Abstract
Background: Discussion continues about right vs. left donor nephrectomy (LDN). Left side is preferred due to longer renal vein while right side has been associated with renal vein thrombosis and shorter vessels. Methods: A retrospective analysis of UNOS database for adult living donor transplants between 1 January 2000 and 31 December 2009. Results: We identified 58 599 living donor transplants, of which 86.1% were LDN. There were no significant differences between the recipients or donors demographics. There were higher rates of delayed graft function in right donor nephrectomy (RDN) recipients with a hazard risk of 1.38 (95% CI 1.24-1.53; p <0.0001). Primary failure rates were similar. In the RDN group, graft thrombosis as cause of graft failure was statistically higher with a hazard ratio of 1.48 (95% CI 1.18-1.86, p = 0.0004), and graft survival was significantly inferior (p = 0.006 log-rank test). For living donors outcomes, the conversion from laparoscopic to open was higher in the RDN group with an odds ratio of 2.02 (95% CI 1.61-2.52; p <0.00001). There was no significant difference in vascular complications or re-operation required due to bleeding. Re-operations and re-admissions were higher in the LDN group. Conclusion: There are statistical differences between left and right kidney donor nephrectomies on recipient outcomes, but the difference is extremely small. The choice and laterality should be based on center and surgeon preference and experience.
| Original language | English (US) |
|---|---|
| Journal | Clinical Transplantation |
| DOIs | |
| State | Accepted/In press - 2016 |
| Externally published | Yes |
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Keywords
- Left
- Living donor
- Nephrectomy
- Recipient
- Right
ASJC Scopus subject areas
- Transplantation
Cite this
Trends and outcomes in right vs. left living donor nephrectomy : An analysis of the OPTN/UNOS database of donor and recipient outcomes - should we be doing more right-sided nephrectomies? / Khalil, Ali; Mujtaba, Muhammad; Taber, Tim E.; Yaqub, Muhammad S.; Goggins, William; Powelson, John; Sundaram, Chandru; Sharfuddin, Asif A.
In: Clinical Transplantation, 2016.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Trends and outcomes in right vs. left living donor nephrectomy
T2 - An analysis of the OPTN/UNOS database of donor and recipient outcomes - should we be doing more right-sided nephrectomies?
AU - Khalil, Ali
AU - Mujtaba, Muhammad
AU - Taber, Tim E.
AU - Yaqub, Muhammad S.
AU - Goggins, William
AU - Powelson, John
AU - Sundaram, Chandru
AU - Sharfuddin, Asif A.
PY - 2016
Y1 - 2016
N2 - Background: Discussion continues about right vs. left donor nephrectomy (LDN). Left side is preferred due to longer renal vein while right side has been associated with renal vein thrombosis and shorter vessels. Methods: A retrospective analysis of UNOS database for adult living donor transplants between 1 January 2000 and 31 December 2009. Results: We identified 58 599 living donor transplants, of which 86.1% were LDN. There were no significant differences between the recipients or donors demographics. There were higher rates of delayed graft function in right donor nephrectomy (RDN) recipients with a hazard risk of 1.38 (95% CI 1.24-1.53; p <0.0001). Primary failure rates were similar. In the RDN group, graft thrombosis as cause of graft failure was statistically higher with a hazard ratio of 1.48 (95% CI 1.18-1.86, p = 0.0004), and graft survival was significantly inferior (p = 0.006 log-rank test). For living donors outcomes, the conversion from laparoscopic to open was higher in the RDN group with an odds ratio of 2.02 (95% CI 1.61-2.52; p <0.00001). There was no significant difference in vascular complications or re-operation required due to bleeding. Re-operations and re-admissions were higher in the LDN group. Conclusion: There are statistical differences between left and right kidney donor nephrectomies on recipient outcomes, but the difference is extremely small. The choice and laterality should be based on center and surgeon preference and experience.
AB - Background: Discussion continues about right vs. left donor nephrectomy (LDN). Left side is preferred due to longer renal vein while right side has been associated with renal vein thrombosis and shorter vessels. Methods: A retrospective analysis of UNOS database for adult living donor transplants between 1 January 2000 and 31 December 2009. Results: We identified 58 599 living donor transplants, of which 86.1% were LDN. There were no significant differences between the recipients or donors demographics. There were higher rates of delayed graft function in right donor nephrectomy (RDN) recipients with a hazard risk of 1.38 (95% CI 1.24-1.53; p <0.0001). Primary failure rates were similar. In the RDN group, graft thrombosis as cause of graft failure was statistically higher with a hazard ratio of 1.48 (95% CI 1.18-1.86, p = 0.0004), and graft survival was significantly inferior (p = 0.006 log-rank test). For living donors outcomes, the conversion from laparoscopic to open was higher in the RDN group with an odds ratio of 2.02 (95% CI 1.61-2.52; p <0.00001). There was no significant difference in vascular complications or re-operation required due to bleeding. Re-operations and re-admissions were higher in the LDN group. Conclusion: There are statistical differences between left and right kidney donor nephrectomies on recipient outcomes, but the difference is extremely small. The choice and laterality should be based on center and surgeon preference and experience.
KW - Left
KW - Living donor
KW - Nephrectomy
KW - Recipient
KW - Right
UR - http://www.scopus.com/inward/record.url?scp=84953438789&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84953438789&partnerID=8YFLogxK
U2 - 10.1111/ctr.12668
DO - 10.1111/ctr.12668
M3 - Article
C2 - 26589133
AN - SCOPUS:84953438789
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
ER -