Minimally Invasive Kidney Transplantation: Surgical Stress and Kidney Injury

1. Introduction

1.1 Background

Living donor kidney transplantation is the optimal treatment for end stage renal disease (ESKD). This process involves a mandatory period of warm and cold ischaemia before the donor kidney is reperfused. The reperfusion injury causes damage to the transplanted kidney that may affect its long term outcome. In living donor kidney transplantation this period of ischaemia is kept to a minimum. However, minimally invasive kidney transplantation (MIKT) has been shown to increase the warm ischaemia time for these patients due to the prolonged anastomosis time and the graft and patient are exposed to pneumoperitoneum for a significant amount of time. It is not clear if these events affect graft outcomes.

Biomarkers of acute kidney injury are of interest in transplantation as they may be used to assess the severity of graft injury and predict the likely clinical outcomes at an early stage. There is evidence that they can predict delayed graft function after kidney transplantation.

MIKT also has the potential in reducing the surgical trauma associated with open surgery due to smaller incisions; this may reduce infections and improve wound healing. Evidence from laparoscopic donor nephrectomy shows clear benefits to patients.