Early and late recipient graft function and donor outcome after laparoscopic vs open adult live donor nephrectomy for pediatric renal transplantation

Christoph Troppmann, Jonathan L. Pierce, Kevin M. Wiesmann, Lavjay Butani, Sudesh P. Makker, John P. McVicar, Bruce Wolfe, Richard V. Perez

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Laparoscopically procured live donor kidney grafts are increasingly transplanted into pediatric recipients. The safety and efficacy of this changed surgical practice are unknown. Hypothesis: Outcomes of laparoscopic vs open donor grafts in recipients 18 years and younger are equivalent. Design and Setting: Retrospective review at an academic tertiary care referral center. Patients: Eleven consecutive pediatric recipients of laparoscopically procured kidneys between April 1, 1997, and December 31, 2001, were pair matched for age with 11 recipients of openly procured kidneys between December 1, 1991, and March 31, 1997; the 22 adult donors were also studied. Main Outcome Measures: Recipients: surgical complications, graft function and survival. Donors: perioperative morbidity and length of hospital stay. Results: Twenty (91%) of 22 kidneys were donated by a parent of the recipient. In recipients of laparoscopically procured grafts, we observed significantly lower creatinine clearances and higher creatinine levels on days 1, 4, and 6, but by 1 month, graft function was similar in both groups. No significant differences in surgical complications, delayed function, acute and chronic rejection, and graft survival rates were found. No laparoscopic or open donor required blood transfusion, reoperation, or hospital readmission. One laparoscopic donor (9%) was converted to open nephrectomy. For laparoscopic vs open donors, median operative time was longer (difference, 67 min; P=.08), but median postoperative length of stay was significantly shorter (3 vs 5 days; P=.02). Conclusions: Laparoscopic live donor nephrectomy has no adverse impact on pediatric recipient outcomes. For donors, the laparoscopic operation is safe and the hospital stay is shortened. These results support the continued use of laparoscopically procured live donor kidneys in pediatric renal transplantation.

Original languageEnglish (US)
Pages (from-to)908-916
Number of pages9
JournalArchives of Surgery
Volume137
Issue number8
StatePublished - 2002
Externally publishedYes

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Nephrectomy
Kidney Transplantation
Tissue Donors
Pediatrics
Transplants
Length of Stay
Kidney
Graft Survival
Tertiary Care Centers
Creatinine
Patient Readmission
Operative Time
Reoperation
Blood Transfusion
Survival Rate
Outcome Assessment (Health Care)
Morbidity
Safety

ASJC Scopus subject areas

  • Surgery

Cite this

Troppmann, C., Pierce, J. L., Wiesmann, K. M., Butani, L., Makker, S. P., McVicar, J. P., ... Perez, R. V. (2002). Early and late recipient graft function and donor outcome after laparoscopic vs open adult live donor nephrectomy for pediatric renal transplantation. Archives of Surgery, 137(8), 908-916.

Early and late recipient graft function and donor outcome after laparoscopic vs open adult live donor nephrectomy for pediatric renal transplantation. / Troppmann, Christoph; Pierce, Jonathan L.; Wiesmann, Kevin M.; Butani, Lavjay; Makker, Sudesh P.; McVicar, John P.; Wolfe, Bruce; Perez, Richard V.

In: Archives of Surgery, Vol. 137, No. 8, 2002, p. 908-916.

Research output: Contribution to journalArticle

Troppmann, C, Pierce, JL, Wiesmann, KM, Butani, L, Makker, SP, McVicar, JP, Wolfe, B & Perez, RV 2002, 'Early and late recipient graft function and donor outcome after laparoscopic vs open adult live donor nephrectomy for pediatric renal transplantation', Archives of Surgery, vol. 137, no. 8, pp. 908-916.
Troppmann, Christoph ; Pierce, Jonathan L. ; Wiesmann, Kevin M. ; Butani, Lavjay ; Makker, Sudesh P. ; McVicar, John P. ; Wolfe, Bruce ; Perez, Richard V. / Early and late recipient graft function and donor outcome after laparoscopic vs open adult live donor nephrectomy for pediatric renal transplantation. In: Archives of Surgery. 2002 ; Vol. 137, No. 8. pp. 908-916.
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abstract = "Background: Laparoscopically procured live donor kidney grafts are increasingly transplanted into pediatric recipients. The safety and efficacy of this changed surgical practice are unknown. Hypothesis: Outcomes of laparoscopic vs open donor grafts in recipients 18 years and younger are equivalent. Design and Setting: Retrospective review at an academic tertiary care referral center. Patients: Eleven consecutive pediatric recipients of laparoscopically procured kidneys between April 1, 1997, and December 31, 2001, were pair matched for age with 11 recipients of openly procured kidneys between December 1, 1991, and March 31, 1997; the 22 adult donors were also studied. Main Outcome Measures: Recipients: surgical complications, graft function and survival. Donors: perioperative morbidity and length of hospital stay. Results: Twenty (91{\%}) of 22 kidneys were donated by a parent of the recipient. In recipients of laparoscopically procured grafts, we observed significantly lower creatinine clearances and higher creatinine levels on days 1, 4, and 6, but by 1 month, graft function was similar in both groups. No significant differences in surgical complications, delayed function, acute and chronic rejection, and graft survival rates were found. No laparoscopic or open donor required blood transfusion, reoperation, or hospital readmission. One laparoscopic donor (9{\%}) was converted to open nephrectomy. For laparoscopic vs open donors, median operative time was longer (difference, 67 min; P=.08), but median postoperative length of stay was significantly shorter (3 vs 5 days; P=.02). Conclusions: Laparoscopic live donor nephrectomy has no adverse impact on pediatric recipient outcomes. For donors, the laparoscopic operation is safe and the hospital stay is shortened. These results support the continued use of laparoscopically procured live donor kidneys in pediatric renal transplantation.",
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AU - Pierce, Jonathan L.

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AU - Butani, Lavjay

AU - Makker, Sudesh P.

AU - McVicar, John P.

AU - Wolfe, Bruce

AU - Perez, Richard V.

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N2 - Background: Laparoscopically procured live donor kidney grafts are increasingly transplanted into pediatric recipients. The safety and efficacy of this changed surgical practice are unknown. Hypothesis: Outcomes of laparoscopic vs open donor grafts in recipients 18 years and younger are equivalent. Design and Setting: Retrospective review at an academic tertiary care referral center. Patients: Eleven consecutive pediatric recipients of laparoscopically procured kidneys between April 1, 1997, and December 31, 2001, were pair matched for age with 11 recipients of openly procured kidneys between December 1, 1991, and March 31, 1997; the 22 adult donors were also studied. Main Outcome Measures: Recipients: surgical complications, graft function and survival. Donors: perioperative morbidity and length of hospital stay. Results: Twenty (91%) of 22 kidneys were donated by a parent of the recipient. In recipients of laparoscopically procured grafts, we observed significantly lower creatinine clearances and higher creatinine levels on days 1, 4, and 6, but by 1 month, graft function was similar in both groups. No significant differences in surgical complications, delayed function, acute and chronic rejection, and graft survival rates were found. No laparoscopic or open donor required blood transfusion, reoperation, or hospital readmission. One laparoscopic donor (9%) was converted to open nephrectomy. For laparoscopic vs open donors, median operative time was longer (difference, 67 min; P=.08), but median postoperative length of stay was significantly shorter (3 vs 5 days; P=.02). Conclusions: Laparoscopic live donor nephrectomy has no adverse impact on pediatric recipient outcomes. For donors, the laparoscopic operation is safe and the hospital stay is shortened. These results support the continued use of laparoscopically procured live donor kidneys in pediatric renal transplantation.

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