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Laparoscopic Live Donor Nephrectomy: A Risk Factor for Delayed Function and Rejection in Pediatric Kidney Recipients? A UNOS Analysis
Author(s) -
Troppmann Christoph,
McBride Maureen A.,
Baker Timothy J.,
Perez Richard V.
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00661.x
Subject(s) - medicine , nephrectomy , dialysis , surgery , multivariate analysis , renal function , retrospective cohort study , kidney transplantation , risk factor , urology , kidney , transplantation
The impact of laparoscopic (vs. open) donor nephrectomy on early graft function and survival in pediatric kidney recipients (≤18 years) is unknown.We studied 995 pediatric live donor txs reported to UNOS from January 2000 to June 2002, in two recipient age groups: 0–5 years (n = 212, 44% laparoscopic donors [LapD]) and 6–18 years (n = 783, 50% LapD).Delayed graft function (DGF) rates were higher for LapD versus open donor (OpD) txs (0–5 years, 12.8% vs. 2.5%[p = 0.004]; 6–18 years, 5.9% vs. 2.8%[p = 0.03]). Acute rejection incidence for LapD versus OpD txs was higher at 6 months for recipients 0–5 years (18.6% vs. 5.9%, p = 0.01) and 6–18 years (22.5% vs. 15.6%, p = 0.03), and 1 year for recipients 0–5 years (24.3% vs. 7.9%, p = 0.004). In multivariate analyses, significant independent risk factors for rejection at 6 months and 1 year were recipient age 6–18 years, pretx dialysis, LapD nephrectomy and DGF. Graft survival was similar for LapD versus OpD txs.In this retrospective UNOS database analysis, LapD procurement was associated with increased DGF and an independent risk factor for rejection during the first year, particularly for recipients 0–5‐years old. Future investigations must confirm these findings and identify strategies to optimize procurement and pediatric recipient outcome.