Korean J Urol.  2009 Mar;50(3):256-260.

Ureteral Complications of the Transplanted Kidney after Hand-Assisted Laparoscopic Donor Nephrectomy: Comparison with Open Procedure

• Oh WS
• Kwon JB
• Yoo ES
• Kwon TG

Abstract

PURPOSE: We compared recipients' ureteral complications after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN).
MATERIALS AND METHODS
Between January 1999 and September 2006, a total of 166 transplantaions were underwent via a HALDN or ODN. Kidney transplantation was performed in a standard fashion and ureteroneocystostomy was done by extravesical Lich-Gregoir method. We retrospecitvely compared 2 groups with regard to ureteral complications and functional recovery of transplanted kidney.
RESULTS
Twenty-six right kidneys (26/88) were transplanted in HALDN and 20 right kidneys (20/78) were done in ODN. 18 multiple arteries were found in HALDN and 13 in ODN. The mean ischemic time of HALDN and ODN was 270 and 290 seconds. If short length of ureter or anastomosis site swelling was found, ureteral catheter was inserted to ureter of recipient (HALDN: 12, ODN: 3). Four ureteral complications were happened in HALDN group; five in ODN group. In HALDN, two ureteral leakages, one ureteral stricture and one ureteral leakage with anastomosis site narrowing were developed. In ODN, one vesicoureteral reflux, three ureteral leakages and one ureteral stricture were developed. Laterality and multiple renal arteries were not related with ureteral complications. Only ureteral stent insertion reduced ureteral complications (p<0.05). Acute rejection in 1 year were 6 patients in HALDN and 4 patients in ODN. In HALDN, 1-year patient and graft survival was 98.9% (87/88) and 95.5% (84/88); In ODN 100% (78/78) and 98.7% (77/78).
CONCLUSIONS
In comparison with ODN, HALDN combined with the extravesical ureteral implantation technique provides similar graft outcomes with low ureteral complication rate. These results suggest that HALDN is safe and effective comparable recipient surgical outcomes.

Keyword

Kidney transplantation; Nephrectomy; Ureteral complication

MeSH Terms

Arteries
Constriction, Pathologic
Graft Survival
Humans
Kidney
Kidney Transplantation
Nephrectomy
Rejection (Psychology)
Renal Artery
Stents
Tissue Donors
Transplants
Ureter
Urinary Catheters
Vesico-Ureteral Reflux

Figure

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  Fig. 1. Serum creatinine of recipients after HALDN and ODN. (A) In ODN group, no significant differences were noted following ureteral complications. (B) In HALDN group, there were no differences, too. HALDN: hand-assisted laparoscopic donor nephrectomy, ODN: open donor nephrectomy.

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