Two Hundred One Consecutive Living-Donor Nephrectomies

Shaffer, David R.; Sahyoun, Anthony I.; Madras, Peter N.; Monaco, Anthony P.

doi:10.1001/archsurg.133.4.426

Cited by 82 publications

(40 citation statements)

References 14 publications

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“…Living donor nephrectomy has been proven safe and is associated with minimal complications and a negligible death rate. 1 The recipient benefits of living donor renal transplantation are multiple: superior patient and graft survival, no prolonged waiting time, decreased incidence of delayed allograft function, and a shorter hospital stay. 2 These superior results and the current shortage of cadaver kidneys provide an incentive to increase the frequency of living donor transplantation.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intravascular Volume Expansion on Renal Function During Prolonged CO2 Pneumoperitoneum

et al. 2000

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ObjectiveTo evaluate whether intravascular volume expansion would improve renal blood flow and function during prolonged CO 2 pneumoperitoneum. Summary Background DataAlthough laparoscopic living donor nephrectomies have a considerably reduced risk of complications for the donors, significant concerns exist regarding procurement of a kidney in the altered physiologic environment of CO 2 pneumoperitoneum. Recent studies have documented adverse effects of CO 2 pneumoperitoneum on renal hemodynamics. MethodsRenal and systemic hemodynamics and renal histology were studied in a porcine CO 2 pneumoperitoneum model. After placement of a pulmonary artery catheter, carotid arterial line, Foley catheter, and renal artery ultrasonic flow probe, CO 2 pneumoperitoneum (15 mmHg) was maintained for 4 hours. Pigs were randomized into three intravascular fluid protocol groups: euvolemic (3 mL/kg/hour isotonic crystalloid), hypervolemic (15 mL/kg/hour isotonic crystalloid), or hypertonic (3 mL/kg/hour isotonic crystalloid plus 1.2 mL/kg/hour 7.5% NaCl). ResultsIn the euvolemic group, prolonged CO 2 pneumoperitoneum caused decreased renal blood flow, oliguria, and impaired creatinine clearance. Both isotonic and hypertonic volume expansions reversed the changes in renal blood flow and urine output, but impaired creatinine clearance persisted. ConclusionsIntravascular volume expansion alleviates the effects of CO 2 pneumoperitoneum on renal hemodynamics in a porcine model. Hypertonic saline (7.5% NaCl) solution may maximize renal blood flow in prolonged pneumoperitoneum, but it does not completely prevent renal dysfunction in this setting. This study suggests that routine intraoperative volume expansion is important during laparoscopic live donor nephrectomy.Living donor renal transplantation has achieved a high level of acceptance from the general public and is the ideal renal replacement therapy for those with end-stage renal disease. Living donor nephrectomy has been proven safe and is associated with minimal complications and a negligible death rate. 1The recipient benefits of living donor renal transplantation are multiple: superior patient and graft survival, no prolonged waiting time, decreased incidence of delayed allograft function, and a shorter hospital stay.2 These superior results and the current shortage of cadaver kidneys provide an incentive to increase the frequency of living donor transplantation. However, a significant disincentive is the invasive nature of the donor nephrectomy and its relatively long postoperative recovery period. Recent reports of laparoscopically assisted living donor nephrectomy have shown that this less invasive approach results in reduced postoperative pain, a shorter hospital stay, and a more rapid return to the work for the donor. [3][4][5][6] In addition, decreased donor discomfort and a shorter convalescence have resulted in a substantially increased rate of consent to living donation and may help to alleviate the ongoing transplant organ shortage.

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Section: Discussionmentioning

confidence: 99%

Effect of Intravascular Volume Expansion on Renal Function During Prolonged CO2 Pneumoperitoneum

et al. 2000

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“…[8][9][10] Our results regarding immediate postoperative complications are on par with those reported previously in different studies from across the world. [12][13][14][15][16][17][18][19] In particular, there were no perioperative deaths, and intermediate-term complications were also low. These results are reassuring and have contributed to the ongoing donations involving living donors at our center.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Hamid

Khan²,

Aziz³

et al. 2018

Exp Clin Transplant

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Key words: Complications, Hypertension, Perioperative IntroductionKidney transplant is the treatment of choice for patients with end-stage renal disease (ESRD). Compared with long-term dialysis, kidney transplant procedures are cost-effective, offer improved quality of life, and confer a progressive survival benefit. 1,2 While the ESRD population continues to grow, the supply of kidneys for transplant from deceased donors is unlikely to increase significantly, resulting in a large gap between the demand for donor kidneys and supply. 3,4 Fortunately, living kidney donation has become an attractive alternative to transplants with deceased donations. With the advent of laparoscopic donor nephrectomy and constantly improving recipient outcomes, the number of living kidney donations has grown by 115% over the past decade. 5 From a recipient standpoint, living-donor transplant is regarded as superior to deceased-donor transplant in every respect. Living-donor transplant allows for a full donor evaluation before transplant, elective scheduling of surgery at the time of optimized recipient health, and a minimum graft ischemic time during the transplant operation. 6 The major downside of living-donor renal transplant is that it subjects a healthy person to unnecessary surgery, with its attendant risks and a life after surgery with reduced renal mass. Fortunately, donor nephrectomy is a relatively safe procedure. The risk of donor death is most commonly cited as 0.03%, the risk of major complications is from 0.23% to 2.1%, and the risk of minor complications is from 8.0% to 14.7%. 7,8 The aim of the present study was to evaluate the short-and long-term outcomes of living-related kidney donors in terms of biochemical parameters and postnephrectomy complications at a single center in Pakistan.

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“…The technique of laparoscopic live donor nephrectomy in humans was first developed by Ratner et al [36] in 1995. Since then, several investigators have reported their experience with this procedure and laparoscopic live donor nephrectomy has resulted in decreased hospital stay, less postoperative analgesic requirements and an earlier return to normal activities [37,38]. Several authors have published their series of the results of laparoscopic live donor nephrectomies.…”

Section: Laparoscopic Donor Nephrectomymentioning

confidence: 99%

“…Several authors have published their series of the results of laparoscopic live donor nephrectomies. A review of experience with 201 live donor nephrectomies by Shaffer et al [38] showed 4.5% major and 16.5% minor complication rate. Most of the major complications occurred during the early period of development of this procedure and included bowel injury, ureteral devascularization, retroperitoneal hematoma and epigastric arterial bleeding learning curve of most surgeons.…”

Section: Laparoscopic Donor Nephrectomymentioning

confidence: 99%

Retroperitoneoscopic Nephrectomy for Benign Diseases of the Kidney

Hemal¹

2001

Urol Int

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Two Hundred One Consecutive Living-Donor Nephrectomies

Cited by 82 publications

References 14 publications

Effect of Intravascular Volume Expansion on Renal Function During Prolonged CO2 Pneumoperitoneum

Effect of Intravascular Volume Expansion on Renal Function During Prolonged CO2 Pneumoperitoneum

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Retroperitoneoscopic Nephrectomy for Benign Diseases of the Kidney

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