Early and late surgical complications following living donor nephrectomy.

Objective: To report early and late surgical complications following laparoscopic, open and hand-assisted laparoscopic living donor nephrectomy, including duration of sick leave, kidney function and potential risk factors for surgical complications.

Material and methods: Retrospective study on living kidney donors between September 2014 and June 2021 at Rigshopitalet, Copenhagen. Patient data included demographics, comorbidities, surgical information, and postoperative complications (early <30 days and late >30 days). Complications were graded according to Clavien Dindo (CD). Return to work and reasons for prolonged sick leave were recorded. Multivariable logistic regression to identify risk factors for early complications CD ≥ 2 and time-dependent cause specific Cox regression to identify risk factors for late complications.  Results: A total of 223 living donors were included. Early complications were observed in 22% of donors. Early complications were often mild, and the most common complications were pneumonia, wound infection, and urinary retention. Of the 201 donors available for long-term follow-up, 10% experienced a late complication, including incisional port-site hernia and chronic post-surgical pain. 18% reported a prolonged sick leave beyond the planned 6 weeks.  Conclusions: Living donor nephrectomy is associated with a low risk of serious early surgical complications although many will experience minor related complications. As surgical safety has been confirmed in several studies the focus should be on the psychoscial and long-term aspects of living kidney donation to meet donor concerns pre-donation.