Purpose: Implementation of low-pressure laparoscopy may be facilitated by the use of valveless, recirculating trocar systems that have less intra-abdominal pressure variability, providing adequate surgical exposure at lower pressures. Using this approach, we hypothesize that low-pressure pneumoperitoneum can be safely performed in living kidney donors, resulting in improved donor and recipient outcomes, the later of which is dependent on donor age. Methods: We conducted a randomized-controlled trial in subjects undergoing laparoscopic donor nephrectomy comparing conventional insufflation (15mmHg) to a valveless trocar insufflator (Airseal®) (10mmHG). Our primary endpoint was to test if narcotic utilization was different between the groups. Secondly, we tested the rate of early renal recovery following transplant and assessed the effect of low-pressure on renal grafts, stratifying for donor age. Results: We performed 41 procedures with a 1:2 allocation ratio (control: intervention). Operative narcotic utilization was reduced in the low-pressure group (99.56mg vs. 113.79mg narcotic equivalents (p=0.05)); however, total hospital narcotic usage was the same. Airseal® was associated with less pressure variability (p<0.001) and clinical outcomes including complications and operative time were similar. Utilizing general estimating equations analysis, transplanted kidneys from the low-pressure group showed superior early transplant renal recovery (p=0.03) when measuring the percentage of improving daily renal function over the first 72 hours from transplant. We conducted a subgroup analysis and determined that the improved renal recovery was statistically significant for younger donors only (age 30 (p=0.01); age 40 (p=0.02), age 50 (p=0.38); age 60 (p=0.44)). Conclusions: Valveless, recirculating trocar systems provide less intra-abdominal pressure variability with similar surgical outcomes at lower pressures. Kidney donors require less operative narcotic utilization suggesting improved stabilization during the operative procedure. Findings of superior early post-transplant renal recovery noted in kidneys procured under low-pressure appears to be an age-dependent finding and provides hypothesis generation for specifically designed and powered studies to assess this outcome.

CITATION INFORMATION: Kulkarni S, Douglas S, Cohen E, Swift S, Hall I. Low-Pressure Pneumoperitoneum in Living Kidney Donors: An Age-Dependent Analysis of Recipient Outcomes. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress