Research project

Patient-reported outcomes following living donor nephrectomy

Kidney transplantation is the optimal treatment for patients with end stage renal disease. In Norway almost 40 % of all renal transplants are performed with organs from living donors, and efforts are made to increase the number of kidneys available for transplantation. The purpose of this thesis was to study clinical and patient-reported outcomes following living kidney donor nephrectomy, with particular emphasis on patient-reported outcomes. A combination of quantitative and qualitative research approaches was used. In a randomized, controlled trial of 122 donors we compared laparoscopic and open donor nephrectomy, focusing on donor safety, postoperative pain, sick leave, health status and overall quality of life at 1, 6 and 12 months follow-up. To explore donor experiences of going through surgery 12 donors were in-depth interviewed at one week and at one year after open donor nephrectomy.

The results from the randomized trial demonstrated that the conventional open donor nephrectomy was superior to laparoscopic donor nephrectomy with regard to donor safety. Yet, an uncomplicated laparoscopic donor nephrectomy had important short-term advantages such as less analgesic requirements, less postoperative pain, shorter sick leave, and better health status and as compared to the open approach. Long-term follow up revealed significant differences in favour of laparoscopy only when adjusting for reoperations and convertions. We therefore conclude that long term benefits are hard to prove in favour of the laparoscopic technique. The in-depth interviews revealed that a positive feeling about being a donor was the dominant theme in both interview series. Though experiencing disincentives from surgery during the first postoperative period, the donors expressed that they were back to their normal health at one year after surgery. Donors experiencing unsuccessful recipient outcome did not regret donation.