Open AccessDoes the Side Matter? A Retrospective Cohort Study Comparing Left and Right Pure Laparoscopic Donor Nephrectomies
Author(s) -
Philip Zeuschner,
Michael Stöckle,
Robert W. Peters,
Kurt Miller,
Lutz Liefeldt,
Fabian Halleck,
Klemens Budde,
L. Hennig,
Frank Friedersdorff
Publication year - 2021
Publication title -
urologia internationalis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.771
H-Index - 53
eISSN - 1423-0399
pISSN - 0042-1138
DOI - 10.1159/000517882
Subject(s) - medicine , surgery , nephrectomy , retrospective cohort study , renal function , kidney , kidney transplantation , laparoscopy , urology , transplantation
Objectives: Right laparoscopic donor nephrectomy (RLDN) is no longer regarded inferior to left LDN (LLDN). However, this knowledge is based on many studies suffering from inherent learning curves, center-specific imbalances, and different laparoscopic techniques. Methods: Pure LDNs at a high-volume referral center from 2011 to 2016 were retrospectively analyzed. Patient, graft characteristics, outcomes of LDNs, and corresponding open kidney transplantations were compared between LLDN and RLDN including a follow-up. Results: 160 (78.4%) LLDNs and 44 (21.6%) RLDNs only differed regarding graft characteristics, as more right grafts had multiple veins (34.1 vs. 6.9%, p < 0.001) and worse scintigraphic function (44 vs. 51%, p < 0.001). RLDNs were shorter (201 vs. 220 min, p = 0.032) with longer warm ischemia time (165 vs. 140 s, p < 0.001), but left grafts were transplanted faster (160 vs. 171 min, p = 0.048). Recipients of right kidneys had more postoperative complications (grade 3: 25.6 vs. 11.3%, p = 0.020). At a follow-up of 45 (range 6–79) months, neither the kidney function, nor death-censored graft (5-year: LLDN 89 vs. 92%, p = 0.969) and patient survival (5-year: LLDN 95 vs. 98%, p = 0.747) differed. Conclusions: Pure LLDN and RLDN can have different outcomes at high-volume centers, especially higher complications for recipients of right grafts. However, long-term function and graft survival are the same irrespective of the chosen side.