Systemic heparinization in kidney donors during nephrectomy
Leonardo Romeo1, Adrián Berdeguer1, Roberto Welti1.
1Urology and Kidney Transplantation. Hospital Español de Mendoza, Urocuyo, Ciudad Mendoza, Argentina
Introduction: Thrombotic complications on the graft are the most terrifying situations in living donor transplantation. Yet, up to this moment no clínical guidalines assure that the use of heparin during surgery prevents from the appearence of those events. Our hyphotesis is that during surgery, there is a significat venous ectasia that may increase the risk of vascular thrombosis.
Methods: We conduct a retrospective trial to asses whether the use of heparin during laparoscopic donor nephrectomy causes surgical complications on the donor as well as the recipient. We select two groups, A (with the use of 7500 units of sodic heparin before vascular clamping) and B (without heparin).
Results: From may 2015 up to may 2021, fifty living laparoscopic transperitoneal donor nephrectomies were performed at our Institution. Of them, 68% were females and 32 % males ranging from 27 to 72 years old. Specifically, 7 cases with multiple renal arteries and 3 cases with retro-aortic renal veins. All surgeries were performed by one surgeron with a pure laparoscopic transperitoneal approach. We use heparin in 35 patients (Group A-70%), the control group B, represents the 30%. We did not find any differences in terms of surgical complications on the donor, graft and recipient survival. However, delayed graft function was higher in the group without heparin, 5 cases that represents 30% in group B, in contrast with A that with no patient. With a mediam follow up of 20 months graft and recipient survival is 96%.
Conclusion: Considering the aforementioned data, the use of heparin before clamping the renal vessels, have no detrimental effect on the posoperative curse of both patients. Hypothetically, this approach may reduce the risk of suffering from vascular thrombus complications on the graft. Future randomized prospective clinical trials would eventually define the real role of this line of action.
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