Artikel
Results of laparoscopic live donor nephrectomy (LLDN) in extended criteria donors
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Autoren
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Matthias Biebl
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Thomas Ratschiller
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Annemarie Weissenbacher
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Robert Öllinger
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Claudia Bösmüller
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Robert Sucher
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Rupert Oberhuber
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Johann Pratschke
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Walter Mark
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
| Veröffentlicht: | 20. Mai 2011 |
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Gliederung
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Introduction: To asses safety of LLDN and post-transplant graft function of kidneys from extended criteria donors.
Materials and methods: Retrospective review of all LLDN between 03/2004 and 10/2009. Side of nephrectomy was determined by renal function and vascular anatomy. Extended criteria donors were defined as body mass index (BMI)>30, age>60 and/or multiple renal arteries. Results are reported as mean ± standard deviation or total number (%). Outcomes of the marginal donor group (study group SG) are compared with all other live donors (control group CG) using chi2- and Mann-Whitney U tests. Significance was assumed for p<0.05.
Results: Of 82 LLDN patients, 18 (22.0%) were marginal donors (50.0% female, mean age 56.5±9.3 years). Although within normal ranges, preoperative serum urea (SG 32.3±8.8 mg/dl vs CG 27.7±8.2 mg/dl; p=0.037) and C-reactive protein levels (SG 0.35±0.38 mg/dl vs CG 0.23±0.30; p= 0.018) were higher in extended criteria donors. Operation time was 211.5±47.1 min (vs CG 186.0±47.8 min; p=0.109), warm ischemia time 1.93±0.7 min (vs CG 1.6±0.7; p=0.074). LLDN was successful in all cases, however, in three patients (16.7%) undergoing left LLDN, open transsection of the vessels was required through a left flank incision (corresponding to the technique for right LLDN) due to retroperitoneal adipositas (n=1) or adhesions (n=2). Mean hospital stay was 11.8±3.5 days (vs CG 10.6±3.3 days; p=0.141), highest C-reactive protein levels 13.6±7.6 mg/dl (vs CG 8.5±5.6; p= 0.018. Complications occurred in 27.8% (CG 20.3%; p=0.351). Upon discharge, serum creatinine (1.2±0.26 mg/dl vs CG 1.16±0.23 mg/dl; p=0.181) and serum urea (30.6±10.23 mg/dl vs 27.7±8.5 mg/dl; p=0.290) were in the range of the regular LLDNs.
After a mean follow-up of 13.7±11.2 months, the transplanted extended criteria kidneys had a creatinine of 1.2±0.36 (vs CG 1.2±0.50; p=0.568).
Conclusion: Although a significant proportion of patients in our series qualifiy as “marginal donors” LLDN is feasable and safe. However, adapted surgical technique and careful monitoring of postoperative renal function is mandatory in these patients.
