TY - JOUR
T1 - Evolution of Living Donor Nephrectomy at a Single Center
T2 - Long-Term Outcomes with 4 Different Techniques in Greater Than 4000 Donors over 50 Years
AU - Serrano, Oscar Kenneth
AU - Kirchner, Varvara
AU - Bangdiwala, Ananta
AU - Vock, David M.
AU - Dunn, T. B.
AU - Finger, Erik B.
AU - Payne, William D.
AU - Pruett, Timothy L.
AU - Sutherland, David E R
AU - Najarian, John S.
AU - Matas, Arthur J.
AU - Kandaswamy, Raja
N1 - Funding Information:
This work was supported by a grant from CIRM (DR1-01423, QT subcontract) and the University of California, San Francisco, Diabetes Endocrinology Research Center grant from NIDDK (P30 DK063720).
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background The development of minimally invasive surgical approaches to donor nephrectomy (DN) has been driven by the potential advantages for the donor, with questions remaining about long-Term outcomes. Methods All living DN performed from June 1963 through December 2014 at the University of Minnesota were reviewed. Outcomes were compared among 4 DN techniques. Results We performed 4286 DNs: 2759 open DN (ODNs), 1190 hand-Assisted (HA) laparoscopic DNs (LDNs), 203 pure LDN (P-LDNs), and 97 robot-Assisted-LDN. Laparoscopic DN was associated with an older (P < 0.001) and heavier (P < 0.001) donor population. Laparoscopic DN was associated with a higher probability of left kidney procurement (P < 0.001). All 3 LDN modalities required a longer operative time (P < 0.001); robot-Assisted-LDN took significantly longer than HA-LDN or P-LDN. Laparoscopic DN decreased the need for intraoperative blood transfusion (P < 0.001) and reduced the incidence of intraoperative complications (P < 0.001) and hospital length of stay (P < 0.001). However, LDN led to a significantly higher rate of readmissions, both short-Term (<30 day, P < 0.001) and long-Term (>30 day, P < 0.001). Undergoing HA-LDN was associated with a higher rate of an incisional hernia compared with all other modalities (P < 0.001). For recipients, LDN seemed to be associated with lower rates of graft failure at 1 year compared with ODN (P = 0.002). The odds of delayed graft function increased for kidneys with multiple arteries procured via P-LDN compared with HA-LDN (OR 3 [1,10]) and ODN (OR 5 [2, 15]). Conclusions In our experience, LDN was associated with decreased donor intraoperative complications and hospital length of stay but higher rates of readmission and long-Term complications.
AB - Background The development of minimally invasive surgical approaches to donor nephrectomy (DN) has been driven by the potential advantages for the donor, with questions remaining about long-Term outcomes. Methods All living DN performed from June 1963 through December 2014 at the University of Minnesota were reviewed. Outcomes were compared among 4 DN techniques. Results We performed 4286 DNs: 2759 open DN (ODNs), 1190 hand-Assisted (HA) laparoscopic DNs (LDNs), 203 pure LDN (P-LDNs), and 97 robot-Assisted-LDN. Laparoscopic DN was associated with an older (P < 0.001) and heavier (P < 0.001) donor population. Laparoscopic DN was associated with a higher probability of left kidney procurement (P < 0.001). All 3 LDN modalities required a longer operative time (P < 0.001); robot-Assisted-LDN took significantly longer than HA-LDN or P-LDN. Laparoscopic DN decreased the need for intraoperative blood transfusion (P < 0.001) and reduced the incidence of intraoperative complications (P < 0.001) and hospital length of stay (P < 0.001). However, LDN led to a significantly higher rate of readmissions, both short-Term (<30 day, P < 0.001) and long-Term (>30 day, P < 0.001). Undergoing HA-LDN was associated with a higher rate of an incisional hernia compared with all other modalities (P < 0.001). For recipients, LDN seemed to be associated with lower rates of graft failure at 1 year compared with ODN (P = 0.002). The odds of delayed graft function increased for kidneys with multiple arteries procured via P-LDN compared with HA-LDN (OR 3 [1,10]) and ODN (OR 5 [2, 15]). Conclusions In our experience, LDN was associated with decreased donor intraoperative complications and hospital length of stay but higher rates of readmission and long-Term complications.
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U2 - 10.1097/TP.0000000000001251
DO - 10.1097/TP.0000000000001251
M3 - Article
C2 - 27136265
AN - SCOPUS:84964703107
SN - 0041-1337
VL - 100
SP - 1299
EP - 1305
JO - Transplantation
JF - Transplantation
IS - 6
ER -