Published online Dec 18, 2022. doi: 10.5500/wjt.v12.i12.405
Peer-review started: August 11, 2022
First decision: September 5, 2022
Revised: October 31, 2022
Accepted: December 6, 2022
Article in press: December 6, 2022
Published online: December 18, 2022
Minimally invasive surgical techniques for live donor nephrectomy (LDN) are varied. These techniques include hand-assisted laparoscopic, retroperitoneoscopic, single port, natural orifice, and robotic nephrectomy techniques. Turkey has a high number of live kidney donors. The reports regarding LDN in Turkey are missing. In this study, we demonstrated the center volume, preferred techniques for LDN, complications, team setup, and training of transplant teams.
In 2019 according to the Turkish Ministry of Health data, 3963 kidney transplantations were performed in Turkey. Among these patients, 3548 were transplanted from live donors. This increased living donor rate stimulated interest in various surgical techniques applied in Turkey and LDN practice.
To gain insight into the practices of LDNs in Turkish transplant centers.
A questionnaire was sent to the Turkish Ministry of Health-accredited transplant centers. It inquired of the number of LDN surgeries, surgical techniques, complications, optimization protocols, the experience of surgeons, and the training. Descriptive statistics were outlined as follows: Discrete numeric variables were expressed as medians (minimum-maximum), while categorical variables were shown as numbers and percentages. As a result of the goodness-of-fit tests, if the significance of the differences between the groups in discrete numerical variables for which the parametric test statistical assumptions were not met, data were analyzed with the Mann Whitney U test and the χ2 test.
The questionnaire was sent to registered transplant centers in Turkey. All 72 centers replied. In 2019, the median number of kidney transplants performed was 45 per center, and the median number of kidney transplants from living donors was 28. There was a wide range between the centers in terms of transplant numbers (1-238 transplant per year). The open technique was preferred by 19 centers (28.4%). The minimally invasive LDN was performed by 48 centers (71.6%). Among the centers, 8 (16.6%) used more than one surgical technique. A positive correlation between the performance of minimally invasive LDN and the case volume of a transplant center, both in the total number of transplants and live donor kidney transplants, existed (15 vs 55, P = 0.001 and 9 vs 42, P ≤ 0.001 respectively). The most frequently reported complication was postoperative atelectasis (n = 33, 49.2%).
The analysis of the questionnaire answers revealed that Turkish transplant centers successfully performed LDN operations using various techniques. A relatively higher numbers of living donor kidney transplants were performed in 2019 at centers using minimally invasive techniques.
The data regarding the annual kidney transplant numbers, complication rates, and center successes should be released by the Ministry of Health in Turkey. This would allow the control and improvement of the transplant centers when necessary. Despite this, the current status of Turkish transplant centers, as observed in the results of this study, is comparable to transplant centers in Europe and the United States.