Trends and outcomes in right vs. left living donor nephrectomy: an analysis of the <scp>OPTN</scp>/<scp>UNOS</scp> database of donor and recipient outcomes – should we be doing more right‐sided nephrectomies?

Khalil, Ali; Mujtaba, Muhammad A.; Taber, Tim E.; Yaqub, Muhammad S.; Goggins, William C.; Powelson, John A.; Sundaram, Chandru P.; Sharfuddin, Asif

doi:10.1111/ctr.12668

Cited by 47 publications

(45 citation statements)

References 19 publications

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“…A subsequent study of 58 599 living donor nephrectomies from a US registry, including 13.9% right nephrectomies, found statistically significant but numerically small differences in outcomes after right versus left donor nephrectomy, including higher rates of conversion from laparoscopic to open nephrectomy (1.9% vs 0.95%, P ≤ 0.00001; OR 1.16 2.02 2.52 ), delayed allograft function (5.7% vs 4.2%, P < 0.0001; HR 1.24 1.38 1.53 ) and early graft thrombosis (1.1% vs 0.79%, P = 0.006; HR 1.18 1.48 1.86 ). 462 The authors concluded that the laterality of donor nephrectomy should be based on surgeon preference and experience.…”

Section: Rationalementioning

confidence: 99%

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

et al. 2017

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The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a “proof-in-concept” risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1–S109.

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Section: Rationalementioning

confidence: 99%

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

et al. 2017

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“…Although any definition based on a single parameter has limitations, the simplicity of defining DGF as dialysis requirement in the first week post‐transplant is appealing . Using a definition of dialysis by day 7, recent registry studies have reported DGF in approximately 25.5% of deceased‐donor recipients and 3%–5% of living‐donor recipients in the United States. While imperfect, these offer a reasonable indication of frequency.…”

Section: Introductionmentioning

confidence: 99%

Prediction, prevention, and management of delayed graft function: where are we now?

Nashan

Abbud-Filho

Citterio

2016

Clinical Transplantation

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Delayed graft function (DGF) remains a major barrier to improved outcomes after kidney transplantation. High-risk transplant recipients can be identified, but no definitive prediction model exists. Novel biomarkers to predict DGF in the first hours post-transplant, such as neutrophil gelatinase-associated lipocalin (NGAL), are under investigation. Donor management to minimize the profound physiological consequences of brain death is highly complex. A hormonal resuscitation package to manage the catecholamine "storm" that follows brain death is recommended. Donor pretreatment with dopamine prior to procurement lowers the rate of DGF. Hypothermic machine perfusion may offer a significant reduction in the rate of DGF vs simple cold storage, but costs need to be evaluated. Surgically, reducing warm ischemia time may be advantageous. Research into recipient preconditioning options has so far not generated clinically helpful interventions. Diagnostic criteria for DGF vary, but requirement for dialysis and/or persistent high serum creatinine is likely to remain key to diagnosis until current work on early biomarkers has progressed further. Management centers on close monitoring of graft (non)function and physiological parameters. With so many unanswered questions, substantial reductions in the toll of DGF in the near future seem unlikely but concentrated research on many levels offers long-term promise.

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“…449 A subsequent study of 58 599 living donor nephrectomies from a US registry, including 13.9% right nephrectomies, found statistically significant but numerically small differences in outcomes after right versus left donor nephrectomy, including higher rates of conversion from laparoscopic to open nephrectomy (1.9% vs 0.95%, P ≤ 0.00001; OR 1.16 2.02 2.52 ), delayed allograft function (5.7% vs 4.2%, P < 0.0001; HR 1.24 1.38 1.53 ) and early graft thrombosis (1.1% vs 0.79%, P = 0.006; HR 1.18 1.48 1.86 ). 462 The authors concluded that the laterality of donor nephrectomy should be based on surgeon preference and experience.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

Mata

Clayton

Kelly

et al. 2020

Transplantation Direct

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The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.

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Trends and outcomes in right vs. left living donor nephrectomy: an analysis of the OPTN/UNOS database of donor and recipient outcomes – should we be doing more right‐sided nephrectomies?

Abstract: There are statistical differences between left and right kidney donor nephrectomies on recipient outcomes, but the difference is extremely small. The choice and laterality should be based on center and surgeon preference and experience.

Cited by 47 publications

References 19 publications

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

Prediction, prevention, and management of delayed graft function: where are we now?

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

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