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Ascertaining the exact nature and frequency of complications for living kidney donors is nearly impossible for multiple reasons:
1. Some transplant centers or studies only consider issues that result in re-hospitalization or occur within a certain time period.
2. Some living kidney donors seek care at a facility other than the transplant center so their issues go unreported.
3. Some transplant centers are lax in reporting data to OPTN, even though it is a federal mandate**.
A 2004 World Transplant Consortium admitted that some physicians will not report a medical issue as a consequence of living donation out of fear of retribution for the living donor from their insurance company.
Complications that living kidney donors report (aka 'self report') during the first year post-donation are higher than previous reports. Rates reported by the transplant programs may greatly underestimate the actual complication rates. Retrospective surveys rely on the responder's memory of complications and their desire to be forthright. Additionally, many living donors come from outside of the state to donate, therefore the transplant program may not be aware of the living donor's complications.
Mjoen et al looked at 1022 living kidney donors from 1997-2008 (median age: 47; 24% laparoscopic) and found 2.9 major and 18% minor complications. The lap procedure resulted in a higher number of major complications (232)
According to data from UNOS and SRTR, 267 living kidney donors sought hospital readmission in the first year post-surgery from January 2008-March, 2009.
.6% within six weeks; 2.3% between six-weeks and six-months; 1.5% between six-months and one-year (of all total living donors during that time).
**3060 of 7481 living donors during that time were 'lost to follow-up' by 12 months, so OPTN is missing chunks of data**
LODN, the living donor insurance program, shows a “serious complication” rate of 3.3% (those requiring overnight hospitalization or an operation), and “complications other than serious” at 17%. (136)
[Unfortunately, only a small minority of all transplant centers participate in LODN, so their data is most likely a cautious underestimate]
Perioperative risks include, but are not limited to, the following (28, 46,47, 49, 50, 111):
- anaphylactic reaction: allergic reaction, usually to anesthesia.
- pneumothorax: abnormal air presence in the chest cavity which can result in lung collapse.
- chest pain: can be related to pneumothorax.
- dyspnea: shortness of breath, difficulty breathing. can be related to pneumothorax.
- pulmonary embolism: blockage of the a main lung related artery; cessation of blood to the lungs.
- bradycardia: abnormally slow heart rate.
- fever: can be a symptom of infection.
- wound infection: Wound infection developed in 3.7% of donors.(88)
- urinary tract infection
- urinary retention
Five years after undergoing a radical nephrectomy (complete removal of kidney and surrounding tissues), patients had a 17% increased chance of death from an infection. (99)
- liver bleeding
- spleen injury, sometimes requiring conversion to open surgical procedure.
- hemorrhage: bleeding. In one study, 3.4% of living kidney donors required a transfusion (52) or conversion to open surgical procedure.
In another, significant perioperative bleeding occurred in 1.6% of 1022 living kidney donors. There were seven cases of renal artery laceration. Increased risk for a combined endpoint of intraoperative incidents, major complications and significant bleeding were seen in relation to laparoscopic surgery as opposed to the open procedure(88).
- anemia: low blood iron. can be a symptom of internal bleeding.
- hematoma: otherwise known as a bruise, can be caused by internal bleeding.
- orchalgia: chronic pain of the testicles. (see Risks for more)
- epididymitis: inflammation of the small tube that rests on top of the testicle, part of the system that carries sperm from the testicle to the penis.
- small peritoneal damage: peritoneal refers to the membrane surrounding the abdomen and its inclusive organs. According to one study, the risk for developing intraperitoneal adhesions (fibrous tissue) after laparoscopy is as high as 90%. Incidence of hospital readmission due to adhesions is 5-20%. (217)
- intestinal obstruction: 60-70% of obstructions are caused by peritoneal adhesions. (217)
- hernia: Specific to the hand-assisted laparoscopic procedure (45). One living donor's experience.
- bleeding ulcer
Readmission rate was higher for Laparoscopic Nephrectomy (1.6%) versus open (0.6%) donors (P 0.001), almost entirely as a result of an increase in gastrointestinal complications in LN/laparscopic donors. (29)
Drugs to treat gastrointestinal disorders, primarily reflux oesophagitis and dyspepsia, accounted for another 6.73% (only one-year post-donation).(28)
Although mostly minor, bowel complications occurred in our laparscopic series with an incidence of 1.3% compared with a reported incidence of 0% with open surgery. (51)
- transient neuromuscular injury
- nerve entrapment
- lap neuroma: growth or tumor of nerve tissue.
- renal (kidney) artery or vein, aorta, common iliac artery, vena cava and mesenteric veins, epigastric (upper stomach region) artery injury
- acute renal/kidney failure
Various Published Study Results:
Early postoperative complications reached a mean of 9%. Conversion rates from 0-13% due to bleeding or vessel injury, inadequate exposure and obesity, stapler malfunction and loss of pneumoperitoneum. (50)
Post-op complications observed in 19%. No deaths.
Laparoscopic renal surgery is associated with unique challenges and complications as compared to open. 5.6% had major complications(49)
The complication rate was
14%, the rate of open conversion was 2%, and 3% of the patients
required transfusions. Complication rates of laparoscopic and open
Norwegian study from 1997-2008 of 1022 living donors found total of 30 major (2.9%) and 184 (18%) minor complications.(88)
Study of 86 living kidney donors revealed a total complication rate of 54.6%. (91) Serious complications occurred in five cases (5.8%). (91)
Perioperative complications and wound healing issues were reported by 23.07% of the donors.
Serious complications were reported by 7.7% of the donors in this registry. There was no difference between the type of donation procedure (open vs. laparscopic) and the complications reported.
(This only ONE YEAR post-donation!)(28)
5% reported that surgery was complicated by a problem that increased hospital stay or time away from normal life beyond their expectations.(4)
Complications not requiring re-operation were reported for 19 (0.3%) open, 22 (1.0%) hand-assisted LN, and 24 (0.8%) non-hand-assisted Laparoscopic Nephrectomy cases (P .02). Readmission rate was higher for Laparoscopic Nephrectomy (1.6%) versus open (0.6%) donors (29)
Conversion rates 6-13%.
The most important reason for conversion is bleeding. Reoperation is
1-5% for hemorrhage, small bowel obstruction, internal hernia,
splenic injury, retrieval of foreign body and wound neuroma.
Present new life-threatening complications that are usually NOT seen in the open approach. The complications unique to laparoscopy include those related to creation of pneumoperitoneum, patient positioning, and surgical intervention.(48)
Perioperative morbidity in lap was 14%, wound complications 6.8% (51)
Donor complications following lap-total complication rate was 16.5%. (52)
The overall rate of intraoperative complications was 2.8%. The overall rate of postoperative complications was 3.4% and included urinary retention, wound infection, temporary lateral thigh numbness, chylous ascites, and nerve entrapment. Thirty of 500 patients in our Living Donor Nephrectomy series experienced an intraoperative or procedure-related complication (6.0%). (53)
Major intraoperative complications was 6.8% and major postoperative complications in 17.1%. Major complications presented a significant risk to the donor. Minor complications redressed laparoscopically and were not thought to present a significant risk—included splenic laceration, liver laceration, pneumothorax, diaphragm injury, stapler misfiring, controlled injury to vein or arteries, cardiac arrhythmias, and urethral strictures. Major postoperative complications included atrial fibrillation, small bowel obstruction requiring return to the OR, sepsis, respiratory distress, pneumonia, retroperitoneal hematomas, and a splenic laceration requiring reoperation. The major complication is bowel function. May take 7-10 days to return to normal. A major complication is internal hernia. (54)
Out of 65 living related kidney donors in Germany, 28% experienced medical complications.