Urinary biomarkers after donor nephrectomy

Transplant International 2015 May;28(5):544-52

Aims
To investigate whether the elevated intra-abdominal pressure (IAP) during laparoscopic donor nephrectomy causes early damage to the remaining kidney.

Interventions
Low-pressure pneumoperitoneum (7 mmHg) versus normal pressure pneumoperitoneum (14 mmHg) in donors undergoing a laparoscopic donor nephrectomy.

Participants
Samples were obtained from 20 donors who participated in the recent Leopard study (Warle MC, et al. Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors’ comfort. Clin Transplant 2013; 27: E478)

Outcomes
Serum creatinine, creatinine, albumin, α-1-MGB, kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), urinary output and saline infusion.

Follow-up
7 days

CET Conclusions
This is a carefully done study in which firstly the authors studied patients having a laparoscopic donor nephrectomy, an open donor nephrectomy, laparoscopic cholecystectomy and colectomy. A number of biomarkers for kidney injury, such as the injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), were studied. These molecules were measures in urine samples collected during and after laparoscopic donor nephrectomy and cholecystectomy. They also randomly assigned patients to standard or low intra abdominal pressure during laparoscopic donor nephrectomy. It should be said firstly that there was no difference between standard and low intra abdominal pressures in terms of the biomarkers. There were small increases in urine KIM-1 during surgery and in urine NGAL two to three days after surgery. The authors suggest that the elevated urinary alpha-1-MGB suggests kidney damage after donor nephrectomy, irrespective of the intra abdominal pressure during the procedure. There is no question that there are statistically significant differences in some of their findings, but I find it hard to conclude that this is consistent with significant kidney injury. The authors themselves say that the findings are suggestive and that further studies are required.

Jadad score
3

Data analysis
Strict intention-to-treat analysis

Allocation concealment
No

Quality notes
Score based on Warle MC, Berkers AW, Langenhuijsen JF, et al. Low pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors’ comfort. Clin Transplant 2013; 27: E478.

Trial registration
None

Funding source
Not reported