Seguridad y calidad de vida de los donadores renales. Comparación entre dos técnicas.

BACKGROUND: Currently there are no studies that determine the safety and quality of life of kidney donors in Mexico. OBJECTIVE: To determine the safety of being a kidney donor and the quality of life, comparing the open approach with hand-assisted laparoscopic technique. METHOD: Observational, cross-sectional, analytical study of the kidney donors in our hospital from January 2015 to December 2018, in two groups: open technique and hand-assisted laparoscopic. To determine safety, the Clavien-Dindo scale and transoperative bleeding were used, and the SF-36 health-related quality of life questionnaire was applied. RESULTS: There are no reports of peri-operative complications in any type of approach. All the patients obtained a grade I in the Clavien-Dindo scale. When the difference in the score of the SF-36 health-related quality of life questionnaire in kidney donor patients with hand-assisted laparoscopic surgical approach versus open approach was compared, a difference between both means of 14.05 was obtained, with p < 0.0001 in favor of the hand-assisted approach. CONCLUSIONS: Being a kidney donor is safe and the approach that we recommend is hand-assisted laparoscopic nephrectomy.

ANTECEDENTES: Actualmente en México no hay estudios que determinen la seguridad y la calidad de vida de los donadores renales. OBJETIVO: Determinar la seguridad de ser donador renal y la calidad de vida, comparando el abordaje abierto frente al laparoscópico mano-asistido. MÉTODO: Estudio observacional, transversal, analítico, de todos los donadores renales de nuestro hospital de enero de 2015 a diciembre de 2018, con seguimiento mínimo de 2 años. Se dividieron en dos grupos: operados con técnica abierta o laparoscópica mano-asistida. Para determinar la seguridad se utilizaron la escala de Clavien-Dindo y el sangrado transquirúrgico, y se les aplicó el cuestionario SF-36 de calidad de vida relacionada con la salud. RESULTADOS: No se reportan complicaciones transquirúrgicas en ningún tipo de abordaje. Todos los pacientes obtuvieron grado I en escala de Clavien-Dindo. En el puntaje del cuestionario SF-36 en pacientes donadores renales con abordaje quirúrgico laparoscópico mano-asistido versus abordaje abierto se obtuvo una diferencia entre ambas medias de 14.05, con p < 0.0001 a favor del abordaje mano-asistido. CONCLUSIONES: Ser donador renal es seguro y el abordaje que recomendamos ofrecer es el laparoscópico mano-asistido.

The sum of kidney donor profile index and estimated post-transplant survival scale and their correlation with egfr decline in deceased donor kidney recipients

Background: The impact of donor quality on post-kidney transplant survival may vary by candidate condition. Objective: Analyzing the combined use of the Kidney Donor Profile Index (KDPI) and the estimated post-transplant survival (EPTS) scale and their correlation with the estimated glomerular filtration rate (eGFR) decline in deceased-donor kidney recipients (DDKR). Methods: This was a retrospective, observational cohort study. We included DDKRs between 2015 and 2017 at a national third-level hospital. Results: We analyzed 68 DDKR. The mean age at transplant was 41 ± 14 years, 47 (69%) had sensitization events, 18 (26%) had delayed graft function, and 16 (23%) acute rejection. The graft survival at 12 and 36 months was 98.1% (95% CI 94-100) and 83.7% (95% CI 65-100), respectively. The Pearson correlation coefficient between the percentage reduction in the annual eGFR and the sum of EPTS and KDPI scales was r = 0.61, p < 0.001. The correlation coefficient between the percentage reduction in the annual eGFR and the EPTS and KDPI scales separately was r = 0.55, p < 0.001, and r = 0.53, p < 0.001, respectively. Conclusions: The sum of EPTS and KDPI scales can provide a better donor-recipient relationship and has a moderately positive correlation with the decrease in eGFR in DDKR.

The Sum of Kidney Donor Profile Index and Estimated Post-Transplant Survival Scale and Their Correlation with eGFR Decline in Deceased Donor Kidney Recipients.

BACKGROUND: The impact of donor quality on post-kidney transplant survival may vary by candidate condition. OBJECTIVE: Analyzing the combined use of the Kidney Donor Profile Index (KDPI) and the estimated post-transplant survival (EPTS) scale and their correlation with the estimated glomerular filtration rate (eGFR) decline in deceased-donor kidney recipients (DDKR). METHODS: This was a retrospective, observational cohort study. We included DDKRs between 2015 and 2017 at a national third-level hospital. RESULTS: We analyzed 68 DDKR. The mean age at transplant was 41 ± 14 years, 47 (69%) had sensitization events, 18 (26%) had delayed graft function, and 16 (23%) acute rejection. The graft survival at 12 and 36 months was 98.1% (95% CI 94-100) and 83.7% (95% CI 65-100), respectively. The Pearson correlation coefficient between the percentage reduction in the annual eGFR and the sum of EPTS and KDPI scales was r = 0.61, p < 0.001. The correlation coefficient between the percentage reduction in the annual eGFR and the EPTS and KDPI scales separately was r = 0.55, p < 0.001, and r = 0.53, p < 0.001, respectively. CONCLUSIONS: The sum of EPTS and KDPI scales can provide a better donor-recipient relationship and has a moderately positive correlation with the decrease in eGFR in DDKR.