Introduction: Laparoscopic live donor nephrectomy (LLDN), in cases with multiple renal arteries, has not been universally practiced worldwide. This paper demonstrates LLDN experience in donors with multiple arteries and compares the results with single artery donors on a case-matched basis.
Methods: Of 553 LLDN surgeries performed between December 1999 and November 2009, 132 cases were performed for multiple renal arteries. One hundred cases were selected. Detailed demographic profiles, operative profiles, and renal function tests in the immediate postoperative period and up to 1 year post transplantation were recorded. A matched comparison was made with 100 cases of LLDN in single arteries.
Results: Ninety-two cases had double arteries, 7 had triple arteries, and 1 revealed quadruple arteries prior to vascular disconnection. One accidental creation of 5 arterial branches was encountered. Warm ischemia time (WIT), total ischemia time (TIT), operative duration, blood loss, analgesic need, and hospital stay were significantly different between 2 groups (p < 0.05). No significant difference was observed in operative complications, renal function at 5 days, time to normalization of creatinine, or creatinine at 1 month, 3 months, and 1 year. Two patients in multiple artery groups required dialysis in the first postoperative week.
Conclusions: LLDN is equally feasible in the scenario of multiple renal arteries.
George P Abraham, Krishanu Das, Krishnamohan Ramaswami, Datson P George, Jisha J Abraham, Thomas J Tachil, Oppukeril S Thampan
Date Received: September 11, 2011 Accepted on: October 14, 2011
KEYWORDS: Laparoscopy, donor nephrectomy
CORRESPONDENCE: Krishanu Das, MS, MRCS, MCh, FCPS, DNB, Senior Specialist in Urology, Lakeshore Hospital, Kochi, 682030, Kerala, India ().
CITATION: UroToday Int J. 2012 Apr;5(2):art 11. http://dx.doi.org/10.3834/uij.1944-5784.2012.04.11
ACRONYMS AND ABBREVIATIONS
ESRD: end stage renal disease
LLDN: laparoscopic live donor nephrectomy
VCUG: voiding cystourethrogram 3D
CTA: three-dimensional spiral computed tomography angiogram
CTU: computed tomography urogram
GRT: Graft retrieval time (minutes)
WIT: Warm ischemia time (minutes)
GRT25, WIT25: GRT, WIT 25 cases, terminal and assisted approach
GRT75, WIT75: GRT, WIT 75 cases, total laparoscopic approach CIT: cold ischemia time (minutes)
TIT: total ischemia time (minutes) RI= resistive index
AT: acceleration time
BMI: body mass index (kg/m2)
BL: blood loss (milliliters)
HS: hospital stay (days)
OD: operation duration (minutes)
OT: time to tolerance of orals (hours)
A: analgesic need (grams of paracetamol)
CNT: serum creatinine normalisation time (days)
Cr5d, Cr1m, Cr3m, Cr6m, Cr1y: serum creatinine at fifth postoperative day, 1 month, 3 months, 6 months, and 1 year post-transplantation (mg/dl)