Laparoscopic Living Donor Nephrectomy: Low Surgical Risk for High-quality Grafts

Abstract Renal transplantation is most important for patients with end-stage renal disease to preserve their survival and quality of life. Living donation has decisive advantages over deceased donor kidney transplantation, and with the continuing organ shortage, it also can reduce the number of patients waiting for an organ. The major problem with living kidney donation is that a healthy person has to undergo a substantial surgical procedure to provide the organ for transplantation; therefore, a nephrectomy technique that is associated with the lowest surgical risk for the donor and the best organ quality for the recipient should be used. Since its introduction by Ratner and colleagues in 1995, laparoscopic donor nephrectomy has become the technique of choice at many major transplant centres. The aim is to achieve less postoperative pain, shorter hospitalisation time, more rapid return to normal activities, a more cosmetically acceptable incision, and, in particular, a greater patient acceptance. All techniques for living donor nephrectomy (open donor nephrectomy, "pure" laparoscopic donor nephrectomy, hand-assisted laparoscopic donor nephrectomy, robot-assisted laparoscopic donor nephrectomy, laparoscopic donor nephrectomy via natural orifice transluminal endoscopic surgery or laparoendoscopic single-site surgery, and retroperitoneoscopic donor nephrectomy) achieve good results, in so far as they are performed at specialised centres. Perioperative complications are rare, and the quality of the grafts is excellent. Renal graft function is specified at up to 96% at 1 yr and 85% at 5 yr after living donor kidney transplantation. Patient summary Living donation has decisive advantages over deceased donor kidney transplantation. When performed at specialised centres, living donor nephrectomy achieves good results, with few perioperative complications and excellent graft quality.