The impact of intraoperative fluid management during laparoscopic donor nephrectomy on donor and recipient outcomes

Abstract

Background Intraoperative fluid management during laparoscopic donor nephrectomy (LDN) may have a significant effect on donor and recipient outcomes. We sought to quantify variability in fluid management and investigate its impact on donor and recipient outcomes. Methods A retrospective review of patients who underwent LDN from July 2011 to January 2016 with paired kidney recipients at a single center was performed. Patients were divided into tertiles of intraoperative fluid management (standard, high, and aggressive). Donor and recipient demographics, intraoperative data, and postoperative outcomes were analyzed. Results Overall, 413 paired kidney donors and recipients were identified. Intraoperative fluid management (mL/h) was highly variable with no correlation to donor weight (kg) (R = 0.017). The aggressive fluid management group had significantly lower recipient creatinine levels on postoperative day 1. However, no significant differences were noted in creatinine levels out to 6 months between groups. No significant differences were noted in recipient postoperative complications, graft loss, and death. There was a significant increase (P < 0.01) in the number of total donor complications in the aggressive fluid management group. Conclusions Aggressive fluid management during LDN does not improve recipient outcomes and may worsen donor outcomes compared to standard fluid management.

The use of intraoperative mannitol during the laparoscopic nephrectomy in living kidney donor and the prevention of delayed graft function

“…In the literature, the DGF is correlated with a higher risk of multiple post-transplant complications and less graft survival in kidney transplant recipients 9,17 . In our findings, the incidence of DGF did not have a significant difference within the comparison groups similar to a study of 413 LKD with laparoscopic nephrectomy 18 . Andrews et al 6 evaluated varying degrees of ATN by performing an optical coherence tomography in LKD comparing mannitol infusion for 15 min versus 30 min in the renal tubules.…”

“…On the other hand, the reduction in the incidence of acute rejection at 1 year of follow-up in the Williams et al 18 results was not significant with the administration of mannitol in LKD equivalent to our findings. In addition, a total of 90 kidney recipients were evaluated to determine the incidence of acute rejection with or without mannitol in kidney transplantation.…”