Journal List > Korean J Urol > v.50(3) > 1005293

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Oh, Kwon, Yoo, and Kwon: Ureteral Complications of the Transplanted Kidney after Hand-Assisted Laparoscopic Donor Nephrectomy: Comparison with Open Procedure
Original Article

Korean J Urol 2009;50(3):256-260.

Published online: 19 March 2009

DOI: https://doi.org/10.4111/kju.2009.50.3.256

Ureteral Complications of the Transplanted Kidney after Hand-Assisted Laparoscopic Donor Nephrectomy: Comparison with Open Procedure

Woo Seok Oh, Joon Beom Kwon, Eun Sang Yoo, Tae Gyun Kwon

From the Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea

Correspondence to: Tae Gyun Kwon Department of Urology, Kyungpook National University Hospital, 200, Dongduk-ro, Jung-gu, Daegu 700-721, Korea TEL: 053-420-5841 FAX: 053-421-9618 E-mail: tgkwon@knu.ac.kr

Received 13 October 2008       Accepted 17 December 2008

Copyright © 2009 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We compared recipients’ ureteral complications after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN).

Materials and Methods

Between January 1999 and September 2006, a total of 166 transplantaions were underwent via a HALDN or ODN. Kidney transplantation was performed in a standard fashion and ureteroneocystostomy was done by extravesical Lich-Gregoir method. We retrospe-citvely compared 2 groups with regard to ureteral complications and functional recovery of transplanted kidney.

Results

Twenty-six right kidneys (26/88) were transplanted in HALDN and 20 right kidneys (20/78) were done in ODN. 18 multiple arteries were found in HALDN and 13 in ODN. The mean ischemic time of HALDN and ODN was 270 and 290 seconds. If short length of ureter or anastomosis site swelling was found, ureteral catheter was inserted to ureter of recipient (HALDN: 12, ODN: 3). Four ureteral complications were happened in HALDN group; five in ODN group. In HALDN, two ureteral leakages, one ureteral stricture and one ureteral leakage with anastomosis site narrowing were developed. In ODN, one vesicoureteral reflux, three ureteral leakages and one ureteral stricture were developed. Laterality and multiple renal arteries were not related with ureteral complications. Only ureteral stent insertion reduced ureteral complications (p＜0.05). Acute rejection in 1 year were 6 patients in HALDN and 4 patients in ODN. In HALDN, 1-year patient and graft survival was 98.9% (87/88) and 95.5% (84/88); In ODN 100% (78/78) and 98.7% (77/78).

Conclusions

In comparison with ODN, HALDN combined with the extra-vesical ureteral implantation technique provides similar graft outcomes with low ureteral complication rate. These results suggest that HALDN is safe and effective comparable recipient surgical outcomes.

Keywords: Kidney transplantation, Nephrectomy, Ureteral complication

REFERENCES

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Fig. 1.
Serum creatinine of recipients after HALDN and ODN. (A) In ODN group, no significant differences were noted following ureteral complications. (B) In HALDN group, there were no differences, too. HALDN: hand-assisted laparoscopic donor nephrectomy, ODN: open donor nephrectomy.
kju-50-256f1.tif
Table 1.
Donor and recipient characteristics
Characteristics HALDN (n=88) ODN (n=78)
Donor
Age (years) 38.6 (19-67) 40.0 (23-67)
Sex (male:female) 48:40 44:34
BMI (kg/m2) 23.1 23.7
Multiple renal artery 18 13
Left/Right 62/26 58/20
Recipient
Age (years) 35.7 (18-67) 36.5 (19-61)
Sex (male:female) 59:29 51:27
BMI (kg/m2) 22.2 21.4

HALDN: hand-assisted laparoscopic donor nephrectomy, ODN: open donor nephrectomy, BMI: body mass index

Table 2.
Comparison of operative parameters between HALDN and ODN
Variable HALDN (n=88) ODN (n=78) p-value
Donor
Operation time (min., mean±SD) 179±49 168±26 0.297
Warm ischemic time (sec., mean±SD) 270±138 290±88 0.216
Estimated blood loss (ml, mean±SD) 247±98 239±111 0.115
Time to oral intake (days, mean±SD) 2.4±0.6 2±0.7 0.097
Complications (No. of patients [%]) 2 (2.3%) 0 (0%)
Recipient
Ureteral stent insertion (%) 12 (13.6%) 6 (7.7%)

HALDN: hand-assisted laparoscopic donor nephrectomy, ODN: open donor nephrectomy, SD: standard deviation

Table 3.
Ureteral complication after HALDN and ODN
Complications HALDN (n=88) ODN (n=78) p-value
PCN or ureteral stent insertion (%) 8 (9.1%) 7 (9.0%) 0.297
Hydronephrosis 5/8 5/7
Anastomosis site fluid collection 3/8 2/7
Reconstruction (%) 4 (4.5%) 5 (6.4%) 0.216
Ureter leakage 2 3
Ureter stricture 1 1
Vesicoureteral reflux 0 1
Ureter leakage＋stricture 1 0

HALDN: hand-assisted laparoscopic donor nephrectomy, ODN: open donor nephrectomy, PCN: percutaneous nephrostomy

Table 4.
Factors related with ureteral complications
Factors No. of patients p-value
HALDN (n=88)
Laterality right/left 26/62 0.131
Mutiple renal artery 18 0.107
Ureteral stent insertion 12 0.03
ODN (n=78)
Laterality right/left 27/51 0.126
Mutiple renal artery 13 0.095
Ureteral stent insertion 6 0.045

HALDN: hand-assisted laparoscopic donor nephrectomy, ODN: open donor nephrectomy

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