Laparoscopic Live Donor Nephrectomy: Experience of High-Volume Center with 2,477 Cases

Abstract

<b><i>Objective:</i></b> Donors’ health and safety are mandatory in the living-donor kidney transplantation procedure. Laparoscopic live donor nephrectomy (LLDN) provides an increase in donor numbers with its benefits and becomes a standard of care. We aimed to explain the results, complication rates, tips, and tricks of the largest number of LLDN case series ever performed in the literature. <b><i>Materials and Methods:</i></b> Between August 2012 and December 2019, 2,477 live donor case files were analyzed retrospectively. Age, gender, hospitalization times, body mass index, warm ischemia times, operation times, numbers of arteries, side of the kidneys, and complications were noted. <b><i>Results:</i></b> 1,421 (57.4%) of 2,477 donors were female (<i>p</i> = 0.007). Operation times and warm ischemia times were found longer in right-sided LLDN and donors with multiple renal arteries (<i>p</i> = 0.046, <0.001, and <0.001, respectively). Obesity (BMI >30 kg/m<sup>2</sup>) did not affect warm ischemia times while prolonging the operation times (<i>p</i> = 0.013). Hospitalization times and numbers of complications were higher in obese donors. <b><i>Conclusions:</i></b> LLDN seems to be a reliable solution with fewer complications and higher satisfaction rates. We hope to illuminate the way with tips and trick points for beginner transplant surgeons based on the experience obtained from 2,477 LLDN cases.

Does a Renal Vascular Variation in the Renal Allograft Determine the Outcome of Renal Transplantation? Experience from the National Kidney Transplantation Center, Ethiopia

“…19 However, most meta-analyses today show that only 20-30% of LDNs are right-sided and there are still high-volume centers which practically do not perform RLDNs at all. 21 In contrast, some centers have used a large number of right-sided renal allografts and reported no significant difference in graft function. 22 The preference of left-sided renal allografts is often due to the longer left renal vein, which makes vascular anastomosis technically easier and has also been shown to decrease operating time.…”

“…During the time of organ harvest, it is crucial for the kidney procurement team to consider significant vascular anatomical variations. Grafts with anatomic variations, such as double ureters and multiple renal vessels, present a challenge to transplant surgeons in both living and deceased donor transplants because these vessels are smaller in diameter and anastomosing them is difficult and time consuming, [17][18][19][20][21] resulting in longer warm ischemia time and a higher incidence of delayed graft function.…”

Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients

“…To reduce the surgery’s risk during a kidney transplantation, a weight reduction is required in obese patients in the evaluation process [19-21]. Even if there is no exact definition of the ideal BMI for the surgical intervention of a kidney transplantation, different studies demonstrated that patients with a BMI of no higher than 26–28 kg/m 2 show the best graft survival [22, 23].…”

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

“…We cannot deny a certain reluctance against right grafts in our analysis, as they were chosen less often and their split-renal function was significantly lower. However, most meta-analyses today show that only 20–30% of LDNs are right-sided and there are still high-volume centers which practically do not to perform RLDNs at all [7, 29].…”