Graft survival after video-assisted minilaparotomy living-donor nephrectomy or conventional open nephrectomy: do left and right allografts differ?

Objective: To examine the effect of the side of the allograft (left vs right) on early graft failure and long-term graft survival rates after conventional open living-donor nephrectomy (OLDN) or video-assisted minilaparotomy living-donor nephrectomy (VLDN).

Materials And Methods: We evaluated 2704 living-donor transplantations using OLDN or VLDN between 1991 and 2011 at a single institution. For analysis, the entire period was divided into "era 1" (1991-1997), when OLDN was prevalent; "era 2" (1998-2004), when both OLDN and VLDN were conducted; and "era 3" (2005-2011), when VLDN became prevalent.

Results: There were 822, 650, and 685 transplantations analyzed in eras 1, 2, and 3, respectively. There were no differences in causes of early graft failure between left and right allografts in any era. The right allograft survival rate in eras 1 and 2 was slightly lower than the left allograft survival rate. In era 2, during which both OLDN and VLDN were conducted, Kaplan-Meier analysis showed lower right allograft survival rate for OLDN. However, the long-term survival rates of the left and right VLDN grafts did not differ.

Conclusion: Right OLDN allografts demonstrated worse long-term survival rate than left OLDN allografts, but the right and left VLDN allografts had similar long-term survival rate. VLDN appears to be an appropriate treatment option when right donor nephrectomy is desired.