PURPOSE: To systematically assess perioperative events in minimally-invasive live donor nephrectomy, and to compare different techniques currently employed for this procedure.

METHODS: A literature search was performed; all studies discussing short-term complications after minimally-invasive live donor nephrectomy were included. Outcomes evaluated were intra- and postoperative complications, conversions, operative and warm ischemia times, blood loss, length of hospital stay, pain score, convalescence, quality of life and costs. Overall results were described in a systematic review. A meta-analysis was performed comparing the individual techniques, with regards to conversion rate, intra-operative events and post-operative complications.

RESULTS: 174 Articles were included in the systematic review, 37 in the meta-analysis. Mortality was reported in 128 articles (74%), three fatalities were described (0.02%). Mean operative time was 197.4 minutes (range 78-320), warm ischemia time 3.6 minutes (0.7-8.7), average blood loss 148.9 milliliters (15-545). Overall conversion rate was 1.3% (n=306), of which 181 emergent (0.8%). Intraoperative event rate was 2.4%, most frequently bleeding (1.6%). Postoperative complications occurred in 6.8% of donors. Ileus (6.3%), infectious complications (2.6%), wound infection (1.6%), and bleeding (1.1%) were seen most. Average length of stay was 4.2 days (0.6-13), average pain score on discharge 2.7 (2-5). Mean duration of convalescence was 23.2 days (4-60), average quality of life (SF36) was 66.3 (34.5-88). None of the minimally-invasive techniques was superior to another with regard to complication or conversion rate. Intra-operative bleeding was more often encountered in hand-assisted procedures (3.9 vs 3.7%, p=0.04), as was postoperative ileus (1.7 vs 0.3%, p=0.06). When compared to mini-open procedures, intra-operative events occurred more often in laparoscopic procedures: 10.2 vs 4.2%, p=0.02, but postoperative infections were more common after mini-open procedures; 18% vs 7.9%, p=0.03. This was mainly attributed to an increased incidence of pneumonia after mini-open procedures: 7.9 vs 4.3%, p=0.04.

CONCLUSIONS: Minimally-invasive live donor nephrectomy is safe, and associated with low complication rates and an even lower risk of mortality. These data, combined with further analysis of donor comprehension and satisfaction will assist us in developing a standardized, donor-tailored informed consent procedure for live donor nephrectomy.

CITATION INFORMATION: Kortram K, Ijzermans J, Dor F. Peri-Operative Events and Complications in Minimally-Invasive Live Donor Nephrectomy: What Should We Tell Potential Donors? Am J Transplant. 2016;16 (suppl 3).

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