William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
Mayo Clin Proc. 2022 May;97(5):894-904. doi: 10.1016/j.mayocp.2021.11.023. Epub 2022 Apr 25.
To study the complications of hand-assisted laparoscopic living donor nephrectomy (HALLDN) with an emphasis on complications occurring early after hospital discharge up to 120 days after surgery.
We retrospectively categorized complications using the Clavien-Dindo classification in 3002 HALLDNs performed at 1 center from January 1, 2000, through December 31, 2019. In addition to overall summaries, modeling was used to identify correlates of complications before and after living donation.
Of these donors, 87% were White, 59% were female, the mean age was 45 years (range, 18-77 years), 30.3% had a body mass index of at least 30, and 36.3% had previous abdominopelvic surgery. There were no deaths related to the surgery. The incidence of major complications (intraoperative complications plus Clavien-Dindo grade ≥III postoperatively) was 2.5% (n=74). The overall complication rate was 12.4% (n=371), including 15 intraoperative, 76 postoperative before discharge, and 280 after discharge to 120 days. Reoperation was required in 1.8% of patients (n=54), and all but 1 of these were incision-related problems. Seventy-six percent of all complications occurred after discharge, including 85% of the reoperations. For major complications, no risk factor was found. Risk factors for any complication included paramedian incision (hazard ratio [HR], 2.54; 95% CI, 1.49 to 4.34; P<.001); a history of abdominopelvic surgery (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), male sex (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), non-White race (HR, 1.40; 95% CI, 1.05 to 1.88; P=.02), and early era of the experience.
Most major complications of HALLDN occur after discharge, suggesting that close follow-up is warranted and that the current literature may underestimate the true incidence.
研究手助腹腔镜活体供肾切除术（HALLDN）的并发症，重点关注术后出院至 120 天内出现的早期并发症。
我们回顾性地使用 Clavien-Dindo 分类对 2000 年 1 月 1 日至 2019 年 12 月 31 日在 1 个中心进行的 3002 例 HALLDN 术后并发症进行分类。除了总体总结外，还使用建模来确定活体捐献前后并发症的相关性。
这些供者中，87%为白人，59%为女性，平均年龄为 45 岁（范围为 18-77 岁），30.3%的体质量指数≥30，36.3%有腹部盆腔手术史。无与手术相关的死亡。主要并发症（术中并发症加术后 Clavien-Dindo 分级≥III 级）发生率为 2.5%（n=74）。总体并发症发生率为 12.4%（n=371），包括 15 例术中、76 例出院前术后、280 例出院至 120 天。有 1.8%的患者（n=54）需要再次手术，所有患者均为切口相关问题。所有并发症中有 76%发生在出院后，包括 85%的再次手术。主要并发症无风险因素。任何并发症的危险因素包括正中切口（风险比[HR]，2.54；95%置信区间，1.49 至 4.34；P<.001）；腹部盆腔手术史（HR，1.37；95%置信区间，1.07 至 1.76；P=.01）、男性（HR，1.37；95%置信区间，1.07 至 1.76；P=.01）、非白人种族（HR，1.40；95%置信区间，1.05 至 1.88；P=.02）和经验的早期阶段。
HALLDN 的大多数主要并发症发生在出院后，这表明需要密切随访，并且目前的文献可能低估了真实的发病率。
