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Laparoscopic Donor Nephrectomy

Laparoscopic Donor Nephrectomy. Mr Yee Chan MB BS , FRACS (Urology) Urological Surgeon University of Melbourne, Department of Surgery, Austin Hospital Austin Hospital , Urology Unit MELBOURNE AUSTRALIA. Why Living Related Donor Renal Transplant?.

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Laparoscopic Donor Nephrectomy

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  1. Laparoscopic Donor Nephrectomy Mr Yee Chan MB BS , FRACS (Urology) Urological Surgeon University of Melbourne, Department of Surgery, Austin Hospital Austin Hospital , Urology Unit MELBOURNE AUSTRALIA

  2. Why Living Related Donor Renal Transplant? • Improvement in quality of life for recipient is obvious • Compared to deceased donor renal transplant: • Better graft survival • Limits time on dialysis (preemptive transplantation – removes the experience of dialysis) • Alleviates shortages in deceased donor kidneys

  3. Kidney Transplant Survival Rates

  4. Who Is Suitable ? • Absence of kidney disease, infection and active malignancy • Fit for surgery • Mental state • BMI <35 • Blood group and HLA compatibility • Process; • Blood tests • CT angiogram • Nuclear Isotope Scan

  5. Advantages of Laparoscopic Donor Nephrectomy • Minimally invasive • Less pain with small incisions • Shorter hospital stay (3-4 days) • Earlier return to daily activities / work (3-6 weeks) • Better cosmesis

  6. Laparoscopic vs Open Approach Laparoscopic Approach Open approach

  7. Risks of Laparoscopic Donor Nephrectomy • Conversion to open surgery • Major complications rare = 0.23% • Thrombo-embolic events eg PE • Major bleeding • Visceral injury • Mortality: 0.02% • Long term risk of kidney failure – slightly increased in long term compared to general population

  8. Laparoscopic vs Open Donor Nephrectomy Nanidis et al 2008: meta-analysis of 73 studies, 6594 patients: -Shorter warm ischaemia time for ODN -Shorter operative time for ODN -Higher overall complication rate for ODN -No difference in graft function long term -Shorter hospital stay, earlier return to work after LDN

  9. National Paired Kidney Exchange Programme

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