Complications and Ethics of Living Donor Kidney Procurement

In the Johns Hopkins laparoscopic donor nephrectomy experience, donor morbidity has been acceptable. In the first 171 living donor nephrectomies, complications related to the operation were seen in 25 patients (14.6%). These included 3 (1.8%) open conversions, 1 (0.6%) reoperation, 6 (3.5%) blood transfusions, 5 (2.9%) wound infections, 7 (4.1%) transient thigh paresthesias, 1 (0.6%) incisional hernia, 1 (0.6%) pneumonia, and 1 (0.6%) bowel injury. This is comparable to the open procedure. Waples et al. (Urology 1995;45:207-209) reported an overall complication rate of 17% in a retrospective 20-year review of 681 open donor nephrectomy patients. In a recent study by Johnson et al. (Transplantation 1997;64:1124-1128), an overall complication rate of 8.2% was noted in 871 open donor nephrectomies. Of note, complications that are not uncommon with the open donor operation, such as pneumothorax, incisional hernia, and chronic wound pain or discomfort, are virtually nonexistent with the laparoscopic operation. Of more importance, to our knowledge, there has been no associated laparoscopic donor nephrectomy mortality in any of centers currently performing laparoscopic live donor nephrectomies.

Of comparable importance to the safety of the donor is that the recipient outcome, graft survival, and cost are at least comparable. No significant differences were observed in patient or graft survival; incidence of technical complications (ureteral or vascular); incidence, timing, or severity of rejection episodes; need for dialysis; hospital stay; or long-term creatinine clearance between recipients of open versus laparoscopically procured kidneys. As with complications in the laparoscopic donor nephrectomy, the recipient ureteral and vascular complications generally occurred early and appeared to be a function of the learning curve. Of timely interest in the current cost-conscious health care environment, there was no overall difference in total hospital charges between these two groups either. In addition, the complication rates and readmission rates were lower for the laparo-scopic compared to the open procedures.

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