Sezai YİLMAZ, Turgut PİSKİN, Bulent UNAL

Open Donor Nephrectomy is a Safe Approach for Starting Kidney Transplantation

Amaç: Türkiye'de canlı vericili böbrek nakli, organ bağışının azlığı nedeni ile oldukça önemlidir. Klasik retroperitoneal açık donör nefrektomi, intraperitoneal organ yaralanması ve postoperataif adezyonları önlemesi bakımından faydalı bir yöntemdir. Biz de kliniğimizde açık donör nefrektomi geçiren hastalarda başlangıç deneyimlerimizi sunmayı amaçladık.Gereç ve Yöntemler: Kasım 2010 ve Haziran 2011 tarihleri arasında açık donör nefrektomi yapılan 14 hasta retrospektif olarak analiz edildi. Bu donörlerde demografik özellikler, intraoperatif ve postoperative komplikasyonlar, hastanede kalış süresi, serum kreatinin seviyeleri ( taburculuk zamanında, postoperative maksimum seviyeleri ve şimdiki değerleri) gözden geçirildi. Bulgular: Bu dönemde 14 donör opere edildi. Erkek kadın oranı 8:6 idi. Ortalama yaş 43.57yıl ( 27y-68y), ortalama vücut kitle indeksi 27.71 kg/m2 ( 21.3-36.1 kg/m2) idi. Beş sağ böbrek, 9 sol böbrek nefrektomi yapıldı. İntraoperatif organ yaralanması gözlenmedi. Tüm greftler hemen çalışmaya başladı. Transplante edilen böbreklerde vasküler tromboz olmadı. Bir adet reoperasyon gerektiren major kanama gözlendi (%7.1). Üç hastada minor yara komplikasyonları gözlendi (%21.4). Hiçbir hastada insizyonel herni gözlenmedi. Ortalama hastanede kalış süresi 5.85 gün (4-18gün), ortalama takip süresi 125gün (18-210 gün) idi. Ortalama serum kreatinin, taburculuk zamanında, postoperative en yüksek olduğu seviye ve şimdiki değerleri sırasıyla; 1.04 mg/dL (0.6-1.7 mg/dL); 1.26 mg/dL (0.8-1.9 mg/dL); 1.08 mg/dL (0.78-1.41 mg/dL) idi. Sonuç: Açık donör nefrektomi yaptığımız başlangıç serimizde major komplikasyon ile karşılaşmadık. Bu nedenle böbrek nakline yeni başlayan merkezler için başlangıçta açık donör nefrektominin güvenli bir yöntem olduğu kanaatindeyiz.

Böbrek Nakline Başlarken Açık Donör Nefrektomi Güvenli Bir Yaklaşımdır

Aim: Living kidney donation is important due to the shortage of organ donors in Turkey. Classic retroperitoneal open donor nephrectomy is more beneficial as it can prevent intraperitoneal organ injuries and postoperative adhesion formation. Here we have presented our initial experience about donors who were undergone open donor nephrectomy. Material and Methods: We retrospectively analyzed 14 donors who were undergone open nephrectomy between November 2010 and June 2011. We reviewed demographic data, intraoperative and postoperative complications, hospital stay, and serum creatinine levels (discharge time, postoperative maximum level and currently) for these donors. Results: Fourteen donors were operated during this period. The male to female ratio was 8:6 among donors. Mean age was 43.57 years. Mean body mass index was 27.71 (range; 21.3-36.1). Five right and nine left kidneys were harvested. There was no intraperitoneal organ injury. All kidney grafts started to function immediately. There was no vascular thrombosis in the transplanted kidneys. There was one major hemorrhagic complication requiring reoperation (7.1%). There were three minor wounds complications (21.4%). None of the donors had incisional hernia. Mean postoperative hospitalization time was 5.85 days. Mean flow up period was 125 days (range; 18-210 days). Mean serum creatinine level of discharge time, postoperative maximum level, and currently were; 1.04 mg/dL (range; 0.6-1.7); 1.26 mg/dL (range; 0.8-1.9); 1.08 mg/dL (range; 0.78-1.41) respectively. Conclusions; We did not have any major complication in our initial series for open donor nephrectomy. For those who are starting kidney transplantation, open donor nephrectomy is a safe method.

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