Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 147 No. 3334 (2017)

Right retroperitoneoscopic living donor nephrectomy does not increase surgical complications in the recipient and leads to excellent long-term outcome

  • Maria J. Schaumeier
  • Alexandra Nagy
  • Salome Dell-Kuster
  • Rachel Rosenthal
  • Stefan Schaub
  • Michael Dickenmann
  • Lorenz Gurke
  • Thomas Wolff
Cite this as:
Swiss Med Wkly. 2017;147:w14472



Right-sided retroperitoneoscopic living donor nephrectomy (LDN) has been shown to be safe for the donor but it is unknown whether the short renal vein is associated with complications or an impaired long-term outcome in the recipient.


In this retrospective cohort study, consecutive transplant recipients after retroperitoneoscopic LDN were enrolled. Complications occurring within 1 year were classified according to the Clavien-Dindo Classification for Surgical Complications and analysed using multivariable logistic regression. Predictors of 1-year creatinine clearance were analysed with multivariable linear regression. Cox proportional hazard models were used to analyse graft survival.


Of the 251 recipients, 193 (77%) received a left kidney and 58 (23%) a right kidney. Surgical complications of Clavien-Dindo grade 3 or higher were comparable in recipients of right and left kidneys (33% vs 29%, odds ratio 0.98, 95% confidence interval [CI] 0.50, 1.94). The occurrence of a surgical complication had a significant impact on creatinine clearance at 1 year (decrease of 6 ml/min/m2, p = 0.016). Vascular complications in right kidneys were more common but were all corrected without impact on graft survival. One-year graft-survival was similar in recipients of right (98.3%) and left (96.9%) kidneys, as was creatinine clearance one year after transplantation (mean difference 3.3 ml/min/m2, 95% CI ˗1.5, 8.1; p = 0.175). After a median follow-up of 5 years, neither the side (hazard ratio 1.56, 95% CI 0.67, 3.63) nor surgical complications (hazard ratio 1.44, 95% CI 0.65, 3.19) were associated with graft failure.


Right retroperitoneoscopic LDN does not compromise the outcome of transplantation. Surgical complications, long-term graft function and graft survival were comparable in right and left kidneys.


  1. Ratner LE, Fabrizio M, Chavin K, Montgomery RA, Mandal AK, Kavoussi LR. Technical considerations in the delivery of the kidney during laparoscopic live-donor nephrectomy. J Am Coll Surg. 1999;189(4):427–30. doi:.
  2. Mandal AK, Cohen C, Montgomery RA, Kavoussi LR, Ratner LE. Should the indications for laparascopic live donor nephrectomy of the right kidney be the same as for the open procedure? Anomalous left renal vasculature is not a contraindiction to laparoscopic left donor nephrectomy. Transplantation. 2001;71(5):660–4. doi:.
  3. Saad S, Paul A, Treckmann J, Nagelschmidt M, Heiss M, Arns W. Laparoscopic live donor nephrectomy for right kidneys: Experience in a German community hospital. Surg Endosc. 2008;22(3):674–8. doi:.
  4. Buell JF, Edye M, Johnson M, Li C, Koffron A, Cho E, et al. Are concerns over right laparoscopic donor nephrectomy unwarranted? Ann Surg. 2001;233(5):645–51. doi:.
  5. Kay MD, Brook N, Kaushik M, Harper SJ, Bagul A, Nicholson ML. Comparison of right and left laparoscopic live donor nephrectomy. BJU Int. 2006;98(4):843–4. doi:.
  6. Hoda MR, Greco F, Wagner S, Heynemann H, Fornara P. Prospective, nonrandomized comparison between right- and left-sided hand-assisted laparoscopic donor nephrectomy. Transplant Proc. 2011;43(1):353–6. doi:.
  7. Tsoulfas G, Agorastou P, Ko D, Hertl M, Elias N, Cosimi AB, et al. Laparoscopic living donor nephrectomy: is there a difference between using a left or a right kidney? Transplant Proc. 2012;44(9):2706–8. doi:.
  8. Bachmann A, Wolff T, Ruszat R, Giannini O, Dickenmann M, Gürke L, et al. Retroperitoneoscopic donor nephrectomy: a retrospective, non-randomized comparison of early complications, donor and recipient outcome with the standard open approach. Eur Urol. 2005;48(1):90–6, discussion 96. doi:.
  9. Sulser T, Gürke L, Langer I, Dickenmann M, Steiger J, Gasser TC, et al. Retroperitoneoscopic living-donor nephrectomy: first clinical experiences in 19 operations. J Endourol. 2004;18(3):257–62. doi:.
  10. 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:.
  11. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR ; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):247–78, quiz 279–80. doi:.
  12. Minnee RC, Bemelman WA, Maartense S, Bemelman FJ, Gouma DJ, Idu MM. Left or right kidney in hand-assisted donor nephrectomy? A randomized controlled trial. Transplantation. 2008;85(2):203–8. doi:.
  13. Abrahams HM, Freise CE, Kang SM, Stoller ML, Meng MV. Technique, indications and outcomes of pure laparoscopic right donor nephrectomy. J Urol. 2004;171(5):1793–6. doi:.
  14. Diner EK, Radolinski B, Murdock JD, Ghasemian SR. Right laparoscopic donor nephrectomy: the Washington Hospital Center experience. Urology. 2006;68(6):1175–7. doi:.
  15. Husted TL, Hanaway MJ, Thomas MJ, Woodle ES, Buell JF. Laparoscopic right living donor nephrectomy. Transplant Proc. 2005;37(2):631–2. doi:.
  16. Ko EY, Castle EP, Desai PJ, Moss AA, Reddy KS, Mekeel KL, et al. Utility of the endovascular stapler for right-sided laparoscopic donor nephrectomy: a 7-year experience at Mayo Clinic. J Am Coll Surg. 2008;207(6):896–903. doi:.
  17. Posselt AM, Mahanty H, Kang SM, Stoller ML, Meng MV, Roberts JP, et al. Laparoscopic right donor nephrectomy: a large single-center experience. Transplantation. 2004;78(11):1665–9. doi:.
  18. Hsu JW, Reese PP, Naji A, Levine MH, Abt PL. Increased early graft failure in right-sided living donor nephrectomy. Transplantation. 2011;91(1):108–14. doi:.
  19. Ma L, Li G, Huang Y, Hou X, Zhao L, Wang G, et al. Retroperitoneoscopic live-donor right nephrectomy: a Chinese single center. Exp Clin Transplant. 2011;9(1):20–5.
  20. Narita S, Inoue T, Matsuura S, Horikawa Y, Kakinuma H, Saito M, et al. Outcome of right hand-assisted retroperitoneoscopic living donor nephrectomy. Urology. 2006;67(3):496–500, discussion 500–1. doi:.
  21. Omoto K, Nozaki T, Inui M, Shimizu T, Hirai T, Sawada Y, et al. Impact of right-sided nephrectomy on long-term outcomes in retroperitoneoscopic live donor nephrectomy at single center. J Transplant. 2013;2013:546373. doi:.
  22. Tanabe K, Miyamoto N, Ishida H, Tokumoto T, Shirakawa H, Yamamoto H, et al. Retroperitoneoscopic live donor nephrectomy (RPLDN): establishment and initial experience of RPLDN at a single center. Am J Transplant. 2005;5(4 Pt 1):739–45. doi:.
  23. Wadström J, Biglarnia A, Gjertsen H, Sugitani A, Fronek J. Introducing hand-assisted retroperitoneoscopic live donor nephrectomy: learning curves and development based on 413 consecutive cases in four centers. Transplantation. 2011;91(4):462–9.
  24. Yashi M, Yagisawa T, Nukui A, Ishikawa N, Miyamoto N, Sakuma Y, et al. Strategic hand assistance for effective and safe retroperitoneoscopic live donor nephrectomy. Transplant Proc. 2009;41(1):88–90. doi:.
  25. Burgos FJ, Pascual J, Quicios C, Marcen R, Fernández A, López Fando L, et al. Post-kidney transplant surgical complications under new immunosuppressive regimens. Transplant Proc. 2006;38(8):2445–7. doi:.
  26. Intissar H, Zoubeir S, Loubna B, Ezzaitouni F, Naima O, Rabia B, et al. [Surgical complications of renal transplantation from living donors: experience of the CHU Ibn Sina, Rabat]. Pan Afr Med J. 2010;6:20. Article in French.
  27. Koçak T, Nane I, Ander H, Ziylan O, Oktar T, Ozsoy C. Urological and surgical complications in 362 consecutive living related donor kidney transplantations. Urol Int. 2004;72(3):252–6. doi:.
  28. Arslan G, Moray G, Bilgin N, Karamehmetoğlu M, Büyükpamukçu N, Haberal M. Early operative morbidity and mortality in 1051 consecutive kidney transplants over 20 years at our centers. Transplant Proc. 1996;28(4):2311.

Most read articles by the same author(s)

<< < 1 2 3