Kocak Burak, Koffron Alan J, Baker Talia B, Salvalaggio Paolo R O, Kaufman Dixon B, Fryer Jonathan P, Abecassis Michael M, Stuart Frank P, Leventhal Joseph R
Division of Organ Transplantation, Department of Surgery, Northwestern University Medical School, Chicago, Illinois 60610, USA.
Urology. 2006 May;67(5):927-31. doi: 10.1016/j.urology.2005.11.023.
A standardized classification for the potential complications of living donor nephrectomy is an essential step in establishing a construct for monitoring and reporting the outcomes of this procedure. It is also helpful in informing potential donors about the inherent risks of the donor operation as part of the informed choice process.
We reviewed 600 laparoscopic live donor nephrectomies performed at our center. A modification of the Clavien classification system describing procedure-related complications was developed and used to grade the severity of all complications.
We observed 43 complications (7.2%) in our series of 600 patients. Grade 1 defines all events that, if left untreated, would have a spontaneous resolution or needed a simple bedside procedure (39.5%). Grade 2 complications differ from grade 1 in that they are potentially life-threatening and usually require some form of intervention, but do not result in ongoing disability. We subdivided grade 2 complications (55.8% in our study) into 2a, 2b, and 2c. The latter describes complications requiring open conversion of laparoscopic donor nephrectomy for patient treatment. Grade 3 complications are events with residual or lasting disability (4.7% in our review). Grade 4 events are those resulting in renal failure or death because of any complication (none occurred in our series).
A graded classification scheme for reporting the complications of donor nephrectomy may be useful for maintaining registry information on donor outcomes and when informing potential donors about the risks and benefits of this procedure.
制定活体供肾肾切除术潜在并发症的标准化分类，是构建该手术监测和报告结果体系的关键步骤。这对于告知潜在供体该供体手术的固有风险、作为知情选择过程的一部分也很有帮助。
我们回顾了在本中心进行的600例腹腔镜活体供肾肾切除术。对描述手术相关并发症的Clavien分类系统进行了修改，并用于对所有并发症的严重程度进行分级。
在我们的600例患者系列中，观察到43例并发症（7.2%）。1级定义为所有未经治疗可自行缓解或只需简单床边操作的事件（39.5%）。2级并发症与1级的不同之处在于，它们有潜在生命危险，通常需要某种形式的干预，但不会导致持续残疾。我们将2级并发症（在我们的研究中占55.8%）细分为2a、2b和2c。后者描述了为治疗患者需要将腹腔镜供肾肾切除术转为开放手术的并发症。3级并发症是导致残留或持久残疾的事件（在我们的回顾中占4.7%）。4级事件是指因任何并发症导致肾衰竭或死亡的事件（我们的系列中未发生）。
报告供肾肾切除术并发症的分级分类方案，可能有助于维护供体结果的登记信息，以及在告知潜在供体该手术的风险和益处时发挥作用。
