Challenges For Urologists In Living Kidney Donation

Main Category: Urology / Nephrology
Also Included In: Transplants / Organ Donations
Article Date: 26 May 2007 - 0:00 PDT

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UroToday.com - Dr. Daneil Shoskes moderated a panel discussion "Challenges for Urologists in Living Kidney Donation" at the Sunday Plenary session of the AUA in Anaheim, May 20, 2007.

Dr. Shoskes discussed the growth of the field of renal transplant, in particular living related transplantation (LRT). He focused on aspects of donor surgery.

The panel included Dr. Tanabe (Japan), Nahas (Brazil) and Kuhr (Seattle). Dr. Tanabe showed that a younger donor age results in better outcomes. Hypertensive donors are generally not acceptable as donors (BP >140/90). Obesity is associated with increased surgical complications and these donors have long term risks of medical conditions to include diabetes. Stone patients are also limited in donating if they have high recurrence rates or bilateral stone disease.

Dr. Nahas discussed imaging. Both MRI and CT provide all information in one technique. CT is fast and detects calcification, but MRI is radiation-free although it fails to detect calcification. Digital subtraction angiography is the gold standard to evaluate arteries, but if fails to detect a second renal artery in 14%. Laparoscopic renal donation can be difficult with a short renal vein and MRI or CT angiography is highly sensitive and specific in this regard. Renovascular abnormalities occur in 6% of cases and CT angiography is best to define vascular anatomy as it is better than MRA in defining renal vein anatomy, he concluded.

Dr. Kuhr discussed the short right renal vein, anomalous vasculature and previous abdominal surgeries as problematic for laparoscopic donor nephrectomy. Right donor nephrectomy is performed laparoscopically in 10% in the country, but 70% in his practice. Right nephrectomy is usually indicated when there are multiple left renal arteries, a smaller right kidney or a retroaortic left renal vein. Dr. Kuhr uses a hand assisted approach with four port sites. He reviewed the steps of the operation, similar to a lap radical nephrectomy. A role for open right donor nephrectomy is indicated with previous hepatic or renal surgery, complex vascular anatomy or a renal vein length <1.5cm. He concluded that right laparoscopic donor nephrectomy can be performed safely. One should preserve the best kidney for the donor.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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