Anterior-retroperitoneal living donor nephrectomy: Technique and outcomes

Of 133 consecutive renal transplants, 61 (46%) were living donor grafts rec overed in an anterior-retroperitoneal approach. Donor demographics, operati ve-anesthetic care, length of stay (LOS), hospital charges, and complicatio ns were reviewed with donor and recipient follow-up of 4 to 40 months. Dono rs included 35 women and 26 men, ages 22 to 61 years (mean, 42.2); thirty-n ine were living related and 22 were living unrelated donors. Pretransplant evaluation defined renal anatomy and function (minimal creatinine clearance , 75 cc/minute). Hospital admission occurred the morning of donation. Nephr ectomy by the anterior-retroperitoneal approach (no rib resection) was foll owed by postoperative epidural pain control, early resumption of diet, prog ressive ambulation, and aggressive pulmonary care. Operating room time door -to-door averaged 2 hours, 43 minutes (range, 1 hour, 45 minutes-3 hours, 5 5 minutes). Donors were hospitalized for 2 (n = 7), 3 (n = 24), 4 (n = 19), and 5 to 8 (n = 11) days (mean LOS, 3.75; range, 2-8 days). The mean charg e for donor hospitalization was $15,329 (range, $10,808-$29,579). One donor required transfusion; another was readmitted for wound drainage and pneumo nia treated medically. All donors remain well with normal renal function. O ne early graft loss (3 days) occurred from arterial intimal dissection; all others gained life-sustaining function. Recipient (98%) and graft (92%) su rvival was excellent at 4 to 40 months. Anterior-retroperitoneal living don or nephrectomy is safe and effective, permitting hospital LOS of usually <4 days, early recovery, and no lasting complications. Excellent donor and re cipient results from this procedure should compel critical assessment of te chniques requiring more extensive operative exposure or more costly operati ng room and hospital approaches to donor surgical management.