Current Status Of Laparoscopic Approach

It has long been documented that grafts from living kidney donors show superior function and survival when compared to those from cadaver donors. Open donor nephrec-tomy has been performed successfully for nearly five decades with low rates of complications and graft loss. Donor nephrectomy is a unique surgery because the outcomes and complications affect both the donor and the recipient. Mis-steps that occur during the harvest may ultimately affect the donor and graft function. The initial laparoscopic experience did not meet the standards of the traditional open surgery technique. The University of Maryland and Johns Hopkins demonstrated an overall complication rate of 14.3% and 17%, respectively (9,75). The most common areas of initial concern, such as ureteral injury, vascular injury, and warm ischemia time, have diminished but not completely disappeared, with increased surgical experience.

Laparoscopic donor grafts have been shown over the short term to function as well as open donor grafts (10,115). Many centers have demonstrated good short-term follow-up of graft survival in kidneys procured with the laparoscopic techniques. Montgomery and coworkers report 94% graft function at five years (115). The jury is still out as regards how long these grafts will function. Living donation is a personal sacrifice for the donor. Therefore, every effort should be made to maximize long-term graft survival. In a large series of living donors from the University of Minnesota, risk factors for worse long-term recipient graft survival included pretransplant smoking, pretrans-plant peripheral vascular disease, pretransplant dialysis for more than one year, acute rejection episodes, and donor age over than 50 (116). Out of respect to the donor, detrimental factors in the recipient should be modified as much as possible.

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