Pub Date : 2024-09-02DOI: 10.1016/j.trre.2024.100880
Gavin G Calpin, Cian Hehir, Matthew G Davey, Benjamin M MacCurtain, Dilly Little, Niall F Davis
Introduction: 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.
Methods: A systematic review and meta-analysis was performed as per PRISMA guidelines. Outcomes of interest were extracted from included studies and analysed.
Results: 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).
Conclusion: 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.
{"title":"Right and left living donor nephrectomy and operative approach: A systematic review and meta-analysis of donor and recipient outcomes.","authors":"Gavin G Calpin, Cian Hehir, Matthew G Davey, Benjamin M MacCurtain, Dilly Little, Niall F Davis","doi":"10.1016/j.trre.2024.100880","DOIUrl":"https://doi.org/10.1016/j.trre.2024.100880","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was performed as per PRISMA guidelines. Outcomes of interest were extracted from included studies and analysed.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94259,"journal":{"name":"Transplantation reviews (Orlando, Fla.)","volume":" ","pages":"100880"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号