Background: In the US majority of living donor uninephrectomy procedures for kidney transplantation are currently done by laparoscopic techniques. We wanted to assess the variations in the frequency of open and laparoscopic uninephrectomy procedures over time and compare post-transplant graft survival rates for kidneys retrieved by open or laparoscopic methods. Methods: We analyzed the UNOS dataset to determine the frequency of surgical techniques and the impact on post-transplant graft survival. Chi-square statistic was used to estimate difference in proportion for various surgical techniques. Kaplan-Meier product limit survival estimates were used to calculate graft survival probability. Results: 99,508 individuals received a kidney transplant from a living donor from October 1, 1987 to May 1, 2009. Five categories of surgical technique were described. Data for surgical technique was available for 61,393 patients. 15,708 nephrectomy procedures were done with open technique, with 13,109 utilizing the retroperitoneal and 2,599 through the transabdominal approach. 45,685 procedures were done with laparoscopic technique, of which 17,598 were hand assisted, 9,411 pure laparoscopic, and the laparoscopic technique was not identified for the remaining 18,676 procedures. In 2001, laparoscopic procedures outnumbered open nephrectomy procedures, with a gradual decline in the number of open nephrectomy procedures over the years. In 2008, only 449 (7.54%) of the 5,950 donor nephrectomies were performed with the open technique; with 3,587 (60.29%) hand assisted technique; and 1,914 (32.17%) by pure laparoscopic procedure. Graft survival was comparable for kidneys retrieved from living donors either through open or laparoscopic techniques (p=0.358; Figure).

Conclusions: In the US majority of living donor uninephrectomy procedures have been performed laparoscopically in recent years. Hand assisted technique has been more common than the unassisted pure laparoscopic approach. Graft survival rates have been comparable for kidneys retrieved by open or laparoscopic methods.

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