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August 2002

Early and Late Recipient Graft Function and Donor Outcome After Laparoscopic vs Open Adult Live Donor Nephrectomy for Pediatric Renal Transplantation

Author Affiliations

From the Departments of Surgery (Drs Troppmann, Pierce, McVicar, Wolfe, and Perez and Mr Wiesmann) and Pediatrics (Drs Butani and Makker), University of California, Davis, Medical Center, Sacramento.

Arch Surg. 2002;137(8):908-916. doi:10.1001/archsurg.137.8.908

Background  Laparoscopically procured live donor kidney grafts are increasingly transplanted into pediatric recipients. The safety and efficacy of this changed surgical practice are unknown.

Hypothesis  Outcomes of laparoscopic vs open donor grafts in recipients 18 years and younger are equivalent.

Design and Setting  Retrospective review at an academic tertiary care referral center.

Patients  Eleven consecutive pediatric recipients of laparoscopically procured kidneys between April 1, 1997, and December 31, 2001, were pair matched for age with 11 recipients of openly procured kidneys between December 1, 1991, and March 31, 1997; the 22 adult donors were also studied.

Main Outcome Measures  Recipients: surgical complications, graft function and survival. Donors: perioperative morbidity and length of hospital stay.

Results  Twenty (91%) of 22 kidneys were donated by a parent of the recipient. In recipients of laparoscopically procured grafts, we observed significantly lower creatinine clearances and higher creatinine levels on days 1, 4, and 6, but by 1 month, graft function was similar in both groups. No significant differences in surgical complications, delayed function, acute and chronic rejection, and graft survival rates were found. No laparoscopic or open donor required blood transfusion, reoperation, or hospital readmission. One laparoscopic donor (9%) was converted to open nephrectomy. For laparoscopic vs open donors, median operative time was longer (difference, 67 min; P = .08), but median postoperative length of stay was significantly shorter (3 vs 5 days; P = .02).

Conclusions  Laparoscopic live donor nephrectomy has no adverse impact on pediatric recipient outcomes. For donors, the laparoscopic operation is safe and the hospital stay is shortened. These results support the continued use of laparoscopically procured live donor kidneys in pediatric renal transplantation.