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Background: The left kidney is preferred for live donation. In open live donor nephrectomy, the right kidney is selected if the left kidney has multiple renal arteries or anomalous venous drainage. With laparoscopic live donor nephrectomy (LLDN), there is reluctance to procure the right kidney because of the more difficult exposure and further shortening of the right renal vein (RRV) after a stapled transection. An experience with LLDN is reviewed to determine whether the right kidney should be procured laparoscopically., Methods: From February 1995 to November 1999, 227 patients underwent live donor renal transplants with allografts procured by LLDN. The results of these transplants were analyzed., Results: Of the 227 kidneys transplanted, 17 (7.5%) were right kidneys. In the early experience, three (37.5%) of the eight right renal allografts developed venous thrombosis, two of which had duplicated RRV. Based on these initially unacceptable results, donor evaluation and LLDN techniques were modified. Spiral computerized tomography (CT) replaced conventional angiography to define better the venous anatomy. LLDN was modified in one of three ways: (1) changing the stapler port placement such that the RRV was transected in a plane parallel to the inferior vena cava, (2) relocation of the incision for open division of RRV, or (3) lengthening of the donor RRV with a panel graft constructed of recipient greater saphenous vein. Finally, the recipient operation enjoined complete mobilization of the left iliac vein with transposition lateral to the iliac artery. With these modifications, there were no vascular complications with the subsequent nine right renal allografts (P<0.05). Of the left kidneys transplanted, 31 had multiple renal arteries, 14 had retroaortic or circumaortic veins, 4 had both multiple arteries and venous anomalies, and 1 had a duplicated IVC draining the left renal vein. There were no vascular complications with left renal allografts that had multiple arteries or venous anomalies., Conclusions: LLDN of the left kidney is technically easier. Left kidneys with multiple arteries or anomalous venous drainage are not problematic. The right kidney can be procured with LLDN; however, a rational approach to preoperative angiographic imaging, donor operation, and recipient operation is crucial.

Background: Laparoscopic live donor nephrectomy offers advantages to the donor in terms of decreased pain and shorter recuperation. Heretofore no detailed analysis of the recipient of laparoscopically procured kidneys has been performed. The purpose of this study was to determine whether laparoscopic donor nephrectomy had any deleterious effect on the recipient., Methods: A retrospective review was conducted of all live donor renal transplantations performed from January 1995 through April 1998. The control group received kidneys procured via a standard flank approach (Open). Rejection was diagnosed histologically. Creatinine clearance was calculated using the Cockroft-Gault formula., Results: A total of 110 patients received kidneys from laparoscopic (Lap) and 48 from open donors. One-year recipient (100% vs. 97.0%) and graft (93.5% vs. 91.1%) survival rates were similar for the Open and Lap groups, respectively. A similar incidence of vascular thrombosis (3.4% vs. 2.1%, P=NS) and ureteral complications (9.1% vs. 6.3%, P=NS) were seen in the Lap and Open groups, respectively. The incidence of acute rejection for the first month was 30.1% for the Lap group and 31.9% for the Open group (P=NS). The rate of decline of serum creatinine level in the early posttransplantation period was initially greater in the Open group, but by postoperative day 4 no significant difference existed. No difference was observed in allograft function long-term. The median length of hospital stay was 7.0 days for both groups., Conclusions: Laparoscopic live donor nephrectomy does not adversely effect recipient outcome. The previously demonstrated benefits to the donor, and the increased willingness of individuals to undergo live kidney donation, coupled with the acceptable outcomes experienced by recipients of laparoscopically procured kidneys justifies the continued development and adoption of this operation.

Noninbred rabbits that were characterized for antigens of the major histocompatibility complex (MHC) by serological (RLA) typing were used as adult donors and newborn recipients of lymphoid cells. The majority of RLA-heterozygous (CE) animals transplanted with homozygous type C cells died before 7 weeks of age with clinical and histological signs of graft-versus-host disease, but a small proportion survived with their lymphoid and erythroid systems completely converted to phenotypes of the donors. Takeover of the host's hematopoietic system was associated with a transient hyperimmunoglobulinemia, mostly of donor origin, and with a striking and permanent abrogation of allotype suppression on the part of donor lymphocytes. In contrast, as shown in this and in earlier publications, recipients of RLA-compatible cells become stable B lymphocyte chimeras without detectable T cells or erythrocytes of donor type. In the latter case allotype suppression is neither established in the recipient nor abrogated in the donor's cells.

In the course of experiments designed to demonstrate an active mechanism of allotype suppression in rabbits, spleen cells from adult donors were transferred to newborn recipients. Among 23 rabbits that received injections, 4 stable chimeras were formed, as determined by the production of serum immunoglobulins marked with light and heavy chain allotypes. The other rabbits that survived the immediate postinjection period displayed a temporary chimeric state lasting up to several weeks, after which they either succumbed to graft-versus-host disease or rejected the donor cells. One chimeric animal was apparently repopulated by the hemopoietic cells of the donor's spleen. Insofar as could be determined, the recipient's blood cells became phenotypically identical to those of the donor. This condition manifested itself as a loss of the recipient gene products associated with both lymphocyte and erythrocytes, accompanied by a seemingly total replacement with those of the donor.

Skin grafts were exchanged between siblings from 16 inbreeding lines of rabbits. Progressive inbreeding and genome fixation through 12 generations of brother X sister matings does not produce a concomitant increase in graft survival time but instead produces a heterogenous response reflecting the residual segregation of individual histocompatibility loci. Grafts exchanged between RL-A incompatible siblings were not maintained for more than 12 days, regardless of the degree of inbreeding. The frequency distributions of the survival times of grafts exchanged between animals from all inbreeding lines from each generation, F5 through F8, agree best with the expected values calculated by assuming that 17 independent histocompatibility loci, with 95% confidence limits of 11 and 28 loci, must be matched to assure acceptance of skin grafts for 60 days or more. However, in animals from line Sh5b, only 3 significant histocompatibility loci appear to be segregating. Two of the significant histocompatibility loci segregating in line Sh5b have not geen identified;the third significant locus is either the Hg blood group locus or is linked to the Hg locus. Established loci that remain polymorphic during intensive inbreeding may be important in the development of a model transplantation system; as inbreeding progresses these established loci may be maekers for histocompatiblity loci thathave a significant effect on allograft survival time.