Category: Laparoscopic/ Robotic: Other

MP17-15 - Comparative Analysis of Donor and Recipient Outcomes of Laparoscopic vs. Open Donor Nephrectomy for Allografts with Multiple Renal Vessels

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Laparoscopic nephrectomy is the preferred method of kidney procurement among living donors.  However, many hesitate to apply this to kidneys with multiple vessels because of the surgical complexity and the potential risks to the donor and the allograft. We compared the donor and recipient outcomes between laparoscopic (LDN) and open donor nephrectomy  (ODN) in kidneys with multiple renal vessels.


Methods :

A retrospective chart review was done on all living donor nephrectomies with multiple renal vessels performed at the National Kidney and Transplant Institute, Philippines from January 2006 to December 2015. Donor and recipient demographic data, operative time, length of hospital stay, estimated blood loss, pre- and post-operative creatinine (1 day, 1 week, 1 month, 1 year), delayed graft function, morbidity and mortality were analyzed. 


Results :

A total of 257 living donors with multiple renal vessels, 118 LDN and 139 ODN were included in the study.  Demographics show that there was no statistically significant difference in mean age in LDN 29.5 (18-66) vs. ODN 32.4 (19-53) and male to female ratio in LDN 1.8:1 vs ODN 1.5:1. More left kidneys were removed via LDN (103 left: 15 right) and more right kidneys were removed via ODN (38 left: 101 right) with surgeons prefering the laparoscopic method for the longer left renal vein.  There was no significant difference in 2-vessel anomalies in LDN 107/118(91%) vs. ODN 124/139(89%), 3-vessel anomalies in LDN 10/118(8%) vs. ODN 15/139(11%), and 4-vessel anomalies in LDN 1/118(1%) vs. ODN 0/139(0%). There was no significant difference between the two groups with regard to operative time (minutes) LDN (191.46±39.98) vs. ODN (182.37±40.39), warm ischemia time (minutes) in LDN (4.65±3.26) vs. ODN (5.53±4.49), delayed graft function in LDN 3/118(2%) vs. ODN 4/139(3%), mean donor and recipient post-operative creatinine (1 week, 1 month and 1 year), and the incidence of major complications. There were no conversions from laparoscopy to open and no mortality in either groups. There was significantly shorter length of hospital stay (days) in LDN (3.41±0.83) vs. ODN (3.76±1.16), less blood loss (ml.) in LDN (138.73±156.91) vs. ODN (232.87±199.88) and lower incidence of post-operative fever  in LDN 32/118(27%) vs. ODN 65/139(47%). 


Conclusions :

When applied to kidneys with multiple vessels, LDN achieves equivalent one-year recipient outcomes to ODN.  However, LDN affords superior benefits to the donor inclusive of a shorter hospital stay, less blood loss and lower morbidity rates. 

Dinno Francis A. Mendiola

Medical Officer III
Department of Urology, National Kidney and Transplant Institute, Philippines
Quezon City, National Capital Region, Philippines

Dr. Dinno Francis Mendiola is a 3rd year Urology Resident at the National Kidney and Transplant Institute. He is a budding young urologist with heavy interest in endourology.

Ernesto L. Gerial

Consultant
Department of Urology, National Kidney and Transplant Institute
Quezon City, National Capital Region, Philippines

Jose Benito A. Abraham

Consultant
Department of Urology, National Kidney and Transplant Institute
Quezon City, National Capital Region, Philippines