Transplant

Aims: Live kidney donation, introduced to increase the transplant rate, has been limited by the disincentives associated with open nephrectomy. Laparoscopic procedures have been developed but it is unclear whether these confer benefits on the donor without compromising the allografted kidney. This study presents the first prospective randomised trial addressing this question. Methods: Seventy-eight live kidney donors were randomised (2 : 1 ratio) to laparoscopic (LDN, n = 52) or minimal incision open donor nephrectomy (ODN, n = 26). Postoperative analgesia was by patient-controlled analgesia and respiratory function was measured by overnight pulse oximetry. Return to normal activities was recorded in patient diaries. Recipient outcome and allograft function were compared. Results: There was no mortality, allograft thrombosis or delayed graft function in either group. LDN led to reductions in length of stay (4 versus 5·5 days, P < 0·01), parenteral morphine requirements (71 ± 32 versus 114 ± 77 mg, P < 0·01) and return to normal activities including employment (6 ± 3 versus 11 ± 6 weeks, P < 0·02). The LDN group had improved postoperative respiratory function (% time < 95% O2 saturation 6 ± 8 versus 23 ± 22, P < 0·001). One LDN required conversion to open operation. There were no differences in donor complication rates. LDN operation time was longer (185 ± 40 versus 135 ± 25 minutes, P < 0·05) but recipient transplant outcome was equivalent (mean 1 year creatinine 130 μmol/l in both groups). Conclusions: LDN removes disincentives to live kidney donation without compromising the transplanted kidney. This is the first high-level evidence to suggest that LDN should be the procedure of choice for live kidney donation. Transplant 7357