Do multiple renal arteries restrict laparoscopic donor nephrectomy?

Abstract

Laparoscopic donor nephrectomy is a new technique. For anatomical and technical reasons, many transplant centers restrict laparoscopic donor nephrectomy to kidneys with a single artery. However, we believe that with increased experience, laparoscopic donor nephrectomy in cases of multiple renal arteries does not affect donor or recipient outcomes. Among 115 living related renal transplantations performed between January 1996 and December 2002, 31 nephrectomies were performed via laparoscopy including eight with multiple arteries and 84 via an open approach, including nine with multiple arteries. The 17 patients with multiple arteries at the two procedures were compared in terms of donor and recipient outcomes. All the patients received the same immunosuppressive regimen. The demographic data were similar in the two groups. Mean durations of the donor operations (223 vs 247 minutes), side of nephrectomy (left/right, 5/4 vs 7/1), mean warm ischemia times (230 vs 432 seconds), mean serum creatinine levels at the end of 1 year follow-up, were statistically similar for the open versus the laparoscopy groups. Urological (11.1% vs 25%) and vascular complication rates (22.2% vs 25%), acute rejection rates (11.1% vs 12.5%) were also statistically similar for open versus laparoscopy groups, respectively. One-year patient and graft survival rates were 87.5% for both groups. Laparoscopic donor nephrectomy was as safe a procedure as open surgery even in the presence of multiple renal arteries in the hands of experienced transplants surgeons.