Renal function recovery in donors and recipients after live donor nephrectomy: Hand-assisted laparoscopic vs. open procedures

Purpose: Laparoscopic donor nephrectomy is associated with less postoperative pain and faster recovery times in living kidney donors. However, pneumoperitoneum, which is required in laparoscopic donor nephrectomy, can result in adverse effects on renal function in donors and recipients. We compared renal function in donors and recipients after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN). Materials and Methods: Between January 1997 and January 2008, 241 live donor nephrectomies were performed by either HALDN (n=118) or ODN (n=123). Preoperative patient characteristics were not significantly different between the donors and recipients. We monitored the changes in serum creatinine levels of the donors and recipients preoperatively and on postoperative days 1, 5, 28, 84, and 365. Results: The mean operative times of HALDN and ODN were 171 and 163 minutes (p=0.284), and the mean warm ischemic times were 292 and 236 seconds (p=0.207), respectively. The mean serum creatinine level in the recipients on postoperative day 1 was significantly higher after HALDN than after ODN (3.48 vs. 2.62 mg/dl, p=0.003). However, from postoperative day 5 to 1 year, there was no significant difference between the two groups. The mean serum creatinine level in the donors was not significantly different between the HALDN and ODN groups throughout the study period. Conclusions: Renal function recovery in the donors was similar with both HALDN and ODN. Graft renal function recovery after HALDN was comparable with that after ODN, except immediately after surgery (postoperative day 1).