Evolution of Living Donor Nephrectomy at a Single Center

Long-Term Outcomes with 4 Different Techniques in Greater Than 4000 Donors over 50 Years

Oscar Kenneth Serrano, Varvara Kirchner, Ananta Bangdiwala, David M. Vock, T. B. Dunn, Erik B. Finger, William D. Payne, Timothy L. Pruett, David E R Sutherland, John S. Najarian, Arthur J. Matas, Raja Kandaswamy

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1299-1305
Number of pages7
JournalTransplantation
Volume100
Issue number6
DOIs
StatePublished - Jun 1 2016

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Living Donors
Nephrectomy
Tissue Donors
Hand
Length of Stay
Delayed Graft Function
Intraoperative Complications
Arteries
Transplants
Kidney

Cite this

@article{695a3a6b4fb54940b033cc61e9ed0fd2,
title = "Evolution of Living Donor Nephrectomy at a Single Center: Long-Term Outcomes with 4 Different Techniques in Greater Than 4000 Donors over 50 Years",
abstract = "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.",
author = "Serrano, {Oscar Kenneth} and Varvara Kirchner and Ananta Bangdiwala and Vock, {David M.} and Dunn, {T. B.} and Finger, {Erik B.} and Payne, {William D.} and Pruett, {Timothy L.} and Sutherland, {David E R} and Najarian, {John S.} and Matas, {Arthur J.} and Raja Kandaswamy",
year = "2016",
month = "6",
day = "1",
doi = "10.1097/TP.0000000000001251",
language = "English (US)",
volume = "100",
pages = "1299--1305",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

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

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

VL - 100

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EP - 1305

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JF - Transplantation

SN - 0041-1337

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