Early and late surgical complications following living donor nephrectomy
DOI:
https://doi.org/10.2340/sju.v60.43346Keywords:
Laparoscopy, hand-assisted laparoscopy, nephrectomy, living kidney donor, surgical complications, renal transplantationAbstract
Objective: To report early and late surgical complications following laparoscopic, open and hand-assisted laparoscopic living donor nephrectomy, including duration of sick leave, kidney function and potential risk factors for surgical complications.
Material and methods: Retrospective study on living kidney donors between September 2014 and June 2021 at Rigshopitalet, Copenhagen. Patient data included demographics, comorbidities, surgical information, and postoperative complications (early <30 days and late >30 days). Complications were graded according to Clavien Dindo (CD). Return to work and reasons for prolonged sick leave were recorded.
Multivariable logistic regression to identify risk factors for early complications CD ≥ 2 and time-dependent cause specific Cox regression to identify risk factors for late complications.
Results: A total of 223 living donors were included. Early complications were observed in 22% of donors. Early complications were often mild, and the most common complications were pneumonia, wound infection, and urinary retention. Of the 201 donors available for long-term follow-up, 10% experienced a late complication, including incisional port-site hernia and chronic post-surgical pain. 18% reported a prolonged sick leave beyond the planned 6 weeks.
Conclusions: Living donor nephrectomy is associated with a low risk of serious early surgical complications although many will experience minor related complications. As surgical safety has been confirmed in several studies the focus should be on the psychoscial and long-term aspects of living kidney donation to meet donor concerns pre-donation.
Downloads
References
Fuggle SV, Allen JE, Johnson RJ, et al. Factors affecting graft and patient survival after live donor kidney transplantation in the UK. Transplantation. 2010;89(6):694–701.
Chapman JR, Baan CC, Bromberg JS, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation [Internet]. 2017;101(8):8–9. Available from: www.transplantjournal.com [cited May 2024]
Dagnæs-Hansen J, Kristensen GH, Stroomberg HV, et al. Surgical approaches and outcomes in living donor nephrectomy: a systematic review and meta-analysis. Eur Urol Focus. 2022;8(6):1795–1801. https://doi.org/10.1016/j.euf.2022.03.021 DOI: https://doi.org/10.1016/j.euf.2022.03.021
Sterkenburg A, Kulu Y, Mieth M, et al. Long-term surgical outcome and risk factors in living kidney donors. Transplant Proc. 2020;52(3):722–730. https://doi.org/10.1016/j.transproceed.2019.12.044 DOI: https://doi.org/10.1016/j.transproceed.2019.12.044
Bellini MI, Nozdrin M, Pengel L, et al. Risks for donors associated with living kidney donation: meta-analysis. BJS 2022, 109, 671-678. https://doi.org/10.1093/bjs/znac114 DOI: https://doi.org/10.1093/bjs/znac114
Serrano OK, Sengupta B, Bangdiwala A, et al. Implications of excess weight on kidney donation: long-term consequences of donor nephrectomy in obese donors. Surgery. 2018;164(5):1071–1076. https://doi.org/10.1016/j.surg.2018.07.015 DOI: https://doi.org/10.1016/j.surg.2018.07.015
Oguten EG, Barlas IS, Akin EB. Mental distress symptoms and life satisfaction among living kidney donors: frequency and association with subjective evaluations. Transplant Proc. 2019;51(7):2232–2236. https://doi.org/10.1016/j.transproceed.2019.01.154 DOI: https://doi.org/10.1016/j.transproceed.2019.01.154
Hanson CS, Chapman JR, Gill JS, et al. Identifying outcomes that are important to living kidney donors: a nominal group technique study. Clin J Am Soc Nephrol. 2018;13(6):916–926. DOI: https://doi.org/10.2215/CJN.13441217
Hanson CS, Sautenet B, Craig JC, et al. Informative for decision making? The spectrum and consistency of outcomes after living kidney donation reported in trials and observational studies. Transplantation. 2019;103(2):284–290. https://doi.org/10.1097/TP.0000000000002489 DOI: https://doi.org/10.1097/TP.0000000000002489
Mitropoulos D, Artibani W, Graefen M, et al. Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol. 2012;61(2):341–349. https://doi.org/10.1016/j.eururo.2011.10.033 DOI: https://doi.org/10.1016/j.eururo.2011.10.033
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: developement and validation. J Chron Dis. 1987;40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8 DOI: https://doi.org/10.1016/0021-9681(87)90171-8
Clavien PA, Barkun J, De Oliveira ML, et al. The clavien-dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 DOI: https://doi.org/10.1097/SLA.0b013e3181b13ca2
Serrano OK, Kirchner V, Bangdiwala A, et al. Evolution of living donor nephrectomy at a single center: long-term outcomes with 4 different techniques in greater than 4000 donors over 50 years. Transplantation. 2016;100(6):1299–1305. https://doi.org/10.1097/TP.0000000000001251 DOI: https://doi.org/10.1097/TP.0000000000001251
Rogde ÅJ, Gudbrandsdottir G, Hjelle KM, et al. Obesity is associated with an improved cancer-specific survival, but an increased rate of postoperative complications after surgery for renal cell carcinoma. Scand J Urol Nephrol. 2012;46(5):348–357. https://doi.org/10.3109/00365599.2012.678382 DOI: https://doi.org/10.3109/00365599.2012.678382
Pyrgidis N, Schulz GB, Stief C, et al. Surgical trends and complications in partial and radical nephrectomy: results from the GRAND study. Cancers (Basel). 2023;16(1):97. DOI: https://doi.org/10.3390/cancers16010097
Saifee Y, Bhatia S, Chamania CS, et al. Introduction of laparoscopic donor nephrectomy: challenges, outcomes and success strategies. Int J Organ Transplant Med. 2021;12(1):23–31.
Kortram K, Ijzermans JNM, Dor FJMF. Perioperative events and complications in minimally invasive live donor nephrectomy: a systematic review and meta-analysis. Transplantation. 2016;100(11):2264–2275. https://doi.org/10.1097/TP.0000000000001327 DOI: https://doi.org/10.1097/TP.0000000000001327
Schoephoerster J, Matas A, Jackson S, et al. Orchialgia after living donor nephrectomy: an underreported entity. Transplant Direct. 2022;8(11):E1383. https://doi.org/10.1097/TXD.0000000000001383 DOI: https://doi.org/10.1097/TXD.0000000000001383
Bruintjes MHD, van Helden EV, de Vries M, et al. Chronic pain following laparoscopic living-donor nephrectomy: prevalence and impact on quality of life. Am J Transpl. 2019;19(10):2825–2832. https://doi.org/10.1111/ajt.15350 DOI: https://doi.org/10.1111/ajt.15350
EAU Guidelines on Renal Transplantation. Edn presented at the EAU Annual Congress Milan March 2023 ISBN 978-94-92671-19-6 [Internet]. 2023; Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Renal-Transplantation-2023.pdf [cited May 2024]
Elmaraezy A, Abushouk AI, Kamel M, et al. Should hand-assisted retroperitoneoscopic nephrectomy replace the standard laparoscopic technique for living donor nephrectomy? A meta-analysis. Int J Surg. 2017;40:83–90. https://doi.org/10.1016/j.ijsu.2017.02.018 DOI: https://doi.org/10.1016/j.ijsu.2017.02.018
Meyer KB, Hartmann A, Mjøen G, et al. Relationships between clinical, self-reported, and donation specific outcomes: a prospective follow-up study 10 years after kidney donation. Ann Transplant. 2017;22:148–155. https://doi.org/10.12659/AOT.902330 DOI: https://doi.org/10.12659/AOT.902330
Lauridsen MB, Skov K, Øzbay LA. Short-term outcome of danish kidney donors: postoperative complications and labor affiliation. Transplant Proc. 2022;54(7):1763–1767. https://doi.org/10.1016/j.transproceed.2022.05.021https://doi.org/10.1016/j.transproceed.2022.05.021 DOI: https://doi.org/10.1016/j.transproceed.2022.05.021
Klop KWJ, Kok NFM, Dols LFC, et al. Cost-effectiveness of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: a randomized study. Transplantation. 2013;96(2):170–175. https://doi.org/10.1097/TP.0b013e318296ca25 DOI: https://doi.org/10.1097/TP.0b013e318296ca25
Sommerer C, Bougioukou Z, Georgiou VL, et al. Shift in living kidney donor demographics over the past 50 years in a german transplant center. Ann Transplant. 2021;26:1–12. https://doi.org/10.12659/AOT.929693 DOI: https://doi.org/10.12659/AOT.929693
Westenberg LB, van Londen M, Sotomayor CG, et al. The association between body composition measurements and surgical complications after living kidney donation. J Clin Med. 2021;10(1):155. https://doi.org/10.3390/jcm10010155 DOI: https://doi.org/10.3390/jcm10010155
Grønkjær M, Eliasen M, Skov-Ettrup LS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52–71. https://doi.org/10.1097/SLA.0b013e3182911913 DOI: https://doi.org/10.1097/SLA.0b013e3182911913
Mjøen G, Øyen O, Holdaas H, et al. Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation. 2009;88(11):1273–1279. https://doi.org/10.1097/TP.0b013e3181bb44fd DOI: https://doi.org/10.1097/TP.0b013e3181bb44fd
Kauffman-Ortega C, Martínez-Delgado GH, Garza-Gangemi AM, et al. Short- and mid-term impact of tobacco smoking on donor renal function following living kidney donation at a tertiary referral hospital. Rev Invest Clin. 2021;73(4):238–244. https://doi.org/10.24875/RIC.20000622 DOI: https://doi.org/10.24875/RIC.20000622
Muzaale AD, Massie AB, Wang MC, et al. Risk of end-stage renal disease following live kidney donation. JAMA. 2014;311(6):579–586. https://doi.org/10.1001/jama.2013.285141 DOI: https://doi.org/10.1001/jama.2013.285141
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Julia Dagnæs-Hansen, Gitte H. Kristensen, Malene Rohrsted, Søren S. Sørensen, Andreas Røder
This work is licensed under a Creative Commons Attribution 4.0 International License.
As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
