Laparoscopic Donor Nephrectomy: Analysis of Donor and Recipient Outcomes A. Koffron, C. Herman, O. Gross, M. Ferrario, D. Kaufman, M. Abecassis, J. Fryer, F. Stuart, and J. Leventhal L APAROSCOPIC donor nephrectomy (LDN) holds the promise of increasing living donation by providing a less invasive alternative to open donor nephrectomy (ODN). Concerns have been raised regarding the safety of LDN, as well as for the short and long-term function of LDN kidneys. A higher incidence of recipient urologic complications, secondary to intraoperative ureteral trauma, has been reported with LDN organs. 1 MATERIALS AND METHODS Between October 1997 and December 1999 we performed 107 LDN. All donors were evaluated for the presence of two functioning kidneys and an assessment of renal vascular anatomy determined by high- resolution computed tomographic angiography. Operative technique for LDN patients remained constant throughout the series (four laparoscopic ports, left lower abdominal extraction incision), remov- ing the left kidney, and performed by the same transplant surgeon. All ODN were performed through a retroperitoneal flank incision, with- out partial rib resection, harvesting the left kidney. LDN patients were compared to a cohort of patients undergoing ODN at our institution from January 1996 to September 1997. LDN and ODN groups were matched for age, gender, weight, and comorbidity. We compared mean serum creatinine at 1 week and 1 month posttransplant in LDN (n = 101) and ODN recipients (n = 50). In addition, we compared LDN and ODN postoperative intravenous narcotic use, hours to resumption of oral intake, and days of inpatient hospital stay. RESULTS All LDN kidneys demonstrated immediate graft function without the need for recipient posttransplant dialysis. There have been no urologic or vascular complications in any recipient of LDN kidneys. There was no significant difference between LDN and ODN mean serum creatinines at 1 week (1.46  0.2 mg/dL vs 1.31  0.2 mg/dL) or 1 month (1.20  0.1 mg/dL vs 1.22  0.1 mg/dL) posttransplant. Patients undergoing LDN (n = 80) required less postop- erative intravenous narcotic use (17.2 vs 38.3 hours), had earlier resumption of oral intake (8.1 vs 20.9 hours), and experienced a shorter hospital stay (2.1 vs 3.2 days) than those undergoing ODN (n = 50). DISCUSSION There are several concerns with the application of minimally invasive techniques for live renal donation. Patients undergo- ing donor nephrectomy are healthy individuals subjected to a major operation for the benefit of another; therefore, the procedure must be safe. Kidneys removed laparoscopically should provide excellent renal function in recipients, which includes both vascular and urologic components. Previous reports of laparoscopic nephrectomy indicate it is a safe procedure with excellent outcomes. 1–3 Periopera- tive morbidity from LDN has compared favorably with ODN. A higher incidence of urologic complications 4 and delayed graft function in LDN kidneys compared to ODN has been reported. 3 In addition, it has been reported that LDN kidneys have inferior immediate function as deter- mined by mean serum creatinine at 7 and 30 days posttrans- plant points. 3 The data presented here compare favorably with other reports of LDN kidney function in that there were no patients experiencing delayed graft function, and there was no significant difference between LDN and ODN recipient mean serum creatinine at 1 week or 1 month posttransplant. LDN has been associated with significant reductions postoperative morbidity. When we compared LDN and ODN, we found that patients undergoing LDN had significantly reduced use of intravenous analgesics, time to resumption of diet, and hospital stay. We conclude that LDN has several potential advantages for the living kidney donor, including shorter hospital stay while producing excellent initial function, without an increased risk of urologic complication, in transplant recipients. REFERENCES 1. Ratner LE, Kavoussi LR, Sroka M, et al: Transplantation 63:229, 1997 2. Flowers JL, Jacobs SJ, Cho E, et al: Ann Surg 226:483, 1997 3. Noguiera JM, Cangro CB, Fink JC, et al: Transplantation 67:722, 1999 4. Philosophe B, Kuo PC, Schweitzer EJ, et al: Transplantation 68:497, 1999 From the Division of Organ Transplantation, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois. Address reprint requests to Dr A. Koffron, Northwest Memorial Hospital, 675 No St Clair St, Galter Pav, Ste 17-200, Chicago, IL 60611. © 2001 by Elsevier Science Inc. 0041-1345/01/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0041-1345(00)02437-4 Transplantation Proceedings, 33, 1111 (2001) 1111