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Living-donor kidney transplantation: comparison of sequential and simultaneous surgical organizations

  • Urology - Original Paper
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Abstract

Purpose

The objective of this study was to compare living-donor kidney transplantation (LDKT) performed either sequentially, in one operating room, leading to extended cold ischemia time (CIT) or simultaneously, in two different operating room, with shorter CIT.

Methods

We retrospectively included all living-donor nephrectomies and kidney transplantations, performed from March 2010 to March 2014, in three French university centers. In the first one (C1), LDKTs were performed in sequential manner (Sequential group) and in C2 and C3, LDKTs were performed in simultaneous manner (Simultaneous group).

Results

A total of 324 LDKT were performed: 176 LDKT in Sequential group and 148 LDKT in Simultaneous group. Patients characteristics were equivalent between groups, except nephrectomy side, ABO mismatch rate and previous kidney transplantation rate. CIT, rewarming time, transfusion and delayed graft function (DGF) were significantly higher in Sequential group. Overall survival and graft survival of kidney transplant recipients were similar in the Sequential and Simultaneous groups. 5-year eGFR was similar between groups. In univariate analysis, number of graft arteries, recipient BMI, previous kidney transplantation status and CIT were significant predictors of DGF. Only previous kidney transplantation status was an independent predictive factor of DGF in the multivariate analysis.

Conclusions

Sequential surgical organization results in the same functional results as simultaneous surgical organization. DGF was higher for LDKT performed sequentially but at 5-year overall survival, graft survival and eGFR were similar between these two types of transplant organizations.

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Abbreviations

BMI:

Body Mass Index

C1:

Center 1

C2:

Center 2

C3:

Center 3

CIT:

Cold ischemia time

DGF:

Delayed graft function

DSA:

Donor-specific anti-HLA antibodies

eGFR:

Estimated glomerular filtration rate

ESRD:

End-stage renal disease

HBP:

High blood pressure

HLA:

Human leukocyte antigen

HMP:

Hypothermic machine perfusion

KPD:

Kidney paired donation

KT:

Kidney transplantation

LDKT:

Living-donor kidney transplantation

LDN:

Living-donor nephrectomy

POD:

Post-operative day

RT:

Rewarming time

VT:

Ventricular tachycardia

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Authors and Affiliations

  1. Department of Urology, Kidney Transplantation and Andrology, TSA 50032 Rangueil Hospital, CHU Toulouse, 31059, Toulouse Cedex 9, France

    Thomas Prudhomme, Thibaut Benoit, Mathieu Roumiguié, Federico Sallusto, Nicolas Doumerc, Mouath Binhazzaa, Michel Soulié & Xavier Gamé

  2. Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 44093, Nantes, France

    Thomas Prudhomme, Benoit Mesnard, Lucas Broudeur, Delphine Kervella, Gilles Blancho, Georges Karam & Julien Branchereau

  3. Centre de Recherche en Transplantation Et Immunologie (CRTI), UMR1064, INSERM, Université de Nantes, 44093, Nantes, France

    Thomas Prudhomme, Delphine Kervella, Gilles Blancho & Julien Branchereau

  4. Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford and National Institute for Health Research, Oxford, UK

    Shruti Mittal & Julien Branchereau

  5. Département d’Urologie et de Transplantation Rénale, CHU Montpellier, 34000, Montpellier, France

    François Iborra & Rodolphe Thuret

  6. Département de Néphrologie et de Transplantation d’Organes, CHU Toulouse, 31059, Toulouse, France

    Nassim Kamar

Authors
  1. Thomas Prudhomme
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  2. Thibaut Benoit
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  4. Mathieu Roumiguié
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  16. Georges Karam
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  17. Xavier Gamé
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  18. Julien Branchereau
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Contributions

TP: protocol development, data collection, data analysis, manuscript writing. TB: protocol development, data collection, data analysis, manuscript writing. SM: manuscript writing and manuscript revision. MR: data collection, data analysis. BM: data collection, data analysis. LB: data collection, data analysis. DK: data collection, data analysis. FS: data collection, data analysis. ND: data collection, data analysis. MB: data collection, data analysis. FI: data collection, data analysis. MS: data collection, data analysis. GB: data collection, data analysis. NK: data collection, data analysis. RT: data collection, data analysis. GK: data collection, data analysis. XG: protocol development, data analysis, manuscript writing. JB: protocol development, data collection, data analysis, manuscript writing.

Corresponding author

Correspondence to Thomas Prudhomme.

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The authors declare that they have no conflict of interest.

Ethical approval retrospective study

According to French legislation, retrospective studies are not subject to IRB approval.

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Prudhomme, T., Benoit, T., Mittal, S. et al. Living-donor kidney transplantation: comparison of sequential and simultaneous surgical organizations. Int Urol Nephrol 52, 865–876 (2020). https://doi.org/10.1007/s11255-019-02366-0

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