Outcome of kidney grafts retrieved by laparoscopy: a study of one hundred cases by recipient risk stratification

Rajasekar, M.R; Vijayarajakumari, D; Goyal, R; Sewkani, A.S; Jasuja, S; Aggarawal, D.K; Mishra, A

doi:10.1016/S0041-1345(02)03867-8

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Volume 35, Issue 1 , Pages 47-48, February 2003

Outcome of kidney grafts retrieved by laparoscopy: a study of one hundred cases by recipient risk stratification

M.R Rajasekar
- Department of HPB Surgery and Organ Transplantation, Indraprastha Apollo Hospital, New Delhi, India
- Address reprint requests to M.R. Rajasekar, Department of HPB Surgery and Organ Transplantation, Indraprastha Apollo Hospital, New Delhi-65, India.
D Vijayarajakumari
- Department of HPB Surgery and Organ Transplantation, Indraprastha Apollo Hospital, New Delhi, India
R Goyal
- Department of HPB Surgery and Organ Transplantation, Indraprastha Apollo Hospital, New Delhi, India
A.S Sewkani
- Department of HPB Surgery and Organ Transplantation, Indraprastha Apollo Hospital, New Delhi, India
S Jasuja
- Department of HPB Surgery and Organ Transplantation, Indraprastha Apollo Hospital, New Delhi, India
D.K Aggarawal
- Department of HPB Surgery and Organ Transplantation, Indraprastha Apollo Hospital, New Delhi, India
A Mishra
- Department of HPB Surgery and Organ Transplantation, Indraprastha Apollo Hospital, New Delhi, India

Laparoscopic Donor nephrectomy (LDN) was introduced at our center in April 1999 to overcome donor morbidities and encourage living-related donation. Our initial study showed no statistical difference in graft outcome when compared to kidneys retrieved by an open technique.¹ Although the safety of the procedure is now well-established,² it remains to be demonstrated whether laparoscopic retrieval added to the poor prognosis, especially when used either with marginal grafts or in recipients with a likelihood of poor outcome due to other factors. With this objective, a retrospective analysis was performed of 100 kidneys retrieved by a transperitoneal laparoscopic technique and transplanted over the last 3 years.

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Methods

Transperitoneal LDN was performed with a mean warm ischemia time of 3.8 minutes and mean cold ischemia time of 17 minutes. All kidneys were perfused with cold Eurocollins solution. All kidneys were transplanted by the same team with no technical problems and good vascular perfusion. Ninety percent of the kidneys had diuresis on reperfusion. One hundred recipients who received LDN kidneys were retrospectively grouped into four risk categories; each recipient may fall into one or more categories. Each category was split into two groups at an arbitrarily chosen cut-off point, where either a favorable or an unfavorable graft outcome would be expected. The categories were Donor age < 60 years versus > 60 years because older donors with a GFR < 80 mL/min were rejected from donating; HLA match of > haplotype match/< haplotype match. High recipient cardiovascular risk due to left ventricular ejection fraction (LVEF) <35% or advanced coronary artery disease versus low or no risk with LVEF >35% and total GFR of the donor kidneys >80 mL/min vs < 80 mL/min. The graft outcome was analyzed with reference to serum creatinine and graft loss at 6 months to 2 years post-kidney transplantation.

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Results

This retrospective study has a follow-up from 6 months to 2 years after transplantation.

Group I

Mean serum creatinine was 1.5 ± 0.4_SD in the <60 years group (n = 89) and 1.8 ± 0.8_SD in the >60 year group (n = 11). Two grafts were lost among 89 in the <60 year group; there was no graft loss in the >60 year group.

Group II

The mean serum creatinine in >1 HLA haplotype matched grafts (n = 49) was 1.6 ± 0.5_SD and in the <1 HLA haplotype match group (n = 51), 1.5 ± 0.3_SD; there was one graft loss in each group.

Group III

Patients with low cardiac risk or LVEF >35% (n = 77) displayed a mean serum creatinine of 1.5 ± 0.4_SD; the group of patients with either a low LVEF of <35% (n = 8) or advanced untreatable coronary artery disease (n = 15) showed a mean serum creatinine of 1.58 ± 0.4_SD with a graft loss of one and two, respectively.

Group IV

Kidneys transplanted from donors with a total DTPA GFR >80 mL/min (n = 96) demonstrated a mean serum creatinine 1.55 ± 0.5_SD; those from donors with <80 mL/min (n = 4), a mean serum creatinine of 1.8 ± 1.04_SD with two grafts lost in the former and one patient lost in the latter group. There was low morbidity among the donors who underwent LDN

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Conclusion

LDN has long been established as a cost-effective,³ low morbidity procedure with significant advantages to the donor. However, there have been few studies to analyze the outcome of grafts when transplanted in high-risk patients, as analyzed in this study. This retrospective study clearly showed that LDN kidneys perform well among patients with high cardiovascular risk and low LVEF states. The two factors that seem to adversely influence the serum creatinine are donor age >60 years and total GFR of the donor <80 mL/min. There was no significant difference in graft survival among the four risk stratification subgroups. The overall patient survival was 94% and the graft survival was 98% during the study period, including 6 months to 2 years post-kidney transplantation.

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