Klinisch I - P13 - Peri-operative events and complications in minimally-invasive live donor nephrectomy: what should we tell potential donors? A systematic review and meta-analysis

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K. Kortram, J.N.M Ijzermans, F.J.M.F. Dor

Chair(s): prof. dr. Jaap Homan van der Heide, nefroloog, AMC

Thursday 10 march 2016

13:30 - 14:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

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Background:
There are many different techniques for live donor nephrectomy, preferences vary per center. A small number of randomized controlled trials have been performed comparing these different techniques with regard to complications and adverse events. Donors have to be educated about all risks and details during the informed consent process. For this to be successful, more information regarding short-term outcome is necessary.

Purpose:
To systematically assess short term complications after minimally-invasive live donor nephrectomy and to compare different techniques currently employed for this procedure.

Methods:
A literature search was performed, all studies discussing short-term complications after minimally-invasive live donor nephrectomy were included. Outcomes evaluated were intra- and postoperative complications, conversions, operative and warm ischemia times, blood loss, length of hospital stay, pain score, convalescence, quality of life and costs.

Results:
174 Articles were included in the systematic review, 37 in the meta-analysis. Conversion rate was 1.3%. Intraoperative complication rate was 2.4%, bleeding being the most frequent (1.6%). Postoperative complications occurred in 6.8% of donors. Ileus (6.3%) infectious complications (2.6%), wound infection (1.6%) and bleeding (1.1%) were encountered most. Mortality was reported in 128 articles, three fatalities were described (0.02%). None of the minimally-invasive techniques stood out from the rest with regard to complication- or conversion rate. A few minor differences were identified: intra-operative bleeding was more often encountered after hand-assisted procedures (3.9 vs 3.7%, p=0.04), as was postoperative ileus (1.7 vs 0.3%, p=0.06). When compared to mini-open procedures, intra-operative events occurred more often after laparoscopic procedures: 10.2 vs 4.2%, p=0.02, but postoperative infections were more often seen after mini-open procedures; 18% versus 7.9%, p=0.03. This was mainly attributed to an increased incidence of pneumonia after mini-open procedures: 7.9 versus 4.3%, p=0.04.

Conclusions:
Minimally-invasive live donor nephrectomy is safe, and associated with low complication rates and an even lower risk of mortality. These data, combined with further analysis of donor comprehension and satisfaction will assist us in developing a standardized, donor-tailored informed consent procedure for live donor nephrectomy.