Laparoscopic donor nephrectomy: Impact on an established renal transplant program

The current disparity of viable organs and patients in need of a transplant has been an impetus for innovative measures. Live donor renal transplantat ion offers significant advantages compared with cadaveric donor transplanta tion: increased graft and patient survival, diminution in incidence of dela yed graft function, acute tubular necrosis (ATN), and reduction in waiting time. Notwithstanding these gains live donors continue to be underutilized and account for only approximately one quarter of all renal transplants per formed in the United States. It has been felt that inherent disincentives t o live donation have slowed its growth. These include degree and duration o f postoperative pain and convalescence, child care concerns, cosmetic conce rns, and time until return to full activities and employment. In an attempt to curtail the disincentives to live donation, laparoscopic live donation (laparoscopic donor nephrectomy; LDN) was developed. The purpose of this st udy was to compare the results of our first 25 laparoscopic nephrectomies ( performed over a 10-month period from September 1998 through July 1999) wit h the previous 25 standard open donor nephrectomies (ODNs) completed over t he past 3 years. We conducted a retrospective review of all donor nephrecto mies and recipient pairs performed over the past 3 years. End points includ ed sex, operative time, length of stay, immediate and long-term renal funct ion, and willingness to donate. There were no differences in demographics o f the ODN versus the LDN group. The average length of stay was 2.48 +/- 0.7 2 days for the LDN vel sus 4.08 +/- 0.28 days for the ODN. ODN and LDN have comparable short- and long-term function with no delayed graft function an d no complications. Growth of living donor transplant has increased from 16 per cent of all kidney transplants performed in 1995 to 23 per cent in 199 9. We conclude that LDN is a viable alternative to the standard donor opera tion. LDN has had a positive impact on the donor pool by minimizing disince ntives to live donation. With the initiation of our laparoscopic program th e number of LDNs has increased. Presently the live donor pool is the most v iable alternative to significantly increase the number of kidneys for trans plantation.