The emergence of robot-assisted laparoscopic donor nephrectomy (RLDN) and new findings regarding renal transplant patients' cancer risk highlight the discussions of transplantation/vascular surgery discussions at this year's AUA meeting.
Christopher L. Marsh
The emergence of robot-assisted laparoscopic donor nephrectomy (RLDN) and new findings regarding renal transplant patients' cancer risk highlight the discussions of transplantation/vascular surgery discussions at this year's AUA meeting. The transplantation/vascular surgery take-home messages were presented by Christopher L. Marsh, MD of Scripps Center for Organ Transplantation, La Jolla, CA.
Robot-assisted laparoscopic donor nephrectomy (RLDN) is beginning to be rolled out, but long-term data are needed to confirm its feasibility. Compared to standard laparoscopic donor nephrectomy, RLDN required longer operation time and warm ischemia time but had shorter hospital stays. Complication rates were similar.
Kidney transplant recipients show higher risk of cancers such as kidney and bladder cancer.
Transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy is a feasible and reproducible alternative to laparoscopic live donor nephrectomy in select cases. The approaches were similar in cold/hot ischemia time, operation time, and length of stay.
Kidneys from older donors (>70 years of age) appear to be feasible for transplantation. Age of donor did not affect graft loss. In donations from donors under age 70 years, average serum creatinine was significantly lower up until 36 months. Cumulative graft survival at 1, 3, and 4 years was lower for kidneys from older donors.
Renal transplant recipients who required percutaneous nephrostomy had similar graft survival as the general transplant population (11.9 vs. 10.5 years). At 63%, distal ureteral stricture was the most common indication.
Robot-assisted re-do ureteroneocystostomy can be performed with acceptable results (despite lengthy operative time) and is linked to early recovery, with all patients discharged on the first day with Foley catheter for 1 week.