Critical analysis of laparoscopic donor nephrectomy in the setting of complex renal vasculature: initial experience and intermediate outcomes.

OBJECTIVE: We report our experience with laparoscopic donor nephrectomy (LDN) in the setting of complex renal vasculature and critically analyze the technique and intermediate recipient outcomes.
METHODS: Thirty-nine living renal donors with multiple renal arteries or veins, or anomalous venous anatomy, who underwent LDN between 2003 and 2007 at our institution were retrospectively reviewed. Demographic and perioperative data were collected on donors and recipients.
RESULTS: Complex vasculature consisted of multiple renal arteries in 26 cases (67%), multiple renal veins in 10 cases (26%), retroaortic renal vein in 5 cases (13%), circumaortic renal vein in 4 cases (10%), and a persistent left-sided inferior vena cava (IVC) in 1 case (3%). Thirty-four (87%) patients had a single anomaly and five (13%) had multiple anomalies. Mean operative time was 196.3 minutes (range 135-311 minutes), mean blood loss was 99.4 mL (range 25-400 mL), and mean hospitalization period was 2.6 days (range 1-4 days). Donor creatinine preoperatively and at discharge was 0.8 mg/dL and 1.2 mg/dL, respectively. Mean warm ischemia time was 168.9 seconds (range 90-300 seconds). Mean recipient creatinine at the time of discharge was 1.45 mg/dL, and nadir creatinine at 1 and 2 years follow-up was 1.41 mg/dL and 1.30 mg/dL, respectively. There were three (7.7%) intraoperative complications and two (5%) cases of allograft failure over the 2-year period.
CONCLUSIONS: LDN in patients with complex vascular anatomy is safe and efficacious and does not negatively impact the complication rate or recipient outcomes. This procedure may improve the availability of allografts.