Risk Factors for Perioperative Complications in Hand-Assisted Laparoscopic Donor Nephrectomy

Alberts, Victor P.; Idu, Mirza M.; Minnee, Robert C.

doi:10.7182/pit2014240

Cited by 8 publications

(6 citation statements)

References 74 publications

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“…In contrast to this study, previous studies have reported that predonation hypertension and obesity were significantly associated with increased rates of perioperative complications in living kidney donors. 2,5,6,33 Whereas we defined obesity as a BMI ≥30 kg/m 2 , some previous studies defined obesity as a BMI ≥35 kg/m 2 , and it is possible that other studies had a higher percentage of donors with a BMI ≥35 kg/m 2 (only 2% of donors in our study had a BMI >35 kg/m 2 ). 33 It is also possible that the risk from obesity and hypertension is augmented by other factors, such as older age, non-white ethnicity, or other predonation risk factors that were not as common in our cohort.…”

Section: Discussionmentioning

confidence: 84%

“…In previous studies, the incidence of perioperative complications in living kidney donors has ranged from 8% to 18%. 2-6 Reasons for this variation may be explained by differences in ascertainment methodology and in the way perioperative complications were defined (eg, some studies used more liberal or restrictive definitions). As well, studies with higher complication rates tended to have a higher proportion of donors with risk factors such as non-white race, obesity, and hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…The perioperative mortality rate of living donor nephrectomy ranges between 0.02% and 0.04% and morbidity rate goes from 8% to 18%. 1-6…”

Section: What Was Known Beforementioning

confidence: 99%

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Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study

Garcia-Ochoa

Feldman

Nguan

et al. 2019

Can J Kidney Health Dis

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Background: While living kidney donation is considered safe in healthy individuals, perioperative complications can occur due to several factors. Objective: We explored associations between the incidence of perioperative complications and donor characteristics, surgical technique, and surgeon’s experience in a large contemporary cohort of living kidney donors. Design: Living kidney donors enrolled prospectively in a multicenter cohort study with some data collected retrospectively after enrollment was complete (eg, surgeon characteristics). Setting: Living kidney donor centers in Canada (n = 12) and Australia (n = 5). Patients: Living kidney donors who donated between 2004 and 2014 and the surgeons who performed the living kidney donor nephrectomies. Measurements: Operative and hospital discharge medical notes were collected prospectively, with data on perioperative (intraoperative and postoperative) information abstracted from notes after enrollment was complete. Complications were graded using the Clavien-Dindo system and further classified into minor and major. In 2016, surgeons who performed the nephrectomies were invited to fill an online survey on their training and experience. Methods: Multivariable logistic regression models with generalized estimating equations were used to compare perioperative complication rates between different groups of donors. The effect of surgeon characteristics on the complication rate was explored using a similar approach. Poisson regression was used to test rates of overall perioperative complications between high- and low-volume centers. Results: Of the 1421 living kidney donor candidates, 1042 individuals proceeded with donation, where 134 (13% [95% confidence interval (CI): 11%-15%]) experienced 142 perioperative complications (55 intraoperative; 87 postoperative). The most common intraoperative complication was organ injury and the most common postoperative complication was ileus. No donors died in the perioperative period. Most complications were minor (90% of 142 complications [95% CI: 86%-96%]); however, 12 donors (1% of 1042 [95% CI: 1%-2%]) experienced a major complication. No statistically significant differences were observed between donor groups and the rate of complications. A total of 43 of 48 eligible surgeons (90%) completed the online survey. Perioperative complication rates did not vary significantly by surgeon characteristics or by high- versus low-volume centers. Limitations: Operative and discharge reporting is not standardized and varies among surgeons. It is possible that some complications were missed. The online survey for surgeons was completed retrospectively, was based on self-report, and has not been validated. We had adequate statistical power only to detect large effects for factors associated with a higher risk of perioperative complications. Conclusions: This study confirms the safety of living kidney donation as evidenced by the low rate of major perioperative complications. We did not identify any donor or surgeon characteristics associated with a higher risk of perioperative complications. Trial registration(s): NCT00319579: A Prospective Study of Living Kidney Donation ( https://clinicaltrials.gov/ct2/show/NCT00319579 ) NCT00936078: Living Kidney Donor Study ( https://clinicaltrials.gov/ct2/show/NCT00936078 )

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study

Garcia-Ochoa

Feldman

Nguan

et al. 2019

Can J Kidney Health Dis

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“…Hand-assisted LDN was introduced aiming to combine the advantages of the laparoscopic technique with the quicker and safer kidney retrieval of the open technique (provided by the tactile feedback) [9]. Despite the recommendations of the Kidney Disease Improving Global Outcomes (KDIGO) report [10], in which extensive previous surgery and/or adhesions would justify an open procedure, the rate of conversion to open surgery for hand-assisted LDN in obese donors and patients who have undergone previous abdominal surgery has been reported even slightly lower than that of totally laparoscopic LDN (2.63% vs 4.1%; P = .35) [9,11]. In fact, Kok et al [12] showed significantly more conversions to open procedure in the presence of intra-abdominal adhesions (0% vs. 10%, P = .005).…”

Section: Discussionmentioning

confidence: 99%

Hand-assisted laparoscopic nephrectomy in a high risk overweight donor with left-sided IVC, and previous abdominal surgery

Serena

González

Garcia

et al. 2019

International Journal of Surgery Case Reports

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“…Multiple renal arteries, BMI ≥ 30, right LDN and male sex were picked as risk factors for complications and compelling factors for the procedures according to the current literature [ 5 ]. These three variables and male sex were investigated in terms of intraoperative complication rates and operative time.…”

Section: Methodsmentioning

confidence: 99%

Hand-assisted laparoscopic donor nephrectomy: 1864 cases in 15 years of experience

GÜNAYDIN¹,

UÇAR²,

ARPALI³

et al. 2022

Turkish Journal of Medical Sciences

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Background/aim To evaluate hand-assisted laparoscopic donor nephrectomy (HALDN) in terms of intraoperative and postoperative results. Materials and methods After institutional review board approval was obtained, a total of 1864 HALDN operations performed between March 2007 and January 2022 were retrospectively analyzed. Age, sex, body mass index (BMI), status of smoking and presence of previous abdominal surgery, laterality, operative time, transfusion requirement, port counts, length of extraction incision, time until mobilization, time until oral intake, donor serum creatinine levels before and one week after the surgery, length of postoperative hospital stay, intraoperative complications, and postoperative recovery and complications were recorded and statistically analyzed. Multiple renal arteries, BMI, right nephrectomy and male sex were also separately evaluated as risk factors for complications and operative time. Results A total of 825 (44.26%) male and 1039 (55.74%) female patients were enrolled in the study. The mean age of the patients was 45.79 ± 12.88 years. There were a total of 143 complications (7.67% of the total 1864 cases) consisting of 68 (3.65%) intraoperative and 75 (4.02%) postoperative complications. Open conversion was necessary for 10 patients (0.53%) to manage intraoperative complications. Reoperation was needed for 1 patient due to bleeding 6 h after the operation. Multiple renal arteries were a risk factor for intraoperative complications and prolonged operative time. Right nephrectomy and male sex were also related with longer operative times. Conclusions HALDN is a safe procedure associated with low complication rates.

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Risk Factors for Perioperative Complications in Hand-Assisted Laparoscopic Donor Nephrectomy

Cited by 8 publications

References 74 publications

Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study

Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study

Hand-assisted laparoscopic nephrectomy in a high risk overweight donor with left-sided IVC, and previous abdominal surgery

Hand-assisted laparoscopic donor nephrectomy: 1864 cases in 15 years of experience

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