Kidney removal from the living donor-technique and evaluation: study on 256 samples
1Department of thoracic and cardiovascular surgery and organ transplantation , Chu Mustapha hospital, Algeirs, Algeria
Introduction: Living donor nephrectomy exposes the surgeon to a particular challenge since it involves performing a major operation on an individual who is not ill. This living donor surgery has undergone many developments. The open technique, considered the technique of choice for many years, can be performed by lumbotomy or subcostally. These two approaches are very safe in terms of mortality and morbidity. This open-air technique was used by our team to take kidney samples from all living donors. The objective is to provide an update on the technical aspects of living kidney donor surgery as well as their follow-up.
Method: From 2010 to 2020, 256 kidney samples were taken by our team (231 left, 25 right) by conventional means. The approach was the classic Lombotomy in extra-peritoneal 98% and 2% s / costal right, 47% were men and 53% women. The average age is 46 years old (20 – 72). The donation was intra-sibling in the majority of cases: 23.5% brother, 23% sisters, 35% mother, 13.5% father, son 2.3%, daughter 1.2%, uncle 0.4%, spouse 1.5%. Preoperative CT angiography showed 1 superior polar artery in 12 cases, 2 renal veins in 9 cases and ureteral duplicity in 1 case. After complete dissection of the kidney and ureter, the adrenal and genital veins are tied, the renal artery and vein sectioned on vascular clamps and sutured. The kidney is extracted then perfused with a cold solution before conditioning and then grafted simultaneously. The main objective to minimize the risks for the donors and to obtain the best possible quality graft and to ensure the harmlessness of this act, a follow-up result of 10 years is reported.
Results: The 256 kidney samples were performed by the exclusive classical route without complication. Blood loss was less than 120 ml. Operative time was on average 122 min (90-155). Warm ischemia during sampling was on average 63 sec (52-74). Cold ischemia was on average 22 min. The mean length of hospitalization was 5.7 days (4-7). Physical activity was resumed after 8 days and professional after 5 weeks. . The perioperative complications are: 03 surgical revisions for haemorrhage, 03 wound sepsis and 01 parietal hematoma. Postoperative complications are: residual pain 6.25% keloid scar 2.7% hypertension 1.5%, minimal IR 0.7% eventration 2.7%, with 0% mortality.
Conclusion: We can conclude that the transplant from the living related donor finds all its legitimacy taking into account the very low risks for the donor both from the point of zero mortality in our series and from the low morbidity. Our study has also demonstrated after sufficient hindsight, lombotomy remains for us the safest and above all the fastest way to extract a quality kidney from the donor, and which has always been entrusted to very experienced surgeons . but we must not oppose a systematic refusal to minimally invasive methods (coelio-surgery and use of the robot) which have the merit of limiting the risk of eventration and painful sequelae.
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