Although hand assisted laparoscopic donor nephrectomy (HALDN) has become a standard of care for living kidney procurement in most centres it is not clear if a retroperitoneal approach offers any advantage over an intraperitoneal approach. Recent RCT data has been published on the subject but the results have been biased by small patient numbers and significant demographic and operative heterogeneity between groups. We therefore conducted a case matched study of retroperitoneal versus intraperitoneal HALDN.

Methods:

61 retroperitoneal HALDNs were matched 2:1 with 122 intraperitoneal HALDNs for age, sex, laterality, multiplicity of arteries and obesity status (BMI > 30) characteristics using a propensity matching score approach using Stata SE 12. Outcomes assessed were Clavien grade 2, 3 and 4 complications, infective episodes, readmission, need for reoperation, postoperative hospital stay, creatinine change at Day 30 and development of incisional hernia.

Results: The mean age of the cohort was 44.1 years (SD11) with 52.5% female. The mean length of surgery was greater in the retroperitoneal cohort (225 mins v 200 mins, p=0.001). Hospital stay (4.2 v 3.9 days p=0.11) and readmission rates (9.1 v 9.6% p=0.12) were similar. Incidence of postoperative surgical site infection (9.9% v 10.1% p=0.1) and the occurrence of minor complications (Clavien 2) were also equivalent (16.3 v 17.3% p=0.45). The abdominal reoperation rate was lower in the retroperitoneal group (1.6% v 3.3% p=0.009) as was the rate of incisional hernia development at one year (0% v 5% p=0.08). Day 2 peak CRP levels were less in the retroperitoneal group (111 v 123 p=0.035). Creatinine rise at day 30 was similar (+34 v +37 p =0.35).

Discussion:

Retroperitoneal HALDN has similar minor complication outcomes compared to the intraperitoneal approach with similar lengths of hospital stay and readmission rates. However there is evidence from this study that it may exhibit a reduced systemic inflammatory response (as measured by Day 2 CRP) and also reduce more serious surgical complications thereby reducing the need for reoperation and ultimately reducing the overall donor morbidity burden.

CITATION INFORMATION: Ahmed Z, Sait M, Tamburrini R, Uwechue R, Chandak P, Kessaris N, Mamode N. Retroperitoneal versus Intraperitoneal Hand Assisted Laparoscopic Donor Nephrectomy: A Case Matched Study. Am J Transplant. 2016;16 (suppl 3).

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