Laparoscopy Early Experience of a Living Donor Kidney Transplant Program Antonio Alcaraz a, *, Antonio Rosales a , Lluı ´s Guirado b , Joan M. Dı ´az b , Mireia Musquera a , Humberto Villavicencio a a Department of Urology, Fundacio ´ Puigvert, Barcelona, Spain b Department of Nephrology, Fundacio ´ Puigvert, Barcelona, Spain european urology 50 (2006) 542–548 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted March 17, 2006 Published online ahead of print on March 31, 2006 Keywords: Life-threatening complications Living donor nephrectomy Renal function Abstract Objectives: Laparoscopic nephrectomy has been shown to reduce the morbidity of live donor nephrectomy, but post-transplant kidney func- tion and safety issues with the procedure are still of some concern. The review of our early experience could detect errors that should be avoided in the refining of the technique. Methods: Our first sixty consecutive laparoscopic donor nephrectomies were analyzed retrospectively. Results: There were conversions to open surgery (5%), all three in the first 18 cases. All donors were alive at 1 year with a glomerular filtration rate of 85  21 ml/min (78% of the basal). Patient and graft survival at 1 year was 100% and 95%, respectively. Creatinine nadir was achieved on post- transplant day 3 (creatinine, 176  122 mmol/l). Late renal function proved a continuous improvement until the 2-year follow-up (creatinine, 135  29 mmol/l). Renal function recovery was better in both recipient and donor when the donor was 50 years old, compared with older patients. Transplant complications that required reintervention included one ureteral fistula, one ureteral stenosis and one case of low renal flow that was re-vascularised. Conclusions: Technical surgical aspects such the use of Haemoloc 1 clips in the clipping of the artery, the hand-assisted extraction of the kidney, a refined surgical technique during the transplant and avoidance of pro- longed warm and cold ischemia, taken together with an adequate intraoperative hemodynamic management of the donor aid in avoiding life-threatening complications and achieving a good post-transplant renal function recovery. # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Hospital Clinic – University of Barcelona, Department of Urology, C/ Villarroel, 170, 08036 Barcelona, Spain. Tel. +34 932275545; Fax: +34 932275545. E-mail address: aalcaraz@clinic.ub.es (A. Alcaraz). 0302-2838/$ – see back matter # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2006.03.033