Laparoscopic nephrectomy safe for obese kidney donors.

Although laparoscopic living donor nephrectomy is more difficult to perform in markedly obese patients, donor morbidity and recipient outcome are comparable to procedures performed in nonobese donors, according to an article

in the December issue of Urology.

Stephen Jacobs, Sr., MD and colleagues at the University of Maryland School of Medicine in Baltimore evaluated laparoscopic living donor nephrectomies performed between 1996 and 1999 in 41 patients with a body mass index (BMI) greater than 35 and 41 controls with a BMI less than 30. The controls were closely matched in terms of sex, race, age, serum creatinine level, creatinine clearance, HLA match to recipient, side of donated kidney, and experience level of the surgeons. The procedures in the obese patients took significantly longer to complete, by an average of 40 minutes, and were associated with greater intraoperative blood loss, longer extraction incision lengths, and an increased incidence of conversion from laparoscopic to open nephrectomy, the researchers reported. Nonetheless, "the postoperative recovery of the gastrointestinal tract, hospitalization time, analgesic requirements, and total complications" were similar in both groups, Jacobs and coauthors noted, as was graft function. Cardiopulmonary problems were more frequent in the obese patients.

"Given the degree of obesity in these patients, with an average BMI of 39, the differences seen were fairly small, and the procedure of laparoscopic donor nephrectomy itself appears appropriate to consider for the markedly obese renal donor," Jacobs' team concluded.