Comparison of Surgical Techniques in Living Donor Nephrectomy: A Systematic Review and Bayesian Network Meta-Analysis.Xiao, Q., et al.
Annals of Transplantation 2020; 25: e926677.
This study aimed to compare different surgical techniques used for living donor nephrectomy (LDN).
A bibliographic search was conducted on PubMed, EMBASE, and Cochrane Library. Two reviewers independently carried out the literature search and data extraction. The methodological quality was assessed using the Cochrane risk of bias assessment tool.
43 studies were included in the review.
The outcomes of interest were nephrectomy side (right or left kidney), warm ischaemia time, body mass index, estimated blood loss, duration of operation, donor intra¬operative and postoperative complications, visual an¬alogue scale on day 1, morphine intake on day 1, duration of hos¬pital stay, delayed graft function, 1-year graft survival and acute rejection.
This systematic review and Bayesian meta-analysis compares open, laparoscopic, hand-assisted and robotic donor nephrectomy for living donors. The authors combined the results of 43 studies and concluded that open nephrectomy is associated with shorter operative and warm-ischaemic times, whereas laparoscopic and robotic procedures reduce blood loss, hospital stay and analgesic requirements. There was no difference in donor postoperative complications, DGF rates or graft survival between techniques. Whilst these findings are in keeping with previous studies, there are some limitations. Of the included studies, only 12 were RCTs leaving a risk of bias in the non-randomised studies particularly those conducted during the learning curve of new procedures. Thus, the magnitude of any risk or benefit may differ depending on the point on the learning curve. It would have been nice to see a subgroup analysis of just the RCTs, to confirm the findings in the overall study cohort. Some comparisons had very few studies, or relied on indirect evidence from the network, although the direct and indirect estimates did appear to be fairly consistent.