Impact of laparoscopic nephrectomy on donor preoperative decision-making and postoperative quality of life and psychosocial outcomes.

Sirs, We read with great interest the study by Neuhaus et al. reporting on live kidney donors (that had donated by open nephrectomy) and their high degree of satisfaction with the predonation decision-making process, along with improved postdonation relationships with their partners and the recipient children [1]. One question that this valuable and insightful study was unable to answer was whether the recent introduction of the less invasive laparoscopic technique (which has rapidly become the standard of care) [2, 3] has had any additional effects on the decision-making process and postoperative family dynamics and quality of life of those donating a kidney to a pediatric recipient. Interestingly, in adult-toadult live donor kidney transplantation, several studies have demonstrated that laparoscopic live donor nephrectomy does not only significantly decrease postoperative morbidity [4], but may therefore also have contributed to the steady increase of live donor kidney transplants observed in recent years [5–7]. Pradel et al. reported that this new, less morbid technique may also have impacted live donation rates positively by increasing the willingness of adult kidney recipients to accept a kidney from a live donor [8]. In a retrospective pilot study, we surveyed the 29 donors of 29 consecutive pediatric (≤18 years old) recipients at our center. All donors were mailed an SF-36 health questionnaire [9] and a structured questionnaire regarding preoperative decision-making, postoperative recovery, family dynamics, and quality of life. We analyzed categorical variables by use of the Chi-square test and, when applicable, Fisher's Exact Test, and continuous variables by use of the Mann-Whitney U test. For all statistical tests, a p value of less than 0.05 was considered significant. Of the 29 adult donors, 14 were laparoscopic donors (04/97–06/02) and 15 open donors (12/91–03/97) (median age, 34 years vs. 31 years; p=n.s.). There were no significant differences in SF-36 responses between laparoscopic donors, open donors, and a normative sample of the general US population. For preoperative variables, we received responses from 11 (79%) laparoscopic and 9 (60%) open donors; for postoperative variables, we received responses from 10 laparoscopic (71%) and 9 (60%) open donors. Ninety-five percent of the responding donors were a biologic or adoptive parent of the recipient. Median recipient age of laparoscopic and open donor kidneys was 9 and 12 years (range, 1 to 17 years for both groups; p=n.s.), respectively. One hundred percent of laparoscopic donors vs. 33% of open donors were working fullor part-time at the time of their donor operation. All but one donor in each group made the decision to donate immediately after hearing for the first time about live donation. One hundred percent of laparoscopic donors stated that the availability of the laparoscopic technique had not affected their decision to donate. For laparoscopic (vs. open) donors, median postoperative length of stay was significantly shorter (3 days vs. 5 days, respectively; p=0.02). Upon returning home, 80% of laparoscopic vs. 66% of open donors had to provide their care for themselves (p=n. s.). At that time, the primary caregiver for the recipient was the donor in 20% of all cases (laparoscopic and open donors), whereas at one month, the rate of the donor being the principal recipient caregiver had increased to 60% in the laparoscopic vs. 50% in the open group (p=n.s.). We noted a trend towards faster early postoperative reconvalescence for laparoscopic (vs. open) donors (p=n.s.; Table 1). At one month, 60% of laparoscopic vs. 11% of C. Troppmann (*) . J. L. Pierce . J. P. McVicar . R. V. Perez Department of Surgery, University of California, Davis, Medical Center, 2315 Stockton Blvd., HSF 2010, Sacramento, CA 95817, USA e-mail: christoph.troppmann@ucdmc.ucdavis.edu Tel.: +1-916-7347267 Fax: +1-916-7346564