Yoon Young Eun, Han Woong Kyu, Choi Kyung Hwa, Yang Seung Choul, Kim Yu Seun, Kang Dae Ryong, Huh Kyu Ha, Kim Myoung Soo, Kim Soon Il, Joo Dong Jin
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, and Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
Urology. 2014 Oct;84(4):832-7. doi: 10.1016/j.urology.2014.06.028. Epub 2014 Aug 22.
To examine the effect of the side of the allograft (left vs right) on early graft failure and long-term graft survival rates after conventional open living-donor nephrectomy (OLDN) or video-assisted minilaparotomy living-donor nephrectomy (VLDN).
We evaluated 2704 living-donor transplantations using OLDN or VLDN between 1991 and 2011 at a single institution. For analysis, the entire period was divided into "era 1" (1991-1997), when OLDN was prevalent; "era 2" (1998-2004), when both OLDN and VLDN were conducted; and "era 3" (2005-2011), when VLDN became prevalent.
There were 822, 650, and 685 transplantations analyzed in eras 1, 2, and 3, respectively. There were no differences in causes of early graft failure between left and right allografts in any era. The right allograft survival rate in eras 1 and 2 was slightly lower than the left allograft survival rate. In era 2, during which both OLDN and VLDN were conducted, Kaplan-Meier analysis showed lower right allograft survival rate for OLDN. However, the long-term survival rates of the left and right VLDN grafts did not differ.
Right OLDN allografts demonstrated worse long-term survival rate than left OLDN allografts, but the right and left VLDN allografts had similar long-term survival rate. VLDN appears to be an appropriate treatment option when right donor nephrectomy is desired.
探讨在传统开放性活体供肾肾切除术（OLDN）或电视辅助小切口活体供肾肾切除术（VLDN）后，同种异体移植肾的侧别（左肾与右肾）对早期移植肾失功及长期移植肾存活率的影响。
我们评估了1991年至2011年在单一机构进行的2704例采用OLDN或VLDN的活体供肾移植。为进行分析，整个时间段被分为“第1阶段”（1991 - 1997年），此阶段OLDN盛行；“第2阶段”（1998 - 2004年），此阶段OLDN和VLDN均开展；以及“第3阶段”（2005 - 2011年），此阶段VLDN盛行。
第1、2、3阶段分别分析了822例、650例和685例移植。在任何阶段，左右同种异体移植肾早期移植肾失功的原因均无差异。第1和第2阶段右同种异体移植肾的存活率略低于左同种异体移植肾。在第2阶段，即同时进行OLDN和VLDN的阶段，Kaplan - Meier分析显示OLDN的右同种异体移植肾存活率较低。然而，左右VLDN移植肾的长期存活率并无差异。
右OLDN同种异体移植肾的长期存活率低于左OLDN同种异体移植肾，但左右VLDN同种异体移植肾的长期存活率相似。当需要进行右供肾肾切除术时，VLDN似乎是一种合适的治疗选择。
