Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study

Carlos Garcia-Ochoa, Liane S Feldman, Christopher Nguan, Mauricio Monroy-Cuadros, Jennifer Arnold, Neil Boudville, Meaghan Cuerden, Christine Dipchand, Michael Eng, John Gill, William Gourlay, Martin Karpinski, Scott Klarenbach, Greg Knoll, Krista L Lentine, Charmaine E Lok, Patrick Luke, G V Ramesh Prasad, Alp Sener, Jessica M Sontrop, Leroy Storsley, Darin Treleaven, Amit X Garg, Donor Nephrectomy Outcomes Research (DONOR) Network, Carlos Garcia-Ochoa, Liane S Feldman, Christopher Nguan, Mauricio Monroy-Cuadros, Jennifer Arnold, Neil Boudville, Meaghan Cuerden, Christine Dipchand, Michael Eng, John Gill, William Gourlay, Martin Karpinski, Scott Klarenbach, Greg Knoll, Krista L Lentine, Charmaine E Lok, Patrick Luke, G V Ramesh Prasad, Alp Sener, Jessica M Sontrop, Leroy Storsley, Darin Treleaven, Amit X Garg, Donor Nephrectomy Outcomes Research (DONOR) Network

Abstract

Background: While living kidney donation is considered safe in healthy individuals, perioperative complications can occur due to several factors.

Objective: We explored associations between the incidence of perioperative complications and donor characteristics, surgical technique, and surgeon's experience in a large contemporary cohort of living kidney donors.

Design: Living kidney donors enrolled prospectively in a multicenter cohort study with some data collected retrospectively after enrollment was complete (eg, surgeon characteristics).

Setting: Living kidney donor centers in Canada (n = 12) and Australia (n = 5).

Patients: Living kidney donors who donated between 2004 and 2014 and the surgeons who performed the living kidney donor nephrectomies.

Measurements: Operative and hospital discharge medical notes were collected prospectively, with data on perioperative (intraoperative and postoperative) information abstracted from notes after enrollment was complete. Complications were graded using the Clavien-Dindo system and further classified into minor and major. In 2016, surgeons who performed the nephrectomies were invited to fill an online survey on their training and experience.

Methods: Multivariable logistic regression models with generalized estimating equations were used to compare perioperative complication rates between different groups of donors. The effect of surgeon characteristics on the complication rate was explored using a similar approach. Poisson regression was used to test rates of overall perioperative complications between high- and low-volume centers.

Results: Of the 1421 living kidney donor candidates, 1042 individuals proceeded with donation, where 134 (13% [95% confidence interval (CI): 11%-15%]) experienced 142 perioperative complications (55 intraoperative; 87 postoperative). The most common intraoperative complication was organ injury and the most common postoperative complication was ileus. No donors died in the perioperative period. Most complications were minor (90% of 142 complications [95% CI: 86%-96%]); however, 12 donors (1% of 1042 [95% CI: 1%-2%]) experienced a major complication. No statistically significant differences were observed between donor groups and the rate of complications. A total of 43 of 48 eligible surgeons (90%) completed the online survey. Perioperative complication rates did not vary significantly by surgeon characteristics or by high- versus low-volume centers.

Limitations: Operative and discharge reporting is not standardized and varies among surgeons. It is possible that some complications were missed. The online survey for surgeons was completed retrospectively, was based on self-report, and has not been validated. We had adequate statistical power only to detect large effects for factors associated with a higher risk of perioperative complications.

Conclusions: This study confirms the safety of living kidney donation as evidenced by the low rate of major perioperative complications. We did not identify any donor or surgeon characteristics associated with a higher risk of perioperative complications.

Trial registrations: NCT00319579: A Prospective Study of Living Kidney Donation (https://ichgcp.net/clinical-trials-registry/NCT00319579)NCT00936078: Living Kidney Donor Study (https://ichgcp.net/clinical-trials-registry/NCT00936078).

Keywords: living kidney donor; nephrectomy; perioperative complications; surgeons’ experience.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Amit Garg was supported by the Dr Adam Linton Chair in Kidney Health Analytics and a Canadian Investigator Award from the Canadian Institutes of Health Research (CIHR) and received operating grant support from the CIHR, which included partnership funding from Astellas for data collection. Dr Liane S. Feldman received investigator-initiated research grants from Merck and Johnson & Johnson and an educational grant from Medtronic.

Figures

Figure 1.
Figure 1.
Participant selection. aReasons include participant decision, recipient illness or death, and other (eg, recipient received a kidney from another donor). bReasons include participant or study team decision, loss to follow-up, and donation after study closed. cIncludes both intraoperative and postoperative complications.

References

    1. Giessing M. Living donor nephrectomy—quantifying the risk for the donor. Transplant Proc. 2012;44(6):1786-1789.
    1. Schold JD, Goldfarb DA, Buccini LD, et al. Comorbidity burden and perioperative complications for living kidney donors in the United States. Clin J Am Soc Nephrol. 2013;8(10):1773-1782.
    1. Patel S, Cassuto J, Orloff M, et al. Minimizing morbidity of organ donation: analysis of factors for perioperative complications after living-donor nephrectomy in the United States. Transplantation. 2008;85(4):561-565.
    1. Clayton PA, McDonald SP, Snyder JJ, Salkowski N, Chadban SJ. External validation of the estimated posttransplant survival score for allocation of deceased donor kidneys in the United States. Am J Transplant. 2014;14(8):1922-1926.
    1. Lentine KL, Lam NN, Axelrod D, et al. Perioperative complications after living kidney donation: a national study. Am J Transplant. 2016;16(6):1848-1857.
    1. Alberts V, Idu MM, Minnee RC. Risk factors for perioperative complications in hand-assisted laparoscopic donor nephrectomy. Prog Transplant. 2014;24(2):192-198.
    1. Mjøen G, Øyen O, Holdaas H, Midtvedt K, Line P-D. Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation. 2009;88(11):1273-1279.
    1. Lentine KL, Patel A. Risks and outcomes of living donation. Adv Chronic Kidney Dis. 2012;19(4):220-228.
    1. Young A, Dixon SN, Knoll GA, et al. The Canadian experience using the expanded criteria donor classification for allocating deceased donor kidneys for transplantation. Can J Kidney Heal Dis. 2016;3(1):1-11.
    1. Reese PP, Feldman HI, McBride MA, Anderson K, Asch DA, Bloom RD. Substantial variation in the acceptance of medically complex live kidney donors across US renal transplant centers. Am J Transplant. 2008;8(10):2062-2070.
    1. Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10):959-966.
    1. Türkvatan A, Özdemir M, Cumhur T, Ölçer T. Multidetector CT angiography of renal vasculature: normal anatomy and variants. Eur Radiol. 2009;19:236-244.
    1. Ames SA, Krol M, Nettar K, et al. Pre-donation assessment of kidneys by magnetic resonance angiography and venography: accuracy and impact on outcomes. Am J Transplant. 2005;5(6):1518-1528.
    1. Tsao S-Y, Lee W-C, Loong C-C, Chen T-J, Chiu J-H, Tai L-C. High-surgical-volume hospitals associated with better quality and lower cost of kidney transplantation in Taiwan. J Chin Med Assoc. 2011;74(1):22-27.
    1. Axelrod DA, Guidinger MK, McCullough KP, Leichtman AB, Punch JD, Merion RM. Association of center volume with outcome after liver and kidney transplantation. Am J Transplant. 2004;4(6):920-927.
    1. Weng S-F, Chu C-C, Chien C-C, Wang J-J, Chen Y-C, Chiou S-J. Renal transplantation: relationship between hospital/surgeon volume and postoperative severe sepsis/graft-failure. A nationwide population-based study. Int J Med Sci. 2014;11(9):918-924.
    1. Serrano OK, Yadav K, Bangdiwala A, et al. Age alone is not a contraindication to kidney donation: outcomes of donor nephrectomy in the elderly. Clin Transplant. 2018;32:e13287.
    1. Felix B, Uyen H, Karine H, et al. Early complications after living donor nephrectomy: analysis of the Swiss Organ Living Donor Health Registry. Swiss Med Wkly. 2017;147(3334):1-7.
    1. Lentine KL, Kasiske BL, Levey AS, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. 2017;101:S1-S109.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-1499.
    1. Janki S, Verver D, Klop KWJ, et al. Vascular management during live donor nephrectomy: an online survey among transplant surgeons. Am J Transplant. 2015;15(6):1701-1707.
    1. Serrano OK, Bangdiwala AS, Vock DM, et al. Defining the tipping point in surgical performance for laparoscopic donor nephrectomy among transplant surgery fellows: a risk-adjusted cumulative summation learning curve analysis. Am J Transplant. 2017;17(7):1868-1878.
    1. Clavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo classification of surgical complications five-year experience. Ann Surg. 2009;250(2):187-196.
    1. Dindo D, Clavien P-A. What is a surgical complication? World J Surg. 2008;32(6):939-941.
    1. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg. 2004;240(2):205-213.
    1. Rosenthal R, Hoffmann H, Clavien PA, Bucher HC, Dell-Kuster S. Definition and classification of intraoperative complications (classic): Delphi study and pilot evaluation. World J Surg. 2015;39(7):1663-1671.
    1. Javadi SAH, Naderi F, Javadi AM. The optimal surgical approach for treatment of chronic subdural hematoma: questionnaire assessment of practice in Iran and review of literature. Acta Med Iran. 2015;53(10):617-621.
    1. Carty MJ, Duclos A, Gu X, Elele N, Orgill D. Patient satisfaction and surgeon experience: a follow-up to the reduction mammaplasty learning curve study. Eplasty. 2012;12:e22.
    1. Wang A, Grayburn P, Foster JA, et al. Practice gaps in the care of mitral valve regurgitation: insights from the American College of Cardiology mitral regurgitation gap analysis and advisory panel. Am Heart J. 2016;172:70-79.
    1. Friedman AL, Cheung K, Roman SA, Sosa JA. Early clinical and economic outcomes of patients undergoing living donor nephrectomy in the United States. Arch Surg. 2010;145(4):356-362; discussion 362.
    1. Voskoboinik A, Gutman MJ, Croagh D, et al. Implementation and learning of laproscopic donor nephrectomy by a non-transplant general surgeon with advanced laparoscopic skills. Asian J Endosc Surg. 2011;4(3):127-132.
    1. Friedersdorff F, Werthemann P, Cash H, et al. Outcomes after laparoscopic living donor nephrectomy: comparison of two laparoscopic surgeons with different levels of expertise. BJU Int. 2013;111(1):95-100.
    1. Heimbach JK, Taler SJ, Prieto M, et al. Obesity in living kidney donors: clinical characteristics and outcomes in the era of laparoscopic donor nephrectomy. Am J Transplant. 2005;5(5):1057-1064.
    1. McGregor TB, Patel P, Sener A, Chan G. Vascular control during laparoscopic kidney donation. Can J Surg. 2017;60(3):150-151.
    1. Recalls Background and Definitions and FDA. U.S. Food & Drug Administration. . Published 2014. Accessed June 11, 2019.
    1. Morche J, Mathes T, Pieper D. Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst Rev. 2016;5(1):1-15.
    1. Spaliviero M, Eastham JA. Relationship between surgical volume and patient outcomes. Trends Urol Men’s Heal. 2015;6:7-12.
    1. Özdemir-van Brunschot DMD, Warlé MC, van der Jagt MF, et al. Surgical team composition has a major impact on effectiveness and costs in laparoscopic donor nephrectomy. World J Urol. 2015;33(5):733-741.
    1. Cannon RM, Eng M, Marvin MR, Buell JF. Laparoscopic living kidney donation at a single center: an examination of donor outcomes with increasing experience. Am Surg. 2011;77(7):911-915.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj