Stephen C. Jacobs

The effect of both donor renal mass and gender on renal function, in both gender recipients, was examined. Qualifying consecutive living-donor renal transplants (n = 730) were stratified into 4 donor–recipient groups: female–female (n = 177), male–female (n = 151), female–male (n = 240), male–male (n = 162). Groups were equivalent in age, race, body mass index (BMI), match, ischemia time, operative time, and estimated glomerular filtration rate (eGFR). Female recipients had lower serum creatinine (Cr_s). Male recipients had higher Cr_s wherever they received a female allograft. Male recipients of male kidneys had a higher eGFR than all other groups for 3 years. Renal function of the recipient correlated with the renal mass of the donor within each group. Male and female kidneys functioned equivalently in the female-recipient environment. Large nephron-mass male donor kidneys function more poorly in female recipients. The male kidney loses 15–20 ml/min eGFR in the female host. The diminished graft function may be related to androgen deprivation. Female and male donor kidneys function equivalently in the male recipient if adjusted for renal mass transplanted. Female kidneys improve eGFR by 7–10 ml/min by being transplanted into a male environment. Donor renal mass and gender affect recipient graft function Expectations of ultimate recipient renal function should take into account both the gender and mass disparity of the donor–recipient pair.

Opinion from JAMA Surgery — Department of Surgery — University of Maryland School of Medicine

Purpose: We determined whether the results of laparoscopic donor nephrectomy warranted expansion of the availability of the technique.Materials and Methods: Donor and recipient charts for 7...

Laparoscopic donor nephrectomy has undergone explosive worldwide growth as the method of choice for removal of living donor kidneys. However, the method does have some distinct disadvantages as well. The objective is to define real and potential difficulties with the generalized uncritical acceptance of this surgical technique. The literature and personal experience at the largest laparoscopic donor program were reviewed and consolidated. Critical areas of technique and management were analyzed. Laparoscopic living donor nephrectomy has increased the pool of willing potential renal donors. In experienced has the recipient renal function results are equivalent to open nephrectomy. There are risks in performing the operation to the donor and to the allograft. These risks are potentially catastrophic and mitigate against any casual attitudes about embarking on a laparoscopic donor nephrectomy program.