Increased transplantation of kidneys with multiple renal arteries in the laparoscopic live donor nephrectomy era - Surgical technique and surgical and nonsurgical donor and recipient outcomes

Background: For anatomical and technical reasons, many transplant centers restrict laparoscopic live donor nephrectomy (in contrast with open live donor nephrectomy) to left kidneys. Hypothesis: This change in surgical practice increases procurement and transplantation rates of live donor kidneys with multiple renal arteries (RAs), without affecting donor and recipient outcomes. Design and Setting: Retrospective review at an academic tertiary care referral center comparing laparoscopically procured single- vs multiple-RA kidney grafts (April 1997 to October 2000). Patients: Seventy-nine consecutive left laparoscopic live kidney donors and 78 transplant recipients. Main Outcome Measures: Donor and recipient complications and postoperative length of stay; cold and warm ischemia time; operating time; short-term and longterm graft function; and survival. Results: We noted multiple RAs in 21 (27%) of all kidneys. The proportion of donors with 1 or more perioperative complications was 19% in the single-RA group vs 10% in the multiple-RA group (P was not significant). For the recipients, we noted no significant differences between groups with respect to surgical complications, quality of early and late graft function, rejection rates, graft losses (all immunologic), and graft survival. Cold and warm ischemia time and length of stay were similar for donors and recipients in both groups. Median operating times were significantly longer for the multiple-RA vs single-RA group (difference, 41 minutes for donors and 45 minutes for recipients; P<.02). Conclusions: While the introduction of laparoscopic live donor nephrectomy has significantly increased the number of grafts with multiple RAs (compared with historical open controls), this change in practice is safe for both donors and recipients from a patient outcome-based perspective. However, from an economic perspective, the longer operating time associated with multiple-RA grafts provides strong added rationale for optimization of surgical instruments and techniques to make right-sided laparoscopic nephrectomy a routine intervention.