Increased rates of donation with laparoscopic donor nephrectomy

Abstract

Objective: To examine the impact of laparoscopic nephrectomy and recipient education on the proportion of kidney recipients who could identify a potential live donor, and on the live donor (LD) transplantation rate.

Summary background data: Laparoscopic donor nephrectomy (LDN) results in less postoperative surgical pain, a shorter hospital stay, and quicker recovery than the standard open donor nephrectomy (ODN). The authors hypothesized that the availability of this less invasive surgical technique would enhance the willingness of family and friends to donate.

Methods: The study population consisted of 3,298 end-stage renal disease patients referred for kidney transplant evaluation between November 1991 and February 2000, divided into three groups. The first group received no formal LD education and had only ODN available. The second group received formal education about the LD process and had only ODN available. The third group had both formal LD education and LDN available. Records were examined to determine what proportion of each group had any potential donors tissue-typed, and the rate at which they received an LD transplant.

Results: Before LDN availability and formal LD education, only 35.1% of referrals found a potential donor, and only 12.2% received an LD transplant within 3 years. Institution of a formal education program increased the volunteer rate to 39.0%, and 16.5% received an LD transplant. When LDN became available, 50% of patients were able to find at least one potential donor, and within 3 years 24.7% received an LD transplant. Regression analysis indicated that availability of LDN was independently associated with a 1.9 relative risk of receiving an LD transplant. Kaplan-Meier death-censored 1- and 3-year graft survival rates for ODN transplants were 95.8% and 90.6%, versus 97.5% and 94. 8% for LDN.

Conclusions: The availability of LDN and an LD family education program has doubled the live donor transplantation rate, and outcomes remain excellent.

Figure 1. Percentage of kidney transplant referrals who had at least one potential live kidney donor tissue-typed. Black bar, group 1 (open donor nephrectomy, no formal family education program); gray bar, group 2 (open donor nephrectomy with formal family education program); white bar, group 3 (laparoscopic donor nephrectomy with formal family education program). P values refer to a chi-square comparison of groups 2 and 3.

Figure 2. Kaplan-Meier rates of living donor transplantation among all kidney registrants. The lowest rate was for group 1 patients (dashed line). The transplant rate was higher after introduction of the formal family education program (gray line, group 2;P = .08 vs. group 1, log-rank test). The rate again increased significantly with the addition of laparoscopic donor nephrectomy (black line, group 3;P < .0001 vs. group 2).

Figure 3. Three-year Kaplan-Meier death-censored graft survival rates for open donor nephrectomy (gray line, n = 168, 90.6%) and laparoscopic donor nephrectomy (black line, n = 452, 94.8%) living donor kidney transplants. Graft survival rates between the two groups were not significantly different (P = .17).