[Frontiers in Bioscience 14, 4746-4757, January 1, 2009]

Surgical aspects of live kidney donation

Leonienke Francisca Dols1, Niels Frederik Kok1, Jan Nicolaas IJzermans1

1 Department of Surgery, Erasmus MC, Gravendijkwal 230, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Benefits of live kidney donor transplantation
4. Innovations in live kidney donation
5. Care of the live donor
5.1. Standard care of the live donor
5.2. Improvements in imaging of the donor
5.3. Improvements in surgical technique
5.3.1. Laparoscopic donor nephrectomy
5.3.2. Hand-assisted laparoscopic donor nephrectomy
5.3.3. Retroperitoneoscopic donor nephrectomy
5.3.4. Minimally invasive open donor nephrectomy
5.3.5. Evidence-based approach in the surgical management
5.4. Improvements in perioperative care
5.5. Improvements in follow-up
6. Conclusion and future perspectives
7. Acknowledgements
8. References

1. ABSTRACT

In the early 1990s live kidney donation regained popularity to meet the demand of kidney transplantation. Significant developments in the field of live kidney donation have established live donation as the potential prime source of kidney transplants in the future. Nowadays management focuses on logistic and immunological innovations, and improvements in care of the live donor. However, a flawless surgical procedure in donors and recipients is a prerequisite for further expansion of live kidney donor transplantation. From a surgical perspective the introduction of the laparoscopic approach has been a major breakthrough. Less invasive techniques to procure live donor kidneys have been held responsible for a steep increase in the number of live donors. In addition, less invasive imaging, improvements in perioperative care, and novel insights in follow-up have all improved the care of the live donor. Live kidney donation may develop as the most promising source of renal organs since artificial kidneys, xenografts and stem cell therapy for restoring intrinsic kidney function will probably not find application on large scale in the near future.