Comparative and prospective analysis of three different approaches for live-donor nephrectomy
PURPOSE: Living donor nephrectomy is usually performed by a retroperitoneal flank incision. Due to the significant morbidity and long recovery time for a flank incision, anterior extra peritoneal sub-costal and transperitoneal video-laparoscopic methods have been described for donor nephrectomy. We prospectively compare the long-term results of donors as well as functional recipients submitted to these three approaches. MATERIALS AND METHODS: A total of 107 live donor renal transplantations were prospectively evaluated from May 2001 to January 2004. Donors were compared with regard to operative and warm ischemia time, postoperative pain, analgesic requirements, and complications. Recipients were compared with regard to graft function, acute cellular rejection, surgical complications, and graft and recipient survival. RESULTS: The mean operative and warm ischemia times were longer in the video-laparoscopic group (p<0.001), whereas patients of the flank incision group presented more postoperative pain (p=0.035), required more analgesics (p<0.001), had longer hospital stays (p<0.001), and suffered more pain on the 90th day after surgery (p=0.006). In the sub-costal and flank incision groups, there was a larger number of paraesthesias and abdominal wall asymmetries (p<0.001). Recipient groups were demographically comparable and presented similar acute tubular necrosis incidence and delayed graft function. The incidence of acute cellular rejection was higher in the video-laparoscopic and flank incision groups (p=0.013). There was no difference in serum creatinine levels, surgical complications, or recipient or graft survival between groups. CONCLUSIONS: The video-laparoscopic and sub-costal approaches proved to be safe, and to provide donor advantages relative to the flank incision approach. Among recipients, the complication rate, graft survival, and recipient survival were similar in all groups.
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Faculdade de Medicina / USP
2009
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oai:scielo:S1807-593220090001000052009-06-18Comparative and prospective analysis of three different approaches for live-donor nephrectomyMitre,Anuar IbrahimDénes,Francisco T.Nahas,William CarlosSimões,Fabiano A.Colombo Jr.,José RobertoPiovesan,Affonso C.Chambô,José L.Arap,SamiSrougi,Miguel Donor nephrectomy Kidney transplantation Laparoscopy Surgical approaches Outcomes PURPOSE: Living donor nephrectomy is usually performed by a retroperitoneal flank incision. Due to the significant morbidity and long recovery time for a flank incision, anterior extra peritoneal sub-costal and transperitoneal video-laparoscopic methods have been described for donor nephrectomy. We prospectively compare the long-term results of donors as well as functional recipients submitted to these three approaches. MATERIALS AND METHODS: A total of 107 live donor renal transplantations were prospectively evaluated from May 2001 to January 2004. Donors were compared with regard to operative and warm ischemia time, postoperative pain, analgesic requirements, and complications. Recipients were compared with regard to graft function, acute cellular rejection, surgical complications, and graft and recipient survival. RESULTS: The mean operative and warm ischemia times were longer in the video-laparoscopic group (p<0.001), whereas patients of the flank incision group presented more postoperative pain (p=0.035), required more analgesics (p<0.001), had longer hospital stays (p<0.001), and suffered more pain on the 90th day after surgery (p=0.006). In the sub-costal and flank incision groups, there was a larger number of paraesthesias and abdominal wall asymmetries (p<0.001). Recipient groups were demographically comparable and presented similar acute tubular necrosis incidence and delayed graft function. The incidence of acute cellular rejection was higher in the video-laparoscopic and flank incision groups (p=0.013). There was no difference in serum creatinine levels, surgical complications, or recipient or graft survival between groups. CONCLUSIONS: The video-laparoscopic and sub-costal approaches proved to be safe, and to provide donor advantages relative to the flank incision approach. Among recipients, the complication rate, graft survival, and recipient survival were similar in all groups.info:eu-repo/semantics/openAccessFaculdade de Medicina / USPClinics v.64 n.1 20092009-01-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322009000100005en10.1590/S1807-59322009000100005 |
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Mitre,Anuar Ibrahim Dénes,Francisco T. Nahas,William Carlos Simões,Fabiano A. Colombo Jr.,José Roberto Piovesan,Affonso C. Chambô,José L. Arap,Sami Srougi,Miguel |
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Mitre,Anuar Ibrahim Dénes,Francisco T. Nahas,William Carlos Simões,Fabiano A. Colombo Jr.,José Roberto Piovesan,Affonso C. Chambô,José L. Arap,Sami Srougi,Miguel Comparative and prospective analysis of three different approaches for live-donor nephrectomy |
author_facet |
Mitre,Anuar Ibrahim Dénes,Francisco T. Nahas,William Carlos Simões,Fabiano A. Colombo Jr.,José Roberto Piovesan,Affonso C. Chambô,José L. Arap,Sami Srougi,Miguel |
author_sort |
Mitre,Anuar Ibrahim |
title |
Comparative and prospective analysis of three different approaches for live-donor nephrectomy |
title_short |
Comparative and prospective analysis of three different approaches for live-donor nephrectomy |
title_full |
Comparative and prospective analysis of three different approaches for live-donor nephrectomy |
title_fullStr |
Comparative and prospective analysis of three different approaches for live-donor nephrectomy |
title_full_unstemmed |
Comparative and prospective analysis of three different approaches for live-donor nephrectomy |
title_sort |
comparative and prospective analysis of three different approaches for live-donor nephrectomy |
description |
PURPOSE: Living donor nephrectomy is usually performed by a retroperitoneal flank incision. Due to the significant morbidity and long recovery time for a flank incision, anterior extra peritoneal sub-costal and transperitoneal video-laparoscopic methods have been described for donor nephrectomy. We prospectively compare the long-term results of donors as well as functional recipients submitted to these three approaches. MATERIALS AND METHODS: A total of 107 live donor renal transplantations were prospectively evaluated from May 2001 to January 2004. Donors were compared with regard to operative and warm ischemia time, postoperative pain, analgesic requirements, and complications. Recipients were compared with regard to graft function, acute cellular rejection, surgical complications, and graft and recipient survival. RESULTS: The mean operative and warm ischemia times were longer in the video-laparoscopic group (p<0.001), whereas patients of the flank incision group presented more postoperative pain (p=0.035), required more analgesics (p<0.001), had longer hospital stays (p<0.001), and suffered more pain on the 90th day after surgery (p=0.006). In the sub-costal and flank incision groups, there was a larger number of paraesthesias and abdominal wall asymmetries (p<0.001). Recipient groups were demographically comparable and presented similar acute tubular necrosis incidence and delayed graft function. The incidence of acute cellular rejection was higher in the video-laparoscopic and flank incision groups (p=0.013). There was no difference in serum creatinine levels, surgical complications, or recipient or graft survival between groups. CONCLUSIONS: The video-laparoscopic and sub-costal approaches proved to be safe, and to provide donor advantages relative to the flank incision approach. Among recipients, the complication rate, graft survival, and recipient survival were similar in all groups. |
publisher |
Faculdade de Medicina / USP |
publishDate |
2009 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322009000100005 |
work_keys_str_mv |
AT mitreanuaribrahim comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy AT denesfranciscot comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy AT nahaswilliamcarlos comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy AT simoesfabianoa comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy AT colombojrjoseroberto comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy AT piovesanaffonsoc comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy AT chambojosel comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy AT arapsami comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy AT srougimiguel comparativeandprospectiveanalysisofthreedifferentapproachesforlivedonornephrectomy |
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