CURRENT ISSUES IN LIVING DONOR NEPHRECTOMY

Of 96 consecutive renal transplants in 2 years, 50 (52%) were living d onor grafts. Donor demographics, treatment plans, length of stay CLOS) , charges, and complications were reviewed. Donors included 27 women a nd 23 men aged 22 to 61 (mean 42.2) years; 33 were living related and 17 living unrelated donors. Racial distribution included 1 Hispanic, 2 Asian, 8 black, and 39 white donors. Pretransplant evaluation defined renal anatomy and function (minimal creatinine clearance 75 cc/min). Hospital admission occurred the morning of donation. Nephrectomy under general anesthesia entailed an anterior flank, extra-retroperitoneal approach (no rib resection); and postoperative epidural pain control w as standard. Progressive early ambulation and pulmonary self-care opti mized recovery. The 50 donors were hospitalized for 2 (n=7), 3 (n=18), 4 (n=15), 5 (n=6), and 6-8 (n=4) days (mean LOS: 3.74 +/- 0.17, range 2-8 days). The mean charge for donor hospitalization was $15,415 +/- $397 (range $10,808-$29,579). One major intraoperative hemorrhage requ ired transfusion; 1 patient was readmitted for wound drainage and pneu monia treated medically. While 40 of 50 patients (80%) were hospitaliz ed for 4 days or less, there was no readmission because of short hospi tal stay. One early graft loss (3 days) occurred from technical proble ms; all others gained excellent life sustaining function. Three additi onal kidneys failed from rejection, noncompliance, and systemic coagul opathy. One recipient died at 8 months (CVA) with normal renal functio n. Current strategies for successful living kidney donation are thorou gh patient and family education, ambulatory preoperative testing, morn ing of surgery admission, and discharge planning beginning before hosp italization. Excellent outcomes may be accompanied by a brief LOS, epi dural pain management, and liberal use of willing and healthy related and unrelated living donors.