Criteria and Relevant Prognostic Factors in Donor Selection, an Analysis of 266 Consecutive Donor Nephrectomies.

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Abstract

Objectives

The proportion of kidney transplants from live donors has steadily increased in recent years. In comparison to postmortem donation, living donor kidney transplantation results in shortening of the waiting period, significantly better transplant survival and less post-operative complications. In particular, choosing donors requires a comprehensive pre-operative evaluation for a careful selection. Aim of our analysis was to investigate relevant prognostic parameters and selection criteria in healthy kidney donors with respect to donor and recipient outcomes.

Methods

A retrospective analysis of a total of 266 consecutive renal transplantation was carried out for the period from January 2010 till September 2017, including radiological imaging, renal clearance, operation time as well as intra- and postoperative outcomes. Further, subgroup analysis for donors with anatomical vascular variations was done.

Results

Kidney donors were on average 53.3 years old [95% confidence interval (CI) 51.97 – 54.60, Standard deviation (SD) 10.71], the gender ratio (male: female) was 41% to 59%. 96% of renal donor donations were performed in a laparoscopic approach, 4% in open-surgical technique. Nephrectomy was carried out on the right side in 45% and on the left side in 55% of the donors. Mean creatinine clearance of the corresponding kidney was 49.6%. Anatomical vascular variations (>1 renal artery or vein) were present in 26% of the donors. The mean operative time was 208.7 minutes (CI 202.84 – 213.49, SD 42.69). Mean operative time for the multiple arteries (CI 204.24 – 223.14, SD 42.85) showed no relevant statistical differences [p-Value (PV) 0.18] compared to kidney with a single artery. Postoperative complications > Dindo-Clavien II occurred in less than 2% of the donors.

Conclusions

Nowadays, a live donor nephrectomy can be safely carried out. However, preoperative donor evaluation and selection requires a careful assessment, taking into account a personalised approach for all individual donor-specific risk factors.

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