Goh Y S B, Cheong P S C, Lata R, Goh A, Vathsala A, Li M K, Tiong H Y
Department of Urology, National University Health System, Singapore; National University Centre for Organ Transplant, National University Hospital, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Transplant Proc. 2014;46(2):310-3. doi: 10.1016/j.transproceed.2013.11.120.
Donor safety is of paramount importance in addressing end-stage renal failure through living kidney transplantation. The United States Food and Drug Administration (FDA) issued a Class II recall on the use of Hem-o-lok (Teleflex, Limerick, Pennsylvania, United States) polymer clips on the renal artery in laparoscopic donor nephrectomy (LDN) in June 2006 following 3 reported cases of donor deaths secondary to slipped ligature. The National University Hospital of Singapore made the transition regarding hilar control in minimally invasive donor nephrectomy, from using polymer and titanium clips to transfixion techniques (pure or hand-assisted laparoscopic) via laparoscopic staples or intracorporeal suturing, respectively. This study assessed safety during the transition in arterial transfixion techniques in minimally invasive donor nephrectomy for both donors and recipients. Forty-five consecutive kidney donors underwent donor nephrectomy over a 2-year period starting from June 2010. A total of 37 donors who underwent LDN (pure laparoscopic or hand-assisted laparoscopic) were included in the analysis. Of the 37 patients, 23 kidney donors had renal arterial control using Hem-o-lok while 14 patients from November 2011 onward underwent transfixion of the renal artery. The 2 groups of donor who underwent renal arterial control by either clips ligature or transfixion technique were comparable. The outcomes for the recipients in each group were similar with no statistical difference between postoperative creatinine level, incidence of delayed graft function, or graft survival at 1 year. We conclude that the transition in renal arterial control technique to transfixion techniques in LDN in line with FDA recommendation is feasible and affords equivalent donor and recipient outcomes.
在通过活体肾移植治疗终末期肾衰竭的过程中，供体安全至关重要。2006年6月，美国食品药品监督管理局（FDA）对在腹腔镜供肾切除术（LDN）中使用Hem-o-lok（泰利福公司，美国宾夕法尼亚州利默里克）聚合物夹夹闭肾动脉的情况发布了二级召回，此前有3例报告称因结扎滑脱导致供体死亡。新加坡国立大学医院在微创供肾切除术中，将肾门控制方法从使用聚合物夹和钛夹，分别转变为通过腹腔镜吻合器或体内缝合进行贯穿缝扎技术（单纯或手辅助腹腔镜）。本研究评估了微创供肾切除术中动脉贯穿缝扎技术转变过程中供体和受体的安全性。从2010年6月开始的两年时间里，连续45例肾脏供体接受了供肾切除术。分析纳入了总共37例接受LDN（单纯腹腔镜或手辅助腹腔镜）的供体。在这37例患者中，23例肾脏供体使用Hem-o-lok夹闭肾动脉，而从2011年11月起，14例患者接受了肾动脉贯穿缝扎。两组分别通过夹闭结扎或贯穿缝扎技术进行肾动脉控制的供体具有可比性。每组受体的结局相似，术后肌酐水平、移植肾功能延迟发生率或1年时的移植物存活率之间无统计学差异。我们得出结论，按照FDA的建议，在LDN中将肾动脉控制技术转变为贯穿缝扎技术是可行的，并且供体和受体的结局相当。
