Mohammed Nasreldin, Zarzour Mohammed Ali, Abdelgawad Amr Mostafa, Ibrahim Hamdy Mohammed, Fornara Paolo, Gadelkareem Rabea Ahmed
Clinic for Urology and Kidney Transplantation Center, University Medical School of Martin-Luther-University Halle/ Wittenberg, Germany; Assiut Kidney Transplantation Center, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.
Assiut Kidney Transplantation Center, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.
Turk J Urol. 2022 Jul;48(4):303-308. doi: 10.5152/tud.2022.22108.
The aim of this study is to compare the outcomes of right- and left-sided live donor nephrectomies using the inverted kidney transplantation technique for right live donor nephrectomy on transplantation.
A retrospective review was done for the cases of live donor nephrectomy, either as open donor nephrectomy or laparoscopic donor nephrectomy between 2004 and 2019. Inverted kidney transplantation was used with right-sided grafts. The variables of the right- and left-sided live donor nephrectomies were compared.
There were 202 live donor nephrectomies including 71 (35.1%) open donor nephrectomies and 131 (64.9%) laparoscopic donor nephrectomies with 4 cases of conversion to open donor nephrectomy. There were 119 (58.9%) right-sided and 83 (41.1%) left-sided live donor nephrectomies with insignificantly different mean operative time (123 and 127 minutes; P=.09), mean warm ischemia time (82.3 and 84.5 seconds; P=.32), and mean blood loss (73 and 78 mL; P=.18), respectively. Inverted kidney transplantation was performed for 86% of grafts from right live donor nephrectomies. Discharge from hospital was on an average of 4.3 days postoperatively. There were only 3 complications (1 in right live donor nephrectomy and 2 in left live donor nephrectomies) with grade 2 according to Clavien-Dindo Classification. Incidence of delayed graft function (P=.09), transplant vein thrombosis (1 case in each group), 1-year graft survival rate (93.2% vs. 94.8%; P=.12), and 1-year serum creatinine levels (1.4 ± 0.3 vs. 1.3 ± 0.2; P=.09) revealed statistically insignificant differences.
Regardless of the surgical technique, the right live donor nephrectomy seems to be technically as safe as the left live donor nephrectomy for both the donors and the recipients. Using inverted kidney transplantation provided convenient extensions of graft's vessels to full length with no significant increased incidence of vascular thrombosis.
本研究旨在比较采用倒置肾移植技术进行右侧活体供肾切除术时，右侧和左侧活体供肾切除术的效果。
对2004年至2019年间进行的活体供肾切除术病例进行回顾性研究，包括开放供肾切除术或腹腔镜供肾切除术。右侧移植肾采用倒置肾移植技术。比较右侧和左侧活体供肾切除术的各项变量。
共有202例活体供肾切除术，其中71例（35.1%）为开放供肾切除术，131例（64.9%）为腹腔镜供肾切除术，4例转为开放供肾切除术。右侧活体供肾切除术119例（58.9%），左侧83例（41.1%），平均手术时间（123分钟和127分钟；P = 0.09）、平均热缺血时间（82.3秒和84.5秒；P = 0.32）和平均失血量（73毫升和78毫升；P = 0.18）差异均无统计学意义。86%的右侧活体供肾切除术的移植肾采用了倒置肾移植技术。术后平均住院天数为4.3天。根据Clavien-Dindo分类，仅有3例并发症（右侧活体供肾切除术1例，左侧活体供肾切除术2例），为2级。移植肾功能延迟发生率（P = 0.09）、移植静脉血栓形成（每组各1例）、1年移植肾存活率（93.2%对94.8%；P = 0.12）和1年血清肌酐水平（1.4±0.3对1.3±0.2；P = 0.09）差异均无统计学意义。
无论采用何种手术技术，对于供体和受体而言，右侧活体供肾切除术在技术上似乎与左侧活体供肾切除术一样安全。采用倒置肾移植技术可使移植肾血管方便地延长至全长，且血管血栓形成的发生率无显著增加。
