To study the effects of warm ischamia time (WIT) during laparoscopic live donor nephrectomy on graft outcomes. In particular, serum creatinine, acute rejection rate and infection episodes during the first year.
Retrospective analysis of 52 succesful laparoscopic live donor nephrectomies performed between 1999 and 2004. Case notes and computer data were reviewed for all donors and recipients. For analysis purposes, recipients were divided into two groups, those receiving a kidney with a WIT <= 3 minutes, and those with a WIT > 3minutes. The following parameters were compared between groups, HLA-mismatch, graft number, rejection episodes, infection episodes, graft survival at one year, and creatinine at day 0, 1, 3, 7, 10, 90, 180, and 365. Analysis was carried out using Fisher Exact test and Student t-test.
All nephrectomies were completed laparoscopically. Of the 52 recipients 13 were <18years of age. Table.1 shows demographic data of both groups. Age of donors/recipients was equally distributed between groups, however, there were more male (donor and recipient) in the longer WIT. There was no difference in HLA mismatch or transplant number between the two groups.
TABLE 1: Demographic data
There was no graft loss in the first year. WIT became shorter over time, ranging from 1-15minutes (mean 4.1±0.4 minutes). Taking into account HLA-mismatch, and number of grafts, there was a trend towards more rejection episodes in recipients of a kidney with a longer WIT, however this did not reach statistical significance (p=0.089).
There was no difference in the rate of decline in serum creatinine in the first three months between the two groups. In addition, delta creatinine (3-12 months) was not affected by the length of WIT (p=0.4). For infective episodes there was no difference between the two groups (p=0.11).
The length of WIT appears to have no effect upon the recipient’s creatinine in the first year. The observed trend towards more rejection episodes in patients receiving a kidney with a longer WIT needs futher evaluation.