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| Right versus left fully robotic live donor nephrectomy and open kidney transplantation: Does the laterality of the donor kidney really matter? |
Brianna Rucha,Deki Tseringa,Chandra Bhatib,Dhiren Kumara,Muhammad Saeeda,Seung Duk Leea,Aamir Khana,Daisuke Imaia,David Brunoa,Marlon Levya,Adrian Cotterella,Amit Sharmaa,*( )
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aHume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
bDivision of Transplant Surgery, University of Maryland, Baltimore, MD, USA |
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Abstract Objective: Robotic-assisted live donor nephrectomy (LDN) is being gradually adopted across transplant centers. The left donor kidney is preferred over right due to anatomical factors and ease of procurement. We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys. Methods: All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed. Results: Out of 196 robotic LDN (49 [right] vs. 147 [left]), 10 (5.1%) donors had intra-operative events (6.1% [right] vs. 4.8% [left], p=0.71). None of the LDN required conversion to open surgery. The operative times were comparable for the two groups. Nausea (13.3%) was the most common post-operative complication. There was no mortality in either LDN group. Herein, we report our outcomes on 156 recipients (39 right and 117 left allografts) excluding robotic implants, exports, and pediatric recipients. There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival (100.0% vs. 98.1%, p=0.45) or graft survival (93.9% vs. 97.1%, p=0.11), or delayed graft function (7.7% vs. 5.1%, p=0.55). Conclusion: Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes. Right LDN was not associated with higher incidence of complications compared to left LDN. Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.
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Received: 06 February 2023
Available online: 20 October 2023
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Corresponding Authors:
*E-mail address: amit.sharma@vcuhealth.org (A. Sharma).
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| Characteristic | Right LDN (n=49) | Left LDN (n=147) | p-Value | | Age, mean±SD, year | 43.8±13.3 | 41.5±11.8 | 0.23 | | Females, n (%) | 33 (67.3) | 89 (60.5) | 0.39 | | BMI, mean±SD, kg/m2 | 27.0±4.2 | 27.3±4.5 | 0.69 | | Race, % | | | - | | Caucasian | 73.5 | 61.9 | | African American | 24.4 | 31.9 | | Others | 2.1 | 6.2 | | Employment, % | | | - | | Full-time | 83.7 | 80.3 | | Unemployed | 0 | 6.8 | | Other | 16.3 | 12.9 | | Relationship to donor, % | | | - | | Relative | 30.6 | 42.9 | | Spouse | 30.6 | 12.2 | | Friend | 30.6 | 37.4 | | Altruism | 8.2 | 7.5 |
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Demographics of live kidney donors.
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| Characteristic | Right LDN (n=49) | Left LDN (n=147) | p-Value | | da Vinci robotic assist, n (%) | | Xi | 40 (81.6) | 112 (76.2) | 0.43 | | Si | 9 (18.4) | 35 (23.8) | 0.43 | | Operative time, mean±SD, min | 186.8±32.5 | 195.0±40.9 | 0.18 | | Blood loss, mean±SD, mL | 41.4±63.8 | 35.0±29.4 | 0.74 | | Renal anatomy, n (%) | | Two arteries | 8 (16.3) | 28 (19.0) | 0.67 | | Two veins | 10 (20.4) | 7 (4.8) | 0.001 | | Hospital stay, mean±SD, day | 3.4±0.8 | 3.3±0.8 | 0.33 | | Serum creatinine, mean±SD, mg/dL | | Pre-donation | 0.82±0.16 | 0.85±0.17 | 0.20 | | 2-week post-donation | 1.25±0.27 | 1.32±0.29 | 0.14 | | 6-month post-donation | 1.21±0.22 | 1.23±0.24 | 0.69 | | eGFR, mean±SD, mL/min | | Pre-donation | 98.6±16.4 | 100.3±15.3 | 0.53 | | 2-week post-donation | 63.0±15.6 | 61.0±13.6 | 0.48 | | 6-month post-donation | 65.5±16.3 | 64.9±14.2 | 0.47 |
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Peri-operative characteristics of robotic live kidney donors.
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| Complication | Right LDN (n=49) | Left LDN (n=147) | Intervention | Clavien-Dindo grade | | Intra-operative | 3 (6.1) | 7 (4.8) | | | | Renal artery stump bleeding | 1 (2.0) | 1 (0.7) | Clip over staple line | - | | Colon mesentery tear | 0 | 2 (1.4) | Mesenteric defect clipped | - | | Gallbladder perforation | 1 (2.0) | 0 | Gallbladder suture repaired | - | | Ureter transected distally | 1 (2.0) | 0 | Used without sequelae | - | | Renal subcapsular hematoma | 0 | 2 (1.4) | No sequelae | - | | Chyle leak | 0 | 2 (1.4) | Lymph leak clipped | - | | Post-operative | 14 (28.6) | 35 (23.8) | | | | Nausea | 9 (18.4) | 17 (11.6) | Anti-emetics | I | | Atelectasis | 2 (4.1) | 3 (2.0) | Chest physiotherapy | I | | Incisional pain | 0 | 3 (2.0) | Oral narcotics | I | | Stridor | 0 | 1 (0.7) | Observation | I | | Reflux esophagitis | 0 | 1 (0.7) | Anti-acid cocktail | I | | Rhabdomyolysis | 0 | 1 (0.7) | Fluids (i.v.) | I | | Testicular swelling | 0 | 2 (1.4) | Observation | I | | Hypotension | 1 (2.0) | 0 | Fluids (i.v.) | I | | Narcotic overdose | 0 | 1 (0.7) | Narcan for reversal | II | | Severe constipation | 1 (2.0) | 0 | Enemas | II | | Meralgia paresthetica | 0 | 1 (0.7) | Neurectomy | III | | Surgical site infection | 0 | 1 (0.7) | Antibiotics | II | | COVID-19 | 0 | 1 (0.7) | Supportive care | I | | Spontaneous pneumothorax | 0 | 1 (0.7) | Chest tube | III | | Pulmonary embolus | 1 (2.0) | 0 | Anticoagulation | II | | Chylous ascites | 0 | 1 (0.7) | Diet, paracentesis | III | | Internal hernia | 0 | 1 (0.7) | Operative repair | III |
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Peri-operative complications of robotic LDN.
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| Parameter | Right kidney recipient (n=39) | Left kidney recipient (n=117) | p-Value | | Age, mean±SD, year | 47.7±15.1 | 50.2±15.3 | 0.38 | | BMI, mean±SD, kg/m2 | 28.6±6.1 | 29.2±6.0 | 0.63 | | Female, n (%) | 16 (41.0) | 63 (53.8) | 0.17 | | Prior dialysis, n (%) | 27 (69.2) | 84 (71.8) | 0.76 | | Prior kidney transplant, n (%) | 5 (12.8) | 10 (8.5) | 0.43 | | Female to male donation, n (%) | 12 (30.8) | 27 (23.1) | 0.34 | | Blood loss, mean±SD, mL | 173.5±167.9 | 150.6±163.9 | 0.87 | | Cold ischemia time, mean±SD, min | 60.4±48.2 | 68.4±61.1 | 0.53 | | Warm ischemia time, mean±SD, min | 33.0±13.3 | 31.3±6.0 | 0.57 |
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Demographics and peri-operative parameters of renal transplant recipients.
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| Outcome | Right kidney recipient (n=39) | Left kidney recipient (n=117) | p-Value | | Hospital stay, mean±SD, day | 5.1±1.8 | 5.2±3.0 | 0.85 | | Serum-creatinine at 1-year, mean±SD, mg/dL | 1.29±0.48 | 1.42±0.38 | 0.12 | | Patient survival at 1-year, % | 100.0% (33/33) | 98.1% (103/105)a | 0.45 | | Graft survival at 1-year, % | 93.9% (31/33)b | 97.1% (102/105)a | 0.11 | | Complication, n (%) | | Early graft loss | 2 (5.1)b | 1 (0.9)a | 0.09 | | Delayed graft function | 3 (7.7) | 6 (5.1) | 0.55 | | Acute rejection | 2 (5.1) | 2 (1.7) | 0.24 | | Urinary infections | 4 (10.3) | 7 (6.0) | 0.37 | | Renal artery stenosis | 1 (2.6) | 0 | - | | Vascular thrombosis | 1 (2.6) | 1 (0.9) | 0.41 | | Re-exploration for bleeding | 0 | 2 (1.7) | - | | Renal torsion | 1 (2.6) | 0 | - | | Ureteral stricture | 1 (2.6) | 1 (0.9) | 0.41 | | Wound seroma | 0 | 4 (3.4) | - | | Lymphocele | 0 | 4 (3.4) | - | | DVT/PE | 1 (2.6) | 3 (2.6) | 1.00 | | Ileus | 1 (2.6) | 1 (0.9) | 0.41 | | Myocardial infarction | 0 | 3 (2.6) | - |
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Recipient outcomes after live donor kidney transplantation.
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