This clinical trial was conducted to compare the graft survival, donor and recipient outcome, donor satisfaction, and complications of LDN (laparoscopic donor nephrectomy) and ODN (open donor nephrectomy) in kidney transplantation.
A hundred cases of LDN and 100 of ODN (mean donor age 27.8 ± 3.9 vs. 29.2 ± 5.2 years) included in our randomized controlled trial. Eligibility criteria included donor body mass index (BMI) <28, no complexity in the donor kidney vessels, recipient age of 18 to 65 years, and absence of hemolytic uremic syndrome or focal segmental glomerulosclerosis and oxalosis in recipient. Mean follow up in the LDN and ODN groups was not significantly different (406.1 versus 403.8 days, p=0.9). Mean operative time and mean kidney warm ischemia for ODN and LDN were 152.2±33.9 and 270.8±58.5 minutes (p<0.05); and 1.87 and 8.7 minutes (p=0.00), respectively. Only one laparoscopic procedure required conversion to open nephrectomy because of bleeding. Mean score for donor satisfaction was 17.3 ± 3.5 for open and 19.6 ± 1 for laparoscopic nephrectomy, respectively (p=0.00). The rate of ureteral complications was 2% in the ODN and 0% in the LDN groups (p=0.25). As determined by serum creatinine on post operative days 3, 21 to 30, 90,180, and 365, graft function was not significantly different. Long-term graft survival in the laparoscopic and open groups was 93.8% and 92.7%, respectively (p=0.7). Our modification to standard procedure sounds cost-effective. LDN is accompanied by greater donors' satisfaction, and less morbidity and equivalent graft outcome.