Schaumeier Maria Johanna, Nagy Alexandra, Dell-Kuster Salome, Rosenthal Rachel, Schaub Stefan, Dickenmann Michael, Gurke Lorenz, Wolff Thomas
Department of Surgery, University Hospital Basel, Basel, Switzerland.
Institute for Clinical Epidemiology and Biostatistics Basel, Basel, Switzerland.
Swiss Med Wkly. 2017 Aug 25;147:w14472. doi: 10.4414/smw.2017.14472. eCollection 2017.
Right-sided retroperitoneoscopic living donor nephrectomy (LDN) has been shown to be safe for the donor but it is unknown whether the short renal vein is associated with complications or an impaired long-term outcome in the recipient.
In this retrospective cohort study, consecutive transplant recipients after retroperitoneoscopic LDN were enrolled. Complications occurring within 1 year were classified according to the Clavien-Dindo Classification for Surgical Complications and analysed using multivariable logistic regression. Predictors of 1-year creatinine clearance were analysed with multivariable linear regression. Cox proportional hazard models were used to analyse graft survival.
Of the 251 recipients, 193 (77%) received a left kidney and 58 (23%) a right kidney. Surgical complications of Clavien-Dindo grade 3 or higher were comparable in recipients of right and left kidneys (33% vs 29%, odds ratio 0.98, 95% confidence interval [CI] 0.50, 1.94). The occurrence of a surgical complication had a significant impact on creatinine clearance at 1 year (decrease of 6 ml/min/m2, p = 0.016). Vascular complications in right kidneys were more common but were all corrected without impact on graft survival. One-year graft-survival was similar in recipients of right (98.3%) and left (96.9%) kidneys, as was creatinine clearance one year after transplantation (mean difference 3.3 ml/min/m2, 95% CI -1.5, 8.1; p = 0.175). After a median follow-up of 5 years, neither the side (hazard ratio 1.56, 95% CI 0.67, 3.63) nor surgical complications (hazard ratio 1.44, 95% CI 0.65, 3.19) were associated with graft failure.
Right retroperitoneoscopic LDN does not compromise the outcome of transplantation. Surgical complications, long-term graft function and graft survival were comparable in right and left kidneys.
右侧后腹腔镜活体供肾肾切除术（LDN）已被证明对供体是安全的，但尚不清楚肾静脉短是否与受体并发症或长期预后受损有关。
在这项回顾性队列研究中，纳入了接受后腹腔镜LDN后的连续移植受体。根据Clavien-Dindo手术并发症分类对1年内发生的并发症进行分类，并使用多变量逻辑回归进行分析。使用多变量线性回归分析1年肌酐清除率的预测因素。采用Cox比例风险模型分析移植物存活率。
在251名受体中，193名（77%）接受了左肾，58名（23%）接受了右肾。右肾和左肾受体中Clavien-Dindo 3级或更高等级的手术并发症相当（33%对29%，优势比0.98，95%置信区间[CI]0.50，1.94）。手术并发症的发生对1年时的肌酐清除率有显著影响（降低6 ml/min/m2，p = 0.016）。右肾的血管并发症更常见，但均得到纠正，对移植物存活无影响。右肾（98.3%）和左肾（96.9%）受体的1年移植物存活率相似，移植后1年的肌酐清除率也相似（平均差异3.3 ml/min/m2，95% CI -1.5，8.1；p = 0.175）。中位随访5年后，供肾侧（风险比1.56，95% CI 0.67，3.63）和手术并发症（风险比1.44，95% CI 0.65，3.19）均与移植物失败无关。
右侧后腹腔镜LDN不会影响移植结果。右肾和左肾在手术并发症、长期移植物功能和移植物存活方面相当。
