LIVING DONOR NEPHRECTOMY: OPEN vs LAPARASCOPY. Renal Function and Complications.

Objectives: This study is to compare the short and long-term renal function between adult recipients of living laparoscopic and open donors (LR vs OR) to highlight the effect of the surgical technique on graft function. Moreover, we chose to compare the organic (hypertension, proteinuria, serum creatinine) and psychological (aspect of libido, need for anxiolytics) long-term effect of the surgery between laparoscopic and open donors (LD vs OD).

Methods: After census of adult recipients and living donors between 2003 and 2012, and after application of exclusion criteria and selection of homogeneous groups of donors and recipients, a retrospective cohort study was conducted between October 2008 and January 2012. In recipients, renal function in the short term was reported by the value of serum creatinine at ± D5 post-op and the long-term values of serum creatinine at 6 and 12 months after surgery. Delayed graft function was defined by a serum creatinine value ≥ 2.5 mg/dl on D5 post-op. A questionnaire for donors was established.

Results: The two groups OR and LR were homogeneous concerning age, sex and body mass index (BMI). Different groups OD and LD, chosen according to the variable of interest, were made homogeneous. Despite a different warm ischemia time between the 2 groups (175.54 seconds in LR vs 44.67 seconds in OR, p < 0.001), renal function in the short- and long-term in recipients was not statistically different (At day 5, 1.54 vs 1.50 mg/dl, p = 0.781; at 6 months, 1.37 vs 1.38, p = 0.871; at 12 months, 1.34 vs 1.36, p = 0.569, in OR and LR respectively). Similarly, there was no significant statistical difference concerning organic and psychological complications between OD and LD except for a shorter period between hospital discharge and return to work in LD.

Conclusion: In our center, renal function in the short- and long-term was similar in OR and LR. Apart from the advantages offered by the laparoscopic technique, organic and psychological long-term effects were similar between OD and LD. Nevertheless, laparoscopy seemed to facilitate kidney donation and is requested by almost all living donors independently of their social status.