Kun Wang1, Peijin Zhang, Xianlin Xu, Min Fan. 1. Department of Surgical Urology, The Third Affiliated Hospital of Soochow University, Jiangsu Changzhou, 213003; and Department of Public Health, Xuzhou Medical College, Xuzhou, China.
Abstract
OBJECTIVES: We assessed the safety and efficacy of right versus left laparoscopic living-donor nephrectomy. Few clinical controlled studies have compared the right and left side, and most trials have a small sample number and varied results. A meta-analysis of published trials was performed to determine the effects of the 2 different approaches. MATERIALS AND METHODS: Major databases including Medline (PubMed), Embase, Ovid, and Cochrane were searched to identify studies comparing right and left laparoscopic living-donor nephrectomy (January 2000 to January 2014). Outcomes evaluated included operative time, warm ischemia time, operative blood loss, 1-year graft loss, donor intraoperative and postoperative complications, recipient postoperative complications, donor blood transfusion, conversion to open donor nephrectomy, length of donor hospital stay, and delayed graft function. RESULTS: There were 15 studies included with 3073 patients (left, 2420 patients [78%]; right, 653 patients [22%]). The right group had shorter operative time (weighted mean difference, -13.44 min; 95% confidence interval, -22.73 to -4.15 min; P = .005) and lower operative blood loss (weighted mean difference, -10.53 mL; 95% confidence interval, -17.43 to -3.64 mL; P = .003) than the left group. There was a higher rate of overall donor intraoperative complications in the left group (odds ratio, 0.53; 95% confidence interval, 0.31-0.92; P = .03). There were no differences between groups in hospital stay, delayed graft function, recipient 1-year graft loss, conversion to open donor nephrectomy, donor blood transfusion, and donor or recipient postoperative complications. CONCLUSIONS: Right and left laparoscopic living-donor nephrectomy were similar in the effect of surgery and postoperative graft function. When there are no differences in bilateral renal function, surgeons can transplant the right or left kidney. However, the longer renal vein of the left kidney could decrease operative difficulty, and we recommend using the left kidney in clinical practice.
OBJECTIVES: We assessed the safety and efficacy of right versus left laparoscopic living-donor nephrectomy. Few clinical controlled studies have compared the right and left side, and most trials have a small sample number and varied results. A meta-analysis of published trials was performed to determine the effects of the 2 different approaches. MATERIALS AND METHODS: Major databases including Medline (PubMed), Embase, Ovid, and Cochrane were searched to identify studies comparing right and left laparoscopic living-donor nephrectomy (January 2000 to January 2014). Outcomes evaluated included operative time, warm ischemia time, operative blood loss, 1-year graft loss, donor intraoperative and postoperative complications, recipient postoperative complications, donor blood transfusion, conversion to open donor nephrectomy, length of donor hospital stay, and delayed graft function. RESULTS: There were 15 studies included with 3073 patients (left, 2420 patients [78%]; right, 653 patients [22%]). The right group had shorter operative time (weighted mean difference, -13.44 min; 95% confidence interval, -22.73 to -4.15 min; P = .005) and lower operative blood loss (weighted mean difference, -10.53 mL; 95% confidence interval, -17.43 to -3.64 mL; P = .003) than the left group. There was a higher rate of overall donor intraoperative complications in the left group (odds ratio, 0.53; 95% confidence interval, 0.31-0.92; P = .03). There were no differences between groups in hospital stay, delayed graft function, recipient 1-year graft loss, conversion to open donor nephrectomy, donor blood transfusion, and donor or recipient postoperative complications. CONCLUSIONS: Right and left laparoscopic living-donor nephrectomy were similar in the effect of surgery and postoperative graft function. When there are no differences in bilateral renal function, surgeons can transplant the right or left kidney. However, the longer renal vein of the left kidney could decrease operative difficulty, and we recommend using the left kidney in clinical practice.
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