Determinants of Laparoscopic Donor Nephrectomy Outcomes

Background: Pure laparoscopic donor nephrectomy (LDN) is a unique intervention because it carries known risks and complications, yet carries no direct benefit to the donor. Therefore, it is critical to continually examine and improve quality of care. Objective: To identify factors affecting LDN outcomes and complications. Design, setting, and participants: A retrospective analysis of prospectively collected data for 1204 consecutive LDNs performed from March 2000 through August 2012. Intervention: LDN performed at an academic training center. Outcome measurements and statistical analysis: Using multivariable regression, we assessed the effect of age, sex, body mass index (BMI), laterality, and vascular variation on operative time, estimated blood loss (EBL), complications, and length of stay. Results and limitations: The following variables were associated with longer operative time (data given as parameter estimate plus or minus the standard error): female sex (9.09 +/- 2.43; p < 0.001), higher BMI (1.03 +/- 0.32; p = 0.001), two (7.87 +/- 2.70; p = 0.004) and three or more (22.45 +/- 7.13; p = 0.002) versus one renal artery, and early renal arterial branching (5.67 +/- 2.82; p = 0.045), while early renal arterial branching (7.81 +/- 3.85; p = 0.043) was associated with higher EBL. Overall, 8.2% of LDNs experienced complications, and by modified Clavien classification, 74 (5.9%) were grade 1, 13 (1.1%) were grade 2a, 10 (0.8%) were grade 2b, and 2 (0.2%) were grade 2c. There were no grade 3 or 4 complications. Three or more renal arteries (odds ratio [OR]: 2.74; 95% CI, 1.05-7.16; p = 0.04) and late renal vein confluence (OR: 2.42; 95% CI, 1.50-3.91; p = 0.0003) were associated with more complications. Finally, we did not find an association of the independent variables with length of stay. A limitation is that warm ischemia time was not assessed. Conclusions: In our series, renal vascular variation prolonged operative time and was associated with more complications. While complicated donor anatomy is not a contraindication of LDN, surgical decision-making should take into consideration these results. (C) 2013 Published by Elsevier B.V. on behalf of European Association of Urology.