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Selection Criteria for Kidney Laterality in Retroperitoneoscopic Living Donor Nephrectomy and the Usefulness of Pretransplant Intervention.

Abstract：

OBJECTIVES:To evaluate the selection criteria for kidney laterality and the usefulness of pretransplant intervention in living donor nephrectomy. METHODS:We compared conventional and revised criteria. The conventional criteria were that left kidneys were chosen in preference and provided the kidney with the fewest structural abnormalities and lowest functional decline and that most renal arteries remained in the donor. From April 2013, we allowed the use of left kidneys with double renal arteries. Patient characteristics and surgical outcomes were retrospectively compared between right and left retroperitoneoscopic living donor nephrectomies. RESULTS:We compared data for 30 right kidney and 222 left kidney nephrectomies. Right kidneys were selected because of multiple renal arteries (n = 18), structural abnormalities (n = 10) of the left kidney, or functional decline (n = 2) of the right kidney. Right retroperitoneoscopic nephrectomies were associated with significantly longer operating times (267 minutes vs 241 minutes), larger blood losses (240 g vs 55 g), and higher open conversion rates (10% vs 0.9%). Pretransplant intervention was necessary for structural abnormalities in right kidneys, but the amended selection criteria resulted in fewer right nephrectomies. Pretransplant intervention was still necessary by ex vivo arterial anastomosis for multiple left renal arteries, which increased the total ischemia time (94 minutes vs 64 minutes); however, post-transplantation renal function was not significantly different. CONCLUSIONS:Pretransplant intervention was beneficial both for repairing structural abnormalities and for reducing the difficulties of retroperitoneoscopic living donor nephrectomy.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Nanmoku K,Kurosawa A,Kubo T,Shinzato T,Shimizu T,Kimura T,Yagisawa T

doi

10.1016/j.transproceed.2017.03.022

subject

Has Abstract

pub_date

2017-06-01 00:00:00

pages

924-929

issue

5

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(17)30237-3

journal_volume

49

pub_type

杂志文章

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