Contributions in Renal Transplantation
Living Donors
Correlation Between the Mayo Adhesive Probability Score and the Operative Time in Laparoscopic Donor Nephrectomy

https://doi.org/10.1016/j.transproceed.2020.10.013Get rights and content

Highlights

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    Adherent perinephric fat is a potential risk factor for surgical difficulty in donor nephrectomy.

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    The Mayo Adhesive Probability (MAP) score is an accurate and reliable indicator of APF.

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    Age, body mass index, MAP score, and presence of multiple renal arteries are affecting operative time in laparoscopic donor nephrectomy.

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    The MAP score is associated with older age, male sex, and higher body mass index.

Abstract

Background

Adherent perinephric fat (APF) is a known risk factor of surgical difficulty during laparoscopic donor nephrectomy (LDN). The Mayo Adhesive Probability (MAP) score predicts APF accurately. The aim of this study is to identify the association between MAP score and operative time in LDN.

Methods

We retrospectively evaluated 154 kidney donors who underwent surgery from December 2017 to December 2019 at İstanbul Aydın University Hospital and İstinye University Hospital. All of the operations were done by 3 senior surgeons by a fully laparoscopic method. The MAP score was derived from computed tomography scans by 1 blinded reader. Demographic data, body mass index (BMI), MAP score, side selection, estimated glomerular filtration rate (eGFR), number of arteries and veins, operative time, hospital stay, and complications are recorded. Single and multiple variable analyses were used to evaluate the correlation between operative time and MAP score, BMI, side selection, and number of vascular structures.

Results

A total of 154 patients (79 men, 75 women) with a mean age of 44.4 ± 12.72 were included in this study. None of the cases were converted to open nephrectomy. There were no major complications. Mean BMI was 27.59 ± 4.32 kg/m2, mean MAP score was 0.69 ± 1.15, and mean operative time was 40.25 ± 9.81 minutes. Although mean BMI was higher in women (28.19 ± 4.52 vs 27.03 ± 4.07; P < .05), mean MAP score was lower than in men (0.35 ± 0.86 vs 1.03 ± 1.29; P < .001). Older age, higher BMI, higher MAP score, and presence of multiple renal arteries were associated with longer operative time of LDN. The MAP score was associated with older age, male sex and higher BMI.

Conclusions

This study showed that different risk factors can affect operative time in LDN. The MAP score was significantly associated with longer operative time, especially in men, so it can be useful for predicting surgical difficulty in kidney donors.

Section snippets

Methods

A total of 154 LDN patients who underwent surgery between December 2017 and December 2019 in İstanbul Aydın University Hospital and İstinye University Hospital were retrospectively evaluated. The Institutional Review Board of Istanbul Aydın University (IRB approval no. 2019/132) approved the study protocol. This study was performed in accordance with the Declaration of Helsinki. All of the operations were done by 3 senior surgeons (EE, MT, ÜÖ) experienced in the fully laparoscopic method with 3

Results

A total of 154 patients with a mean age of 44.4 ± 12.7 years (range, 22-73 years) were included in this study. Of the patients, 79% (51.3%) were men, with a mean age of 42.6 ± 12.8 years, and 75 (48.7%) of them were women, with a mean age of 46.3 ± 12.5 years. The mean BMI was 27.6 ± 4.3 kg/m2 for all donors: 27 ± 4.1 kg/m2 for men and 28.2 ± 4.5 kg/m2 for women, respectively. The mean operative time was 40.2 ± 9.8 minutes for all donors: 40 ± 9.5 minutes for men and 40.5 ± 10.2 minutes for

Discussion

Kidney transplantation is the best treatment option for end-stage renal disease. Approximately 80% of kidney transplants in Turkey were performed from living donors because of the lack of cadaveric donors [18]. LDN has become the gold standard in living donor nephrectomy. Preoperative CT imaging is used in living donors to evaluate kidney size and morphology, number and early bifurcation of vascular structures, and pathologic findings such as stones and tumors that may preclude donation.

Acknowledgments

The authors thank to Professor Ayşe Canan Yazıcı Güvercin, Department of Biostatistics and Medical Informatics, Istanbul Aydin University Faculty of Medicine, Beşyol mahallesi, İnönü Cd. No:38, Küçükçekmece, 34295, İstanbul, Turkey; [email protected], for the statistical analysis of this study.

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