Renal Transplantation: Laparoscopic Live Donor Nephrectomy

Renal transplantation has been one of the most significant developments in surgery during the last century because it has markedly altered the survival of patients with end-stage renal disease. Advances in understanding transplant immunology and in drug development have led to improved patient and graft survival; however, live donation remains the single most consistent factor impacting on long-term survival. 3 Five-year graft and patient survival are significantly greater with transplantation from living related donors versus cadavers. 1 Living transplants are associated with improved graft survival, shorter waiting times, optimization of medical health of the recipient, and overall reduced cost when compared with cadaveric transplantation. Although live donor renal transplants are increasing, they currently account for a minority of transplants. Living donors are involved in approximately 25% of transplants performed in the United States. Unfortunately, the demand for kidneys continues to outpace the availability of organs. According to the 1998 United Network for Organ Sharing data registry, more than 40,800 patients are currently awaiting renal transplants. 2 Waiting lists have increased at an annual rate of 12% while the number of transplants performed has increased by only 4% per year. This trend is reflected in the increased waiting times for cadeveric transplants, which have grown from 400 days in 1988 to 824 days in 1996. 2 One potential solution to the organ shortage is to increase live donation; however, there are several disincentives to individuals contemplating donation. Live renal donation is a unique operative situation that places a healthy individual at risk for morbidity and mortality to aid a sick individual. Healthy donors must experience a significant postsurgical recovery while sacrificing time from work and their families. The surgeon must attempt to minimize potential donor morbidity while at the same time delivering an optimal kidney for transplantation. Laparoscopic live donor nephrectomy was developed to help decrease disincentives to live donation. 16 Although kidney removal requires an incision, it is placed in a location and minimized to reduce postoperative pain, quicken recovery, and optimize the cosmetic result.