Laparoscopic donor nephrectomy in the presence of vascular anomalies: evaluation of outcome.

Purpose: In this study we show the outcome of laparoscopic kidney donation for donors and recipients in cases of donors with vascular anomalies.

Material And Methods: We consider donors to have vascular anomalies if they have multiple arteries or venous abnormalities. Fifty-six cases had double renal arteries (left side n = 52, right side n = 4). Three patients had triple renal arteries. Eighteen cases had venous anomalies (retro-aortic renal vein n = 11, double renal vein n = 4, circum-aortic renal vein n = 2, atrophic proximal renal vein, n = 1). Two donors had multiple abnormalities (double renal arteries, double renal veins, and a retro-aortic renal vein in one case, and double renal artery and double renal vein in one case). Donor surgery was done transperitoneally in all cases, using three trocars on the left side and four on the right side. Outcome in these cases is compared to the outcome in cases with no vascular abnormalities (n = 321) performed in our institution.

Results: The total number of patients with vascular anomalies in our series is 79 (19.7%). All cases were completed laparoscopically. The mean operative time was 161 +/- 35 minutes. The mean blood loss was 65 +/- 38 mL, and no donor required blood transfusion. Mean warm ischemia time was 2.6 +/- 0.4 minutes, mean renal artery length was 3.1 +/- 0.4 cm, and mean renal vein length was 3.5 +/- 1.2 cm. Donors were discharged on the second postoperative day, and no donor required readmission. Kidneys were transplanted successfully and mean creatinine of the recipients on discharge was 1.3 +/- 0.3 mg/dL. Five patients had acute tubular necrosis; however, only one of them required dialysis (delayed graft function). Kidney function recovered thereafter in all patients. There were no significant differences in blood loss, warm ischemia time, donor hospital stay, or patient creatinine on discharge, between patients with vascular abnormalities in donors and those without vascular abnormalities in donors. However, operative time was significantly longer in donors with vascular abnormalities.

Conclusion: Laparoscopic donor nephrectomy is safe for donors with vascular anomalies. Donors benefit from a less morbid procedure with no effect on functional outcome.