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Donor Nephrectomy

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  • Appropriate volunteer to donate to a person with renal failure.

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Renal Transplantation

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  • All causes of impending or established end-stage renal disease.

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Donor Nephrectomy

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Absolute

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  • Impaired renal function (generally considered to be a glomerular filtration rate < 80 mL/min per 1.73 m2).
  • Active infection.
  • Diabetes.
  • Pregnancy.
  • Age younger than 18 years.
  • Poorly controlled psychosis.

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Relative (Open or Laparoscopic)

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  • Proteinuria or hematuria.
  • History of malignancy.
  • Kidney stones.
  • Disorder requiring anticoagulation.
  • Active substance abuse.
  • Cardiovascular disease.
  • Chronic illness.
  • Hypertension.
  • Abnormal urologic anatomy.
  • Family history of diabetes.
  • History of kidney stones.
  • Obesity.

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Relative (Laparoscopic)

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  • Previous laparotomies.
  • History of pyelonephritis.
  • Horseshoe kidney.
  • Short right renal vein.
  • Multiple renal arteries.

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Renal Transplantation

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Absolute

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  • Untreated ongoing infection.
  • Active malignancy with short life expectancy.
  • Chronic illness (with life expectancy < 1 year).
  • Poorly controlled psychosis.

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Relative

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  • Cardiovascular disease.
  • Infection.
  • Active substance abuse.
  • Cerebrovascular disease.
  • Obesity.
  • Proven habitual noncompliance with medical recommendations.

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Donor Nephrectomy

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  • This procedure is unique in that it involves operating on a patient who has no chance for medical benefit from surgical intervention. For this reason, an extensive psychosocial evaluation is required prior to surgery.
  • The motivation of the volunteer must be established as genuinely altruistic and the patient must be aware that he or she can opt out at any time.
  • Postoperative pain, transient urinary retention, and superficial surgical site infections are common minor complications.
  • Compared with an open approach, laparoscopic donor nephrectomy is associated with a quicker convalescence.
  • Operative mortality and major complications are infrequent, but not nonexistent.
    • Major complications include systemic complications of major surgery (pulmonary emboli, cardiovascular events, pneumonia, sepsis, infection, and bleeding).
    • Other risks include pancreatitis; injury to bowel, spleen, or adrenal gland; small bowel obstruction; and conversion to an open procedure when a laparoscopic approach is planned.
  • Importantly, there is no increased risk of renal failure after donor nephrectomy.

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Renal Transplantation

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Expected Benefits

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  • For most patients with end-stage renal disease, renal transplantation is superior to dialysis in terms of long-term mortality risk. Therefore, candidates commonly undergo transplantation once a suitable donor is identified and appropriately allocated.

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Potential Risks

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  • Systemic complications associated with any major surgery (cardiovascular events, pneumonia, pulmonary emboli, and venous thromboemboli).
  • Other operative risks include:
    • Acute rejection.
    • Arterial or venous thrombosis.
    • Post-transplantation renal dysfunction.
    • Urine leaks.
    • Ureteral obstruction.
    • Wound infection.
    • Abscess.
    • Seroma.
    • Allograft fracture.
    • Lymphocele and hemorrhage.
  • Late complications include:
    • Acute or chronic rejection episodes.
    • Renal artery stenosis.
    • Infection.
    • Malignancy.

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Donor Nephrectomy

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Open Nephrectomy

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  • No special equipment is required.

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Laparoscopic Transperitoneal Donor Nephrectomy

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