Abstract
Background
Patients undergoing laparoscopic live donor nephrectomy (LLDN) commonly receive large amounts of fluid intraoperatively to counter the negative effects of pneumoperitoneum on renal function. Our aim is to demonstrate that a low-volume fluid management strategy does not adversely affect donor or recipient outcomes.
Methods
Fifty-two patients underwent LLDN between December 2000 and January 2004. Data were collected in prospective databases, and augmented with retrospective medical record review. Donors were divided into two groups: the fluid-load group (n=24) received >10 ml/kg/h of intravenous crystalloids intraoperatively, while the fluid-restriction group (n=28) received <10m/kg/h.
Results
Donors in the fluid-restriction group had a lower intraoperative urine output. There were no differences in postoperative creatinine levels (117.5 μmol/L vs 121.5 μmol/L,p=0.8) or complications (4.2% vs 7.1%,p=0.9). In the recipients, there were no differences in postoperative creatinine levels up to 12 months, incidence of delayed graft function (18% vs 10%,p=0.7) or acute rejection (9% vs 5%,p=1.0) between groups.
Conclusion
Lower volume fluid management strategies in LLDN do not appear to worsen recipient outcomes nor are they detrimental to the donors.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Baverstock RJ, Manson AD, Liu L, Gourlay WA (2002) A prospective comparison of simultaneous and sequential live-donor renal transplantation. Transplantation 74: 1194–1197.
Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindroff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen PE, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238: 641–648
Fabrizio MD, Ratner LE Montgomery RA, Kavoussi LR (1999) Laparoscopic live donor nephrectomy. Urol Clin North Am 26: 247–256.
Flowers JL, Jacobs S, Cho E, Morton A, Rosenberger WF, Evans D, Imbembo AL, Bartlett ST (1997) Comparison of open and laparoscopic live donor nephrectomy. Ann Surg 226: 483–489; discussion 489–490
Gan TJ, Soppitt A, Maroof M (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay After Major Surgery. Anesthesiology 97: 820–826
Gill IS, Matin SF, Desai MM (2003) Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 170: 64–68
Handschin AE, Weber M, Demartines N, Clavien PA (2003) Laparoscopic donor nephrectomy. Br J Surg 90: 1323–1332
Hawasli A, Oh H, Schervish E (2003) The effect of pneumoperitoneum on kidney function in laparoscopic donor nephrectomy. Am Surg 69: 300–303
Hazebroek EJ, de Bruin RW, Bouvy ND, Marquet RL, Bonthuis F, Bajema IM, Hayes DP, Ijzermans JN, Bonjer HJ (2003) Longterm impact of pneumopertoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient rats. Ann Surg 237: 351–357
Holte K, Sharrock NE, Kehlet H (2002) Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 89: 622–632
Jacobs SC, Cho E, Foster C, Liao P, Bartlett ST (2004) Laparoscopic donor nephrectomy: The University of Maryland 6-year experience. J Urol 171: 47–51
London E, Rudich S, McVicar J, Wolfe B, Perez R (1999) Equivalent renal allograft function with laparoscopic versus open liver donor nephrectomies. Transplant Proc 31: 258–260
London ET, Ho HS, Neuhaus AM, Wolfe BM, Rudich SM, Perez RV (2000) Effect of intravascular volume expansion on renal function during prolonged CO2 pneumoperitoneum. Ann Surg 231: 195–201
Mythen MG, Webb AR (1995) Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 130: 423–429.
Nogueira JM, Cangro CB, Fink JC, Schweitzer EJ, Wiland A, Klassen DK, Gardner J, Flowers J, Jacobs S, Cho E, Philosophe B, Bartlett ST, Weir MR (1999) A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation 67: 722–728
Philosophe B, Kuo PC, Schweitzer EJ, Farney AC, Lim JW, Johnson LB, Jacobs S, Flowers JL, Cho ES, Bartlett ST (1999) Laparoscopic versus open donor nephrectomy: comparing ureteral complications in the recipients and improving the laparoscopic technique. Transplantation 68: 497–502.
Ratner LE, Kavoussi LR, Sroka M, Hiller J, Weber R, Schulam PG, Montgomery R (1997) Laparoscopic assisted live donor nephrectomy a comparison with the open approach Transplantation 63: 229–233.
Sasaki TM, Finelli F, Bugarin E, Fowlkes D, Trollinger J, Barhyte DY, Light JA (2000) Is laparoscopic donor nephrectomy the new criterion standard? Arch Surg 135: 943–947
Schweitzer EJ, Wilson J, Jacobs S, Machan CH, Philosophe B, Farney A, Colonna J, Jarrell BE, Bartlett ST (2000) Increased rates of donation with laparoscopic donor nephrectomy. Ann Surg 232: 392–400.
Sinclair S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised control trial. Br Med J 315: 909–921
Venn R, Steele A, Richardson P (2002) Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth 88: 65–71
Author information
Authors and Affiliations
Additional information
Online publication: 13 October 2004
Rights and permissions
About this article
Cite this article
Bergman, S., Feldman, L.S., Carli, F. et al. Intraoperative fluid management in laparoscopic live-donor nephrectomy. Surg Endosc 18, 1625–1630 (2004). https://doi.org/10.1007/BF02637133
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02637133