COMPARISON OF OPEN AND LAPAROSCOPIC LIVE DONOR NEPHRECTOMY

Objective This study compares an initial group of patients undergoing laparoscopic live donor nephrectomy to a group of patients undergoing open donor nephrectomy to assess the efficacy, morbidity, and patient recovery after the laparoscopic technique. Summary Background Data Rec ent data have shown the technical feasibility of harvesting live renal allografts using a laparoscopic approach. However, comparison of dono r recovery, morbidity, and short-term graft function to open donor nep hrectomy has not been performed previously. Methods An initial series of patients undergoing laparoscopic live donor nephrectomy were compar ed to historic control subjects undergoing open donor nephrectomy. The groups were matched for age, gender, race, and comorbidity. Graft fun ction, intraoperative variables, and clinical outcome of the two group s were compared. Results Laparoscopic donor nephrectomy was attempted in 70 patients and completed successfully in 94% of cases. Graft survi val was 97% versus 98% (p = 0.6191), and immediate graft function occu rred in 97% versus 100% in the laparoscopic and open groups, respectiv ely (p = 0.4961). Blood loss, length of stay, parenteral narcotic requ irements, resumption of diet, and return to normal activity were signi ficantly less in the laparoscopic group. Mean warm ischemia time was 3 minutes after laparoscopic harvest. Morbidity was 14% in the laparosc opic group and 35% in the open group. There was no mortality in either group. Conclusions Laparoscopic live donor nephrectomy can be perform ed with morbidity and mortality comparable to open donor nephrectomy, with substantial improvements in patient recovery after the laparoscop ic approach. Initial graft survival and function rates are equal to th ose of open donor nephrectomy, but longer follow-up is necessary to co nfirm these observations.