Calpin Gavin G, Hehir Cian, Davey Matthew G, MacCurtain Benjamin M, Little Dilly, Davis Niall F
Department of Urology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
Department of Urology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
Transplant Rev (Orlando). 2025 Jan;39(1):100880. doi: 10.1016/j.trre.2024.100880. Epub 2024 Sep 2.
The left kidney is preferable in living donor nephrectomy (LDN). We aimed to investigate the safety and efficacy of right versus left LDN in both donor and recipients. A subgroup analysis of outcomes based on operative approach was also performed.
A systematic review and meta-analysis was performed as per PRISMA guidelines. Outcomes of interest were extracted from included studies and analysed.
There were 31 studies included with 79,912 transplants. Left LDN was performed in 84.1 % of cases and right LDN in 15.9 %. Right LDN was associated with reduced EBL (P = 0.010), intra-operative complications (P = 0.030) and operative time (P = 0.006), but higher rates of conversion to open surgery (1.4 % vs 0.9 %). However, right living donor renal transplantation (LDRT) had higher rates of delayed graft function (5.4 % vs 4.2 %, P < 0.0001) and graft loss (2.6 % vs 1.1 %, P < 0.0001). Graft survival was reduced in right LDRT at 3 years (92.0 % vs 94.2 %, P = 0.001) but comparable to left LDRT at 1- and 5-years. Otherwise, donor and recipient peri-operative outcomes and serum creatinine levels were comparable in both groups. Hand-assisted LDN was associated with shorter warm ischaemia time (P < 0.0001) but longer length of stay (LOS) than laparoscopic LDN and robotic-assisted LDN (P < 0.0001). RA-LDN was associated with less EBL and shorter LOS (both P < 0.0001) while patients who underwent L-LDN had a lower mean serum creatinine (SCr) level on discharge (P < 0.0001).
Right LDRT has higher rates of delayed graft function and graft loss compared to left LDRT. Minimally-invasive surgical approaches potentially offer improved outcomes but further large-scale randomised controlled trials studies are required to confirm this finding.
活体供肾肾切除术（LDN）中，左肾是更优选择。我们旨在研究右肾与左肾LDN在供体和受体中的安全性及有效性。还基于手术方式对结果进行了亚组分析。
按照PRISMA指南进行系统评价和荟萃分析。从纳入研究中提取并分析感兴趣的结果。
共纳入31项研究，涉及79912例移植手术。84.1%的病例采用左肾LDN，15.9%采用右肾LDN。右肾LDN与较低的估计失血量（EBL）（P = 0.010）、术中并发症（P = 0.030）及手术时间（P = 0.006）相关，但转为开放手术的比例更高（1.4%对0.9%）。然而，右肾活体供肾肾移植（LDRT）的移植肾功能延迟发生率更高（5.4%对4.2%，P < 0.0001），移植肾丢失率也更高（2.6%对1.1%，P < 0.0001）。右肾LDRT在3年时的移植肾存活率降低（92.0%对94.2%，P = 0.001），但在1年和5年时与左肾LDRT相当。此外，两组供体和受体围手术期结果及血清肌酐水平相当。手辅助LDN与较短的热缺血时间相关（P < 0.0001），但住院时间（LOS）比腹腔镜LDN和机器人辅助LDN更长（P < 0.0001）。机器人辅助LDN与较少的EBL和较短的LOS相关（均为P < 0.0001），而接受腹腔镜LDN的患者出院时平均血清肌酐（SCr）水平较低（P < 0.0001）。
与左肾LDRT相比，右肾LDRT的移植肾功能延迟发生率和移植肾丢失率更高。微创外科手术方式可能会改善结果，但需要进一步的大规模随机对照试验来证实这一发现。
