If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Laparoscopic Donor Nephrectomy Is Recommended for Paediatric Procurement -- Contrary to Previous Studies: Presented at ATC By Cheryl Lathrop BOSTON -- June 7, 2009 -- Laparoscopic donor nephrectomy (LDN) offers better medium-term graft survival for paediatric recipients than open donor nephrectomy (ODN) and should be the method of choice for procurement, according to a study presented here at the 2009 American Transplant Congress (ATC) on June 2. This finding is contrary to previous reports. In both the United States and the United Kingdom, LDN is the most common form of procurement (70%) for living-donor paediatric recipients. No difference is found in outcomes in adult recipients when both LDN- and ODN-procured organs are compared. However, the United Network for Organ Sharing (UNOS) analysis of 995 paediatric recipients suggested a higher delayed graft function (DGF) and early acute rejection (AR) in the laparoscopic group. Therefore, some doubts about safety persist. Nizam Mamode, Transplantation, Guys Hospital, London, United Kingdom, reported outcomes -- graft and patient survival, AR, and DGF -- in paediatric recipients of living-donor kidneys procured by LDN and ODN. The National Health Service Blood and Transplant, UK Transplant (UKT), is a government-funded agency with mandatory reporting of all live-donor surgery since 2000. Previous analysis of the UKT database had suggested the safety of laparoscopic surgery in 2,509 donors. In this study, the UKT database was interrogated to find all donors to paediatric recipients from November 2000 to October 2007. Donor demographic and recipient outcome data were recorded, including AR, short- and long-term graft survival, and patient survival after both LDN and ODN. A total of 306 recipients were found, aged 1 to 17 years, of whom one-third were female; 119 (40%) had LDN, and 178 (60%) had ODN. A lower AR rate was found in the LDN group; no difference in DGF was seen between groups. The 1-year graft survival was higher in the LDN group, with no difference in 1-year patient survival. Patients aged younger than 5 years had no difference in 3-year patient or graft survival. In regard to AR, 10 of 28 occurred in the ODN group and 3 of 24 in the LDN group. The findings in this study suggest that LDN donation is safe for paediatric recipients. These results contradict UNOS data, but UNOS did not control for learning curves, type of LDN, or centre effect. The researchers noted that further monitoring by LDN type might be worthwhile. [Presentation title: Laparoscopic Procurement Results in Better Outcomes for Pediatric Recipients: An Analysis of 306 Cases. Abstract 420]
|
