Association of the Mayo-Adhesive Probability Score With the Total Operative Time of Hand-Assisted Laparoscopic Donor Nephrectomy.

Introduction: Living-donor kidney transplantation (LDKT) is often performed using hand-assisted laparoscopic donor nephrectomy (HALDN). Adherent perinephric fat (APF) can complicate HALDN, increasing operative time. The Mayo Adhesive Probability (MAP) score predicts APF preoperatively. This study investigates the association between MAP score and operative time in patients undergoing HALDN.

Methodology: This cross-sectional study included 133 patients undergoing HALDN at Shifa International Hospital, Islamabad, Pakistan, from December 2021 to July 2023. The primary outcome was total operative time, defined as incision-to-closure duration. The predictor of interest was the MAP score, calculated from preoperative CT scans assessing posterior renal fat thickness and perinephric fat stranding. Data collection included demographic and clinical characteristics of the patients. Data analysis was done using IBM SPSS Statistics software, version 25 (IBM Corp., Armonk, NY), to determine a significant association between the mean operative time across different MAP scores and other parameters, taking a p-value <0.05 as significant.

Results: The mean donor age was 35.1 ± 10.1 years, and females were predominant (85, 63.9%). Most patients had a MAP score of 0 (76.7%) and an American Society of Anesthesiologists (ASA) score of one (81.2%). The mean operative time was 196.86 + 53.81 minutes. The MAP score was not significantly associated with operative time (p = 0.244). Mean operative time did not significantly differ across MAP score groups (p = 0.148). There was a significant association between gender and MAP score, with females having lower scores (p = 0.001). No significant correlations were found between operative time and MAP score, gender, or ASA score (p > 0.05).

Conclusions: The MAP score does not significantly correlate with operative time in HALDN among the studied population. Interestingly, a significant association was noted between lower MAP scores and female gender, adding to the understanding of gender-specific characteristics in laparoscopic donor nephrectomy and highlighting the need for further research to validate the utility of this score in diverse clinical settings and populations. These results underline the need for larger, multicentered studies to validate the utility of the MAP score in predicting operative complexity across diverse clinical settings and populations. Our study contributes to the ongoing efforts to optimize preoperative planning and enhance outcomes in LDKT cases.