Department of Urology, Charité Universitätsmedizin, Berlin, Germany.
World J Urol. 2011 Aug;29(4):561-6. doi: 10.1007/s00345-011-0704-1. Epub 2011 May 24.
Systemic heparin administration during laparoscopic donor nephrectomy (LDN) may prevent microvascular thrombus formation following warm ischemia. We herein present our experience with and without systemic heparinization during LDN.
We retrospectively reviewed donor complications and graft outcomes in 119 consecutive live donor kidney transplantations between January 2005 and December 2009. Systemic heparin was administered to the first 65 donors. LDN was carried out by 2 surgeons using a pure laparoscopic technique.
Total operating time for LDN was significantly longer in the heparin group (202 vs. 157 min). The incidence of renal artery multiplicity was significantly higher in the heparin group. Mean warm ischemia time was 160 s, and mean hospital stay was 5 days with no differences between groups. Postoperative hemorrhage occurred in 3 donors with systemic heparinization and in 1 without heparinization. Two donors received blood transfusions, and 2 underwent laparoscopic reexploration. Three grafts were lost in the heparin group and 1 in the non-heparin group. Graft loss was due to early vascular thrombosis (n = 3) and due to acute rejection (n = 1). Overall, 1-year graft survival was 96.6%, and 1-year serum creatinine was 1.41 mg/dl (P = n. s. between groups).
Abandoning systemic donor heparinization in LDN with short warm ischemia has a low complication rate without adverse effects on short- and long-term graft outcomes.
腹腔镜供肾切取术（LDN）期间全身肝素化可预防热缺血后微血管血栓形成。本文报告了我们在 LDN 期间进行和不进行全身肝素化的经验。
我们回顾性分析了 2005 年 1 月至 2009 年 12 月期间 119 例连续活体供肾移植受者的供者并发症和移植物结局。前 65 例供者给予全身肝素化。LDN 由 2 位外科医生使用纯腹腔镜技术进行。
LDN 的总手术时间在肝素组明显较长（202 分钟 vs. 157 分钟）。肝素组肾动脉多发性的发生率明显较高。平均热缺血时间为 160 秒，平均住院时间为 5 天，两组之间无差异。术后出血发生在 3 例接受全身肝素化的供者和 1 例未接受肝素化的供者中。2 例供者接受输血，2 例接受腹腔镜再次探查。肝素组 3 例移植物丢失，非肝素组 1 例。移植物丢失的原因是早期血管血栓形成（n=3）和急性排斥反应（n=1）。总的 1 年移植物存活率为 96.6%，1 年血清肌酐为 1.41mg/dl（两组间 P=无统计学意义）。
在 LDN 中放弃短时间热缺血期间的全身供者肝素化具有较低的并发症发生率，而对短期和长期移植物结局无不良影响。
