Supplementary Material for: Does the Side Matter? A Retrospective Cohort Study Comparing Left and Right Pure Laparoscopic Donor Nephrectomies

Objectives: Right laparoscopic donor nephrectomy (RLDN) is no longer regarded inferior to left LDN (LLDN). However, this knowledge is based on many studies suffering from inherent learning curves, center-specific imbalances, and different laparoscopic techniques. Methods: Pure LDNs at a high-volume referral center from 2011 to 2016 were retrospectively analyzed. Patient, graft characteristics, outcomes of LDNs, and corresponding open kidney transplantations were compared between LLDN and RLDN including a follow-up. Results: 160 (78.4%) LLDNs and 44 (21.6%) RLDNs only differed regarding graft characteristics, as more right grafts had multiple veins (34.1 vs. 6.9%, p < 0.001) and worse scintigraphic function (44 vs. 51%, p < 0.001). RLDNs were shorter (201 vs. 220 min, p = 0.032) with longer warm ischemia time (165 vs. 140 s, p < 0.001), but left grafts were transplanted faster (160 vs. 171 min, p = 0.048). Recipients of right kidneys had more postoperative complications (grade 3: 25.6 vs. 11.3%, p = 0.020). At a follow-up of 45 (range 6–79) months, neither the kidney function, nor death-censored graft (5-year: LLDN 89 vs. 92%, p = 0.969) and patient survival (5-year: LLDN 95 vs. 98%, p = 0.747) differed. Conclusions: Pure LLDN and RLDN can have different outcomes at high-volume centers, especially higher complications for recipients of right grafts. However, long-term function and graft survival are the same irrespective of the chosen side.

研究目的：右侧腹腔镜供肾切除术（Right Laparoscopic Donor Nephrectomy, RLDN）如今已不再被认为劣于左侧腹腔镜供肾切除术（Left Laparoscopic Donor Nephrectomy, LLDN）。但该结论的相关研究均存在固有学习曲线、中心特异性病例失衡以及腹腔镜操作技术不统一等局限性。研究方法：回顾性分析2011至2016年某高流量转诊中心开展的所有纯腹腔镜供肾切除术（laparoscopic donor nephrectomy, LDN）病例。对比左侧与右侧腹腔镜供肾切除术的患者基线特征、移植肾特征、手术结局，以及对应的开放性肾移植情况，并纳入随访数据进行分析。研究结果：本研究共纳入160例（78.4%）左侧腹腔镜供肾切除术病例与44例（21.6%）右侧腹腔镜供肾切除术病例，两组仅在移植肾特征上存在差异：右侧供肾的多静脉畸形比例更高（34.1% vs. 6.9%，p < 0.001），核素显像评估的肾功能更差（44% vs. 51%，p < 0.001）。右侧腹腔镜供肾切除术的手术时长更短（201 min vs. 220 min，p = 0.032），但热缺血时间更长（165 s vs. 140 s，p < 0.001）；而左侧供肾的移植手术时长更短（160 min vs. 171 min，p = 0.048）。右侧供肾受者的术后并发症发生率更高（3级并发症：25.6% vs. 11.3%，p = 0.020）。在中位随访45个月（范围6~79个月）后，两组受者的肾功能、死亡删失移植物5年存活率（左侧组89% vs. 右侧组92%，p = 0.969）以及患者总体5年存活率（左侧组95% vs. 右侧组98%，p = 0.747）均无显著统计学差异。研究结论：在高流量转诊中心开展的纯腹腔镜供肾切除术中，左侧与右侧术式的手术结局存在差异，尤其是右侧供肾受者的术后并发症发生率更高。但无论选择左侧还是右侧供肾，受者的长期肾功能与移植物存活率均无显著区别。