Introduction: Patients undergoing donor nephrectomy are fit and well individuals. Despite this, 1 in 5 will suffer a perioperative complication causing significant morbidity. Recent published data has highlighted the importance of the predictive value of early postoperative C reactive protein (CRP) rises for complications in similar abdominal surgical procedures. We assessed the predictive value of traditional markers CRP and white cell count as well as putative markers of infection (Procalcitonin) for clinically significant postoperative complications in this growing patient cohort.

Methods: 746 patients undergoing laparoscopic donor nephrectomy between 2003 and 2013 were analysed. Data was collected on 30 day perioperative complications stratified by the Clavien-Dindo classification and separately for infective complications. Predictive values of days 1,2,3 CRP levels and white cell count (WCC) were evaluated by receiver operating characteristic (ROC) curves. In a smaller cohort of 50 patients serum procalcitonin was also measured prospectively using an Enzyme Linked Immunsorbent Assay (ELISA) kit.

Results: 147 clinically significant surgical complications occurred in 746 patients. 142 were of an infective aetiology. Early peak CRP was not a sensitive marker of postoperative infections (AUC 0.59, 95% CI 0.5 – 0.65). WCC was also an inaccurate predictor (AUC 0.60, 95% 0.53 – 0.66). For the prediction of major (clavien 3 / 4) complications Day 1 WCC AUC was 0.7 (95% CI 0.5 – 0.87) and neutrophil:lymphocyte ratio (NLR) subset was 0.75 (95% CI 0.69 – 0.88). In a cohort of 50 patients Procalcitonin (PCT) levels peaked on Day 1 (mean 753nmol/L SD 133). PCT was also poor at predicting postoperative infection (AUC 0.58 95% CI 0.42 – 0.75).

Conclusions: This is the largest surgical cohort study to date examining the relationship between the CRP, WCC and postoperative outcomes. Early postoperative CRP is a poor predictor of postoperative complications. Day 1 WCC and its NLR subset provides clinical value in stratifying those at risk of serious postoperative complications. However, overall predictive accuracy remains suboptimal using current parameters. Procalcitonin – although purported as a specific infection biomarker – had poor predictive accuracy for postoperative infection in kidney donors. Given the significant incidence of postoperative donor nephrectomy complications; new biomarkers require urgent evaluation.

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