Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 12;10(6):1195.
doi: 10.3390/jcm10061195.

The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience

Spyridon Vernadakis  1 , Smaragdi Marinaki  2 , Maria Darema  2 , Ioanna Soukouli  2 , Ioannis El Michelakis  3   4 , Chrysoula Beletsioti  5 , Georgios Zavvos  1 , Ioannis Bokos  1 , Ioannis N Boletis  2
Affiliations

The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience

Spyridon Vernadakis et al. J Clin Med. .

Abstract

Since its introduction in 1995, laparoscopic nephrectomy has emerged as the preferred surgical approach for living donor nephrectomy. Given the ubiquity of the surgical procedure and the need for favorable outcomes, as it is an elective operation on otherwise healthy individuals, it is imperative to ensure appropriate preoperative risk stratification and anticipate intraoperative challenges. The aim of the present study was to compare peri-and postoperative outcomes of living kidney donors (LD), who had undergone laparoscopic nephrectomy (LDN), with a control group of those who had undergone open nephrectomy (ODN). Health-related quality of life (QoL) was also assessed using the validated SF-36 questionnaire. Data from 252 LD from a single transplant center from March 2015 to December 2020 were analyzed retrospectively. In total, 117 donors in the LDN and 135 in the ODN groups were assessed. Demographics, type of transplantation, BMI, duration of surgery, length of hospital stay, peri- and postoperative complications, renal function at discharge and QoL were recorded and compared between the two groups using Stata 13.0 software. There was no difference in baseline characteristics, nor in the prevalence of peri-and postoperative complications, with a total complication rate of 16% (mostly minor, Clavien-Dindo grade II) in both groups, while a different pattern of surgical complications was noticed between them. Duration of surgery was significantly longer in the ODN group (median 240 min vs. 160 min in LDN, p < 0.01), warm ischemia time was longer in the LDN group (median 6 min vs.2 min in ODN, p < 0.01) and length of hospital stay shorter in the LDN group (median 3 days vs. 7 days in ODN). Conversion rate from laparoscopic to open surgery was 2.5%. There was a drop in estimated glomerular filtration rate (eGFR) at discharge of 36 mL/min in the LDN and 32 mL/min in the ODN groups, respectively (p = 0.03). No death, readmission or reoperation were recorded. There was a significant difference in favor of LDN group for each one of the eight items of the questionnaire (SF1-SF8). As for the two summary scores, while the total physical component summary (PCS) score was comparable between the two groups (57.87 in the LDN group and 57.07 in the ODN group), the mental component summary (MCS) score was significantly higher (62.14 vs. 45.22, p < 0.001) in the LDN group. This study provides evidence that minimally invasive surgery can be performed safely, with very good short-term outcomes, providing several benefits for the living kidney donor, thereby contributing to expanding the living donor pool, which is essential, especially in countries with deceased-donor organ shortage.

Keywords: kidney transplantation; laparoscopic; living donation; outcomes; quality of life.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Port placement for laparoscopic donor nephrectomy (LDN). (A) Overview of the port placement for left-sided LDN. Four trocars. (B) Overview of the port placement for right-sided LDN. Five trocars.
Figure 1
Figure 1
Port placement for laparoscopic donor nephrectomy (LDN). (A) Overview of the port placement for left-sided LDN. Four trocars. (B) Overview of the port placement for right-sided LDN. Five trocars.
Figure 2
Figure 2
Port placement for laparoscopic donor nephrectomy (LDN). (A) Dissection of the renal arteries. (B) Control of the renal arteries with the vascular Endo-GIA. (C) Control of the renal vein with the vascular Endo-GIA.
Figure 2
Figure 2
Port placement for laparoscopic donor nephrectomy (LDN). (A) Dissection of the renal arteries. (B) Control of the renal arteries with the vascular Endo-GIA. (C) Control of the renal vein with the vascular Endo-GIA.
Figure 3
Figure 3
Port placement for laparoscopic donor nephrectomy (LDN). (A) Ligation of the ureter. (B) Ligation of the renal vessels.
See this image and copyright information in PMC

References

    1. Wolfe R.A., Ashby V.B., Milford E.L., Ojo A.O., Ettenger R.E., Agodoa L.Y., Held P.J., Port F.K. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N. Engl. J. Med. 1999;341:1725–1730. doi: 10.1056/NEJM199912023412303. - DOI - PubMed
    1. Cecka J.M. Kidney transplantation from living unrelated donors. Annu. Rev. Med. 2000;51:393–406. doi: 10.1146/annurev.med.51.1.393. - DOI - PubMed
    1. Shokeir A.A. Open versus laparoscopic live donor nephrectomy: A focus on the safety of donors and the need for a donor registry. J. Urol. 2007;178:1860–1866. doi: 10.1016/j.juro.2007.07.008. - DOI - PubMed
    1. Ratner L.E., Ciseck L.J., Moore R.G., Cigarroa F.G., Kaufman H.S., Kavoussi L.R. Laparoscopic live donor nephrectomy. Transplantation. 1995;60:1047–1049. - PubMed
    1. Wilson C.H., Sanni A., Rix D.A., Soomro N.A. Laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst. Rev. 2011 doi: 10.1002/14651858.CD006124.pub2. - DOI - PubMed

LinkOut - more resources