.093 (1.016-1.177), P = 0.018], and preoperative eGFR [odds ratio (95% confidence interval), 0.902 (0.881-0.924), P < 0.001]. There were no significant differences in postoperative hospital stay duration and intensive care unit admission rate between the two groups. In addition, 383 of 643 donors were analyzed at postoperative year 1. Sixty donors consisting of 14 (5.0%) from the group of 279 donors in eGFR ≥ 60 mL/min/1.73 m2, and 46 (44.2%) from the group of 104 donors in eGFR < 60 mL/min/1.73 m2 had eGFR < 60 mL/min/1.73 m2 at postoperative year 1 (P < 0.001).Conclusions: Increased age, male sex, higher BMI, and decreased preoperative eGFR were risk factors for decreased renal function after hand-assisted laparoscopic donor nephrectomy by a single experienced surgeon. These results provide important evidence for the safe perioperative management of living renal donors.

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Kidney Laterality and the Safety of Hand-assisted Live Donor Nephrectomy: Review of 1000 Consecutive Cases at a Single Center

Cited by 10 publications

References 36 publications

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Recipient outcomes in total laparoscopic live donor nephrectomy with multiple renal vessels

Risk Factors Associated with Decreased Renal Function after Hand-Assisted Laparoscopic Donor Nephrectomy: A Multivariate Analysis of a Single Surgeon Experience

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