%0 Journal Article
%T Systemic Heparinisation in Laparoscopic Live Donor Nephrectomy
%A Charlotte Crotty
%A Yasmin Tabbakh
%A Sarah A. Hosgood
%A Michael L. Nicholson
%J Journal of Transplantation
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/138926
%X Introduction. Systemic heparinisation is advocated during laparoscopic live donor nephrectomy (LDN) as a preventative measure against renal vascular thrombosis during the warm ischaemic interval. This study compares the outcome with and without the administration of systemic heparinisation. Methods. A retrospective analysis was performed on 186 consecutive LDN patients between April 2008 and November 2012. Systemic heparin (2000¨C3000£żIU) was administered intravenously to donors (hep ). From January 2010, heparin was not used systemically in this group of LDN (no hep ). Outcome measures included donor and recipient complications, initial graft function, and 12 month graft survival. Results. The demographics of both heparinised and non-heparinised donors were similar. The warm ischaemic time (WIT) was comparable in both groups (WIT; hep versus no hep minutes; ). There was no difference in complication rates, no episodes of graft thrombosis, and no incidences of primary nonfunction in either group. Delayed graft function occurred in 4/109 and 1/77 (3.6% versus 1.2%; ) and there was no significant difference in graft survival ( ). Conclusion. Omitting systemic heparinisation during laparoscopic donor nephrectomy is a feasible and safe approach that does not compromise donor or recipient outcome. 1. Introduction Minimally invasive techniques of surgery for live donor nephrectomy have been rapidly adopted across the UK. Unquestionably this has helped to increase the number of live donor kidney transplants [1]. Kidneys donated by living donors accounted for approximately 36% of all transplants performed in the UK in 2011-2012 [1]. The pure laparoscopic approach uses small incision sites which results in less postoperative pain, reduced hospital stay, improved cosmetics, and earlier return to work than the traditional open technique [2, 3]. This has reduced many of the disincentives associated live kidney donation. During laparoscopic live donor nephrectomy (LDN) the kidney endures a period of warm ischaemic injury before it is retrieved and flushed with cold preservation solution [4]. Systemic heparin has been advocated during laparoscopic live donor nephrectomy as a preventative measure against intra-renal microthrombi formation during the warm ischaemic interval [5]. However, this subjects the patients to an increased risk of haemorrhage. Protamine sulphate can be used to reverse the effects of heparin but is associated with anaphylactic reactions and pulmonary hypertension [6, 7]. Systemic heparin was previously used for LDN in Leicester but in 2010 the
%U http://www.hindawi.com/journals/jtrans/2013/138926/