Obesity in Living Kidney Donors: Clinical Characteristics and Outcomes in the Era of Laparoscopic Donor Nephrectomy

Julie K. Heimbach; Sandra J. Taler; Mikel Prieto; Fernando G. Cosio; Stephen C. Textor; Yogish C. Kudva; George K. Chow; Michael B. Ishitani; Timothy S. Larson; Mark D. Stegall

Disclosures

American Journal of Transplantation. 2005;5(5):1057-1064. 

In This Article

Materials and Methods

The study involved a retrospective review of the medical records of living renal donors who underwent laparoscopic donor nephrectomy at Mayo Clinic Rochester during the period from October 1, 1999 through April 1, 2003. The institutional review board of the Mayo Clinic approved the data collection procedures for those individuals who had not declined use of their medical records for research at the time their clinical care commenced. A summary of the clinical evaluation process is provided in Appendix A. Donors underwent laparoscopic donor nephrectomy performed by one of a group of three surgeons using the hand-assisted technique.[6] For the majority of obese donors, an infra-umbilical midline incision was utilized for the hand-port to facilitate nephrectomy, while non-obese donors had the option of a Pfannenstiel incision.

Based on the information in the medical record, donors were divided into four groups according to BMI: < 25 kg/m2, 25—29.9 kg/m2, 30-34.9 kg/m2 and ≥ 35 kg/m2 for analysis. Surgical outcomes including operative time, length of hospital stay (LOS) and perioperative complications were compared across BMI groups. Baseline clinical characteristics recorded at the time of donor evaluation including BMI, blood pressure, fasting plasma glucose, lipid levels, renal function (serum creatinine and glomerular filtration rate by iothalamate clearance), proteinuria and microalbuminuria were compared across BMI groups. For 325 donors with paired pre- and post-donor nephrectomy measurements, blood pressure, fasting plasma glucose, body weight and microalbuminuria at baseline were compared to values at the 6- to 12-month follow-up visits. Prevalence of hypertension, smoking status (non-smoker, or current or any past smoking) and family history of diabetes mellitus or cardiovascular disease was compared across BMI groups. We then compared prevalence rates of these same historical characteristics in donors to renal donor candidates evaluated over this time period who were not approved for donation, using the same BMI defined groups.

We defined perioperative parameters as follows: (i) length of stay—from admission to the hospital on the day of donation to discharge including the operative day; (ii) operative time—time from patient entering the operating room to time to exiting the room including induction of anesthesia, positioning and actual procedure time; (iii) intra-operative complication—an unexpected operative event including conversion to open nephrectomy, unexpected injury to the donor or the donor kidney; (iv) wound infection—wound with purulent drainage that necessitated opening of at least a portion of the incision; (v) wound seroma—non-purulent drainage or aspiration of a subcutaneous fluid collection that was shown to be sterile on subsequent culture; (vi) hernia—fascial defect requiring operative repair; (vii) ileus—lack of bowel function requiring readmission and intravenous fluids and (viii) urinary tract complications—urinary tract infection, testicular pain, epididymitis, urinary retention requiring reinsertion of urethral catheter.

Data were analyzed using JMP 5.1 (SAS Institute) statistical software. Data were expressed as mean ± SEM. Comparisons across multiple BMI groups were performed by ANOVA with specific group comparisons performed using unpaired t -tests. Prevalence rates were compared using chi-square analyses. Pre-operative clinical and laboratory values were compared to post-nephrectomy values using paired t -tests.

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