Laparoscopic versus open live donor nephrectomy in renal transplantation - A meta-analysis

Objective: The aim of this study was to compare laparoscopic versus open live donor nephrectomy using meta-analytical techniques. Summary Background Data: Laparoscopic live donor nephrectomy has gained widespread acceptance and is increasingly performed. The body of evidence assessing the safety and efficacy of laparoscopic compared with established open techniques is growing; however, very few randomized control trials exist and individual studies often have small patient numbers with varying results. We combined the available raw data to strengthen the current literature in comparing these techniques. Methods: A literature search was performed and comparative studies published between 1997 and 2006 of open versus laparoscopic donor nephrectomy were included. Outcomes evaluated were operative and warm ischemia times, blood loss, donor complications, length of hospital stay, time to return to work, and delayed graft function. Results: Seventy-three studies matched the selection criteria and included 6594 patients, 3751 (57%) had undergone laparoscopic surgery and 2843 (43%) open nephrectomy. The open nephrectomy group had shorter operative and warm ischemia times by 52 minutes (P < 0.001) and 102 seconds (P < 0.001), respectively. This did not translate into higher delayed graft function or graft loss rates between the 2 groups. Patients in the laparoscopic group had a shorter hospital stay and a faster return to work by 1.58 days (P < 0.001) and 2.38 weeks (P < 0.001), respectively. There was a significantly higher rate of overall donor complications in the open group (P = 0.007), a finding not reproduced in any subsequent sensitivity analyses. When only randomized control trials were considered, there were shorter operative times (P = 0.002) for the open group but nonsignificantly different warm ischemia times. In contrast to the main analysis there were no differences in the overall complication rate, postoperative analgesia, hospital stay, or time taken to return to work. Conclusions: Laparoscopic nephrectomy in live donor transplantation is a safe alternative to the open technique. Although open nephrectomy may be associated with shorter operative and warm ischemia times, patients undergoing laparoscopic nephrectomy may benefit from a shorter hospital stay and faster return to work without compromising graft function.