Bootcongres

The number of live donor nephrectomies (LDN) is increasing. Since live donors are healthy individuals, it is essential to further minimize possible complications. In 2006, a survey was conducted among American Society of Transplant Surgeons members; results showed significant haemorrhagic complications of vascular management (VM) during LDN. Locking and standard clips are associated with the greatest risk and has led to the contraindication of the use of hemostatic clips in the US. In the current study, we assessed which vascular control methods are used, which are considered most safe, and the incidence of haemorrhagic complications. An online survey was sent to 598 European Society for Organ Transplantation members whom profiled their profession as “surgeon” and selected “kidney” as organ type. Questions included: LDN techniques used, vascular control methods used, experience of technical failures, and vascular control methods considered most safe. Of the 598 surveys, 243 (41%) were returned; 156 surgeons perform LDN and constitute the study group. Of the 156 respondents, 105 (67%) perform/prefer laparoscopic LDN, while 51 (33%) perform/prefer an open technique. The European responders annually perform around 6500 LDN in total. In venous and arterial VM, the GIA stapler and TA stapler are used most frequently; in terms of safety, 66% of respondents considered the GIA stapler safest for venous control, and 63% considered the TA stapler safest for renal arterial control. Of 121 mishaps, 67 (55.5%) involved venous and 54 (45.5%) involved arterial control. Slippage and dislodgement of locking clips was reported to occur in at least 38 cases, while staple malfunction occurred at least 40 times. Blood transfusion and open conversion (from laparoscopic approach) were reported by 34 (28.1%) respondents. There was at least 1 death from haemorrhage related to VM clip dysfunction. A variety of LDN and VM techniques are extant within Europe where approximately 6500 LDN procedures are performed annually. Haemorrhagic complications of LDN with fatal and non-fatal outcome still occur. Strikingly, many surgeons do not use the vascular control method that they consider most safe, and apparently persist in applying clips to the renal artery and other major vessels. Clip failures are known to cause donor death from sudden massive haemorrhage. Control of major vessels in LDN must employ transfixion techniques for optimal donor safety.