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Original article

Vol. 147 No. 3334 (2017)

Early complications after living donor nephrectomy: analysis of the Swiss Organ Living Donor Health Registry

  • Felix Burkhalter
  • Uyen Huynh-Do
  • Karine Hadaya
  • Marice Matter
  • Thomas F. Mueller
  • Isabelle Binet
  • Christa Nolte
  • Juerg Steiger
DOI
https://doi.org/10.4414/smw.2017.14497
Cite this as:
Swiss Med Wkly. 2017;147:w14497
Published
25.08.2017

Summary

BACKGROUND

We evaluated the prospectively collected data about the incidence of early peri- and postoperative complications, and potential risk factors for adverse outcomes after living kidney donation in Switzerland.

METHODS

Peri- and postoperative events were prospectively recorded on a questionnaire by the local transplant teams of all Swiss transplant centres and evaluated by the Swiss Organ Living Donor Health Registry. Complications were classified according to the Clavien grading system. A total of 1649 consecutive donors between 1998 and 2015 were included in the analysis.

RESULTS

There was no perioperative mortality observed. The overall complication rate was 13.5%. Major complications defined as Clavien ≥3 occurred in 2.1% of donors. Obesity was not associated with any complications. Donor age >70years was associated with major complications (odds ratio [OR] 3.99) and genitourinary complications (urinary tract infection OR 5.85; urinary retention OR 6.61). There were more major complications observed in donors with laparoscopic surgery versus open surgery (p = 0.048), but an equal overall complication rate (p = 0.094).

CONCLUSION

We found a low rate of major and minor complications, independent of surgical technique, after living donor nephrectomy. There was no elevated complication rate in obese donors. In contrast, elderly donors >70 years had an elevated risk for perioperative complications.

References

  1. Swiss Transplant cohort. Annual Report 2015; http://www.stcs.ch/research/publications.
  2. Bundesamt für Gesundheit BAG. https://www.bag.admin.ch/bag/de/home/service/zahlen-fakten/zahlen-fakten-zu-transplantationsmedizin/zahlen-fakten-zur-spende-und-transplantation-von-organen.htlm.
  3. Wehmeier C, Georgalis A, Hirt-Minkowski P, Amico P, Hoenger G, Voegele T, et al. 2222 kidney transplantations at the University Hospital Basel: a story of success and new challenges. Swiss Med Wkly. 2016;146:w14317.
  4. Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol. 2008;3(2):471–80. doi:https://doi.org/10.2215/CJN.05021107.https://doi.org/10.2215/CJN.05021107
  5. Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol. 2002;13(5):1358–64. doi:https://doi.org/10.1097/01.ASN.0000013295.11876.C9.https://doi.org/10.1097/01.ASN.0000013295.11876.C9
  6. Taler SJ, Messersmith EE, Leichtman AB, Gillespie BW, Kew CE, Stegall MD, et al.; RELIVE Study Group. Demographic, metabolic, and blood pressure characteristics of living kidney donors spanning five decades. Am J Transplant. 2013;13(2):390–8. doi:https://doi.org/10.1111/j.1600-6143.2012.04321.x.https://doi.org/10.1111/j.1600-6143.2012.04321.x
  7. Clayton PA, Saunders JR, McDonald SP, Allen RD, Pilmore H, Saunder A, et al. Risk-Factor Profile of Living Kidney Donors: The Australia and New Zealand Dialysis and Transplant Living Kidney Donor Registry 2004-2012. Transplantation. 2016;100(6):1278–83. doi:https://doi.org/10.1097/TP.0000000000000877.https://doi.org/10.1097/TP.0000000000000877
  8. Mjøen G, Øyen O, Holdaas H, Midtvedt K, Line PD. Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation. 2009;88(11):1273–9. doi:https://doi.org/10.1097/TP.0b013e3181bb44fd.https://doi.org/10.1097/TP.0b013e3181bb44fd
  9. Janki S, Klop KW, Dooper IM, Weimar W, Ijzermans JN, Kok NF. More than a decade after live donor nephrectomy: a prospective cohort study. Transpl Int. 2015;28(11):1268–75. doi:https://doi.org/10.1111/tri.12589.https://doi.org/10.1111/tri.12589
  10. Minnee RC, Bemelman WA, Polle SW, van Koperen PJ, Ter Meulen S, Donselaar-van der Pant KA, et al. Older living kidney donors: surgical outcome and quality of life. Transplantation. 2008;86(2):251–6. doi:https://doi.org/10.1097/TP.0b013e31817789dd.https://doi.org/10.1097/TP.0b013e31817789dd
  11. Hadjianastassiou VG, Johnson RJ, Rudge CJ, Mamode N. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery. Am J Transplant. 2007;7(11):2532–7. doi:https://doi.org/10.1111/j.1600-6143.2007.01975.x.https://doi.org/10.1111/j.1600-6143.2007.01975.x
  12. Thiel GT, Nolte C, Tsinalis D. Prospective Swiss cohort study of living-kidney donors: study protocol. BMJ Open. 2011;1(2):e000202. doi:https://doi.org/10.1136/bmjopen-2011-000202.https://doi.org/10.1136/bmjopen-2011-000202
  13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. doi:https://doi.org/10.1097/01.sla.0000133083.54934.ae.https://doi.org/10.1097/01.sla.0000133083.54934.ae
  14. Thiel GT, Nolte C, Tsinalis D. Das Schweizer Lebendspender-Gesundheitsregister (SOL-DHR) [The Swiss Organ Living Donor Health Registry (SOL-DHR)]. Ther Umsch. 2005;62(7):449–57. [Article in German] doi:https://doi.org/10.1024/0040-5930.62.7.449.https://doi.org/10.1024/0040-5930.62.7.449
  15. Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10):959–66. doi:https://doi.org/10.1001/jama.2010.237.https://doi.org/10.1001/jama.2010.237
  16. Friedman AL, Cheung K, Roman SA, Sosa JA. Early clinical and economic outcomes of patients undergoing living donor nephrectomy in the United States. Arch Surg. 2010;145(4):356–62, discussion 362. doi:https://doi.org/10.1001/archsurg.2010.17.https://doi.org/10.1001/archsurg.2010.17
  17. Lentine KL, Lam NN, Axelrod D, Schnitzler MA, Garg AX, Xiao H, et al. Perioperative Complications After Living Kidney Donation: A National Study. Am J Transplant. 2016;16(6):1848–57. doi:https://doi.org/10.1111/ajt.13687.https://doi.org/10.1111/ajt.13687
  18. Patel S, Cassuto J, Orloff M, Tsoulfas G, Zand M, Kashyap R, et al. Minimizing morbidity of organ donation: analysis of factors for perioperative complications after living-donor nephrectomy in the United States. Transplantation. 2008;85(4):561–5. doi:https://doi.org/10.1097/TP.0b013e3181643ce8.https://doi.org/10.1097/TP.0b013e3181643ce8
  19. Schold JD, Goldfarb DA, Buccini LD, Rodrigue JR, Mandelbrot DA, Heaphy EL, et al. Comorbidity burden and perioperative complications for living kidney donors in the United States. Clin J Am Soc Nephrol. 2013;8(10):1773–82. doi:https://doi.org/10.2215/CJN.12311212.https://doi.org/10.2215/CJN.12311212
  20. Ruszat R, Sulser T, Dickenmann M, Wolff T, Gürke L, Eugster T, et al. Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques. World J Urol. 2006;24(1):113–7. doi:https://doi.org/10.1007/s00345-006-0051-9.https://doi.org/10.1007/s00345-006-0051-9
  21. Friedman AL, Peters TG, Jones KW, Boulware LE, Ratner LE. Fatal and nonfatal hemorrhagic complications of living kidney donation. Ann Surg. 2006;243(1):126–30. doi:https://doi.org/10.1097/01.sla.0000193841.43474.ec.https://doi.org/10.1097/01.sla.0000193841.43474.ec
  22. Hartmann A, Fauchald P, Westlie L, Brekke IB, Holdaas H. The risk of living kidney donation. Nephrol Dial Transplant. 2003;18(5):871–3. doi:https://doi.org/10.1093/ndt/gfg069.https://doi.org/10.1093/ndt/gfg069
  23. Capocasale E, Iaria M, Vistoli F, Signori S, Mazzoni MP, Dalla Valle R, et al. Incidence, diagnosis, and treatment of chylous leakage after laparoscopic live donor nephrectomy. Transplantation. 2012;93(1):82–6. doi:https://doi.org/10.1097/TP.0b013e31823b2d8e.https://doi.org/10.1097/TP.0b013e31823b2d8e
  24. Greco F, Hoda MR, Alcaraz A, Bachmann A, Hakenberg OW, Fornara P. Laparoscopic living-donor nephrectomy: analysis of the existing literature. Eur Urol. 2010;58(4):498–509. doi:https://doi.org/10.1016/j.eururo.2010.04.003.https://doi.org/10.1016/j.eururo.2010.04.003
  25. Nanidis TG, Antcliffe D, Kokkinos C, Borysiewicz CA, Darzi AW, Tekkis PP, et al. Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis. Ann Surg. 2008;247(1):58–70. doi:https://doi.org/10.1097/SLA.0b013e318153fd13.https://doi.org/10.1097/SLA.0b013e318153fd13
  26. Wilson CH, Sanni A, Rix DA, Soomro NA. Laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev. 2011;(11):CD006124.
  27. Andersen MH, Mathisen L, Oyen O, Edwin B, Digernes R, Kvarstein G, et al. Postoperative pain and convalescence in living kidney donors-laparoscopic versus open donor nephrectomy: a randomized study. Am J Transplant. 2006;6(6):1438–43. doi:https://doi.org/10.1111/j.1600-6143.2006.01301.x.https://doi.org/10.1111/j.1600-6143.2006.01301.x
  28. Wolf JS, Jr, Merion RM, Leichtman AB, Campbell DA, Jr, Magee JC, Punch JD, et al. Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation. 2001;72(2):284–90. doi:https://doi.org/10.1097/00007890-200107270-00021.https://doi.org/10.1097/00007890-200107270-00021
  29. Bachmann A, Wolff T, Giannini O, Dickenman M, Ruszat R, Gürke L, et al. How painful is donor nephrectomy? Retrospective analysis of early pain and pain management in open versus laparoscopic versus retroperitoneoscopic nephrectomy. Transplantation. 2006;81(12):1735–8. doi:https://doi.org/10.1097/01.tp.0000225800.69089.b4.https://doi.org/10.1097/01.tp.0000225800.69089.b4
  30. O’Brien B, Mastoridis S, Sabharwal A, Hakim N, Taube D, Papalois V. Expanding the donor pool: living donor nephrectomy in the elderly and the overweight. Transplantation. 2012;93(11):1158–65. doi:https://doi.org/10.1097/TP.0b013e31824ef1ae.https://doi.org/10.1097/TP.0b013e31824ef1ae
  31. Kuang W, Ng CS, Matin S, Kaouk JH, El-Jack M, Gill IS. Rhabdomyolysis after laparoscopic donor nephrectomy. Urology. 2002;60(5):911. doi:https://doi.org/10.1016/S0090-4295(02)01911-8.https://doi.org/10.1016/S0090-4295(02)01911-8
  32. van Dellen D, Tavakoli A, Wadsworth R, Augustine T. Intraoperative hyperkaliemia complicating hand-assisted live-donor nephrectomy. Exp Clin Transplant. 2011;9(6):417–20.
  33. Thiel GT, Nolte C, Tsinalis D, Steiger J, Bachmann LM. Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors. BMJ Open. 2016;6(3):e010869. doi:https://doi.org/10.1136/bmjopen-2015-010869.https://doi.org/10.1136/bmjopen-2015-010869

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