Division of Transplantation, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Transplantation. 2011 Jan 15;91(1):108-14. doi: 10.1097/TP.0b013e3181fd0179.
Laparoscopic donor nephrectomy (LDN) is well established; however, there is concern about early graft loss because of technical issues with right-sided LDN. Prior studies on the subject were mostly single centered and not powered to detect clinically significant differences in allograft failure.
We conducted a retrospective cohort study of recipients of live donor kidney transplants using national registry data. The primary endpoint was 90-day allograft failure. Multivariable logistic regression analyses were stratified as overall live donor transplantation, transplantation after LDN, and transplantation after open donor nephrectomy (ODN).
Between 2001 and 2006, a total of 2555 right LDNs, 25,387 left LDNs, 2496 right ODNs, and 5552 left ODNs were performed. For the entire cohort compared with ODN, LDN was not associated with early allograft loss (odds ratio [OR]=0.94, P=0.4); however, right-sided nephrectomy increased the risk of allograft loss (OR=1.49, P<0.01). When stratified by procedure type, right LDN (OR=1.58, P<0.01) and right ODN (OR=1.38, P=0.02) demonstrated an association with increased risk of graft failure compared with the left side. The observed risk of allograft failure with right-sided LDN was 3.8% vs. 2.5% with left-sided LDN.
Right-sided donor nephrectomy is associated with a small increased risk of allograft failure regardless of open or laparoscopic approach. However, the low observed risk of allograft failure with right-sided nephrectomy suggests that recovering the right kidney is a reasonable option for donors with contraindications for donating the left kidney.
腹腔镜供肾切除术（LDN）已经得到广泛应用；然而，由于右侧 LDN 存在技术问题，人们担心会导致早期移植物丢失。先前关于该主题的研究大多是单中心的，并且没有足够的能力来检测同种异体移植失败的临床显著差异。
我们使用国家登记数据对活体供肾移植受者进行了回顾性队列研究。主要终点是 90 天移植物失败。多变量逻辑回归分析分为整体活体供肾移植、LDN 后移植和开放供肾切除术（ODN）后移植。
在 2001 年至 2006 年间，共进行了 2555 例右侧 LDN、25387 例左侧 LDN、2496 例右侧 ODN 和 5552 例左侧 ODN。与 ODN 相比，整个队列中 LDN 并不与早期移植物丢失相关（比值比[OR]=0.94，P=0.4）；然而，右侧肾脏切除术增加了移植物丢失的风险（OR=1.49，P<0.01）。按手术类型分层时，右侧 LDN（OR=1.58，P<0.01）和右侧 ODN（OR=1.38，P=0.02）与移植失败的风险增加相关，与左侧相比。右侧 LDN 的移植物失败风险为 3.8%，而左侧 LDN 的移植物失败风险为 2.5%。
无论采用开放还是腹腔镜方法，右侧供肾切除术都与移植物失败的小风险增加相关。然而，右侧肾脏切除术的移植物失败风险较低表明，对于有左肾捐献禁忌的供体，回收右肾是一个合理的选择。
