Prélèvement de rein pour transplantation à donneur vivant, suites opératoires et évolution des donneurs : évaluation des pratiques au CHU de Grenoble-Alpes et aux hospices civils de Lyon : étude KLiDE : Kidney Living Donor Evaluation

Abstract : Introduction : Organ shortage has resulted in the emergence of living donor kidney transplantation. Evaluation of surgical practices is essential to ensure safety and optimal management of donors. Methods: We carried out a bi-centric retrospective study between 1997 and 2017. The main objective was to study the intraoperative difficulties and the outcomes of the donors. The various surgical techniques and predicting factors of operative difficulties or complications were evaluated. Results: Four hundred and twenty-five patients were included. Median age at the time of donation was 50 years old. The procedures were performed by laparoscopy in 88% of cases. The surgical conversion rate was 4,9%. Postoperative complications were found in 32% patients. The major complication rate (Clavien> 2) was 4.2%. The average loss of GFR at one year of the donation was 25%. The overall complication rate was not different according to the technique. The presence of an anatomical variant was predictive of surgical difficulties (OR 2.30, 95% CI 1.16-4.55). In one third of cases the variation was not described by preoperative imaging.The MAP score was predictive of intraoperative difficulties (OR 13.05, 95% CI 5.25-32.47), conversion (OR 18.96, 95% CI 3.42-105.14), and postoperative complication (OR 2.37, 95% CI 1.13-5.00). Conclusion: Living donor nephrectomy for transplantation is a surgery at risk that needs to be done by experts. Special attention should be given to preoperative imaging to anticipate surgical difficulties. The MAP score seems to be an innovative tool to predict the risk of complications. These data must to be confirmed by a prospective study.
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Master Thesis
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Quentin Franquet. Prélèvement de rein pour transplantation à donneur vivant, suites opératoires et évolution des donneurs : évaluation des pratiques au CHU de Grenoble-Alpes et aux hospices civils de Lyon : étude KLiDE : Kidney Living Donor Evaluation. Médecine humaine et pathologie. 2019. ⟨dumas-02121616⟩

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