Complications After Hand-Assisted Laparoscopic Living Donor Nephrectomy

[Clark]

https://www.sciencedirect.com/science/article/abs/pii/S0025619621008752

Complications After Hand-Assisted Laparoscopic Living Donor Nephrectomy
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Xiomara Benavides
https://doi.org/10.1016/j.mayocp.2021.11.023

Abstract

Objective
To study the complications of hand-assisted laparoscopic living donor nephrectomy (HALLDN) with an emphasis on complications occurring early after hospital discharge up to 120 days after surgery.
Patients and Methods
We retrospectively categorized complications using the Clavien-Dindo classification in 3002 HALLDNs performed at 1 center from January 1, 2000, through December 31, 2019. In addition to overall summaries, modeling was used to identify correlates of complications before and after living donation.

Results
Of these donors, 87% were White, 59% were female, the mean age was 45 years (range, 18-77 years), 30.3% had a body mass index of at least 30, and 36.3% had previous abdominopelvic surgery. There were no deaths related to the surgery. The incidence of major complications (intraoperative complications plus Clavien-Dindo grade ≥III postoperatively) was 2.5% (n=74). The overall complication rate was 12.4% (n=371), including 15 intraoperative, 76 postoperative before discharge, and 280 after discharge to 120 days. Reoperation was required in 1.8% of patients (n=54), and all but 1 of these were incision-related problems. Seventy-six percent of all complications occurred after discharge, including 85% of the reoperations. For major complications, no risk factor was found. Risk factors for any complication included paramedian incision (hazard ratio
, 2.54; 95% CI, 1.49 to 4.34; P<.001); a history of abdominopelvic surgery (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), male sex (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), non-White race (HR, 1.40; 95% CI, 1.05 to 1.88; P=.02), and early era of the experience.[/font][/size]

Conclusion
Most major complications of HALLDN occur after discharge, suggesting that close follow-up is warranted and that the current literature may underestimate the true incidence.

[Clark]

Full disclosure: I underwent this procedure in 2003, so my surgery must be one of these. As a white male, at the time 44 years old, and at the time a BMI of 23. I believe my abdominal issues since then are not a result of surgical complications, whoever the state of being a donor with one kidney has affected medical decision making about appropriate treatment options and recommendations, and changed the risk profiles for the conditions I have experienced, considered normal changes due to aging.