Protamine sulphate can be used to reverse the effects of heparin but is associated with anaphylactic reactions and pulmonary hypertension find more information [6, 7]. Systemic heparin was previously used for LDN in Leicester but in 2010 the protocol was changed and heparin was not administered. The aim of this study was to examine donor and recipient outcomes associated with or without the administration of systemic heparin during LDN. 2. Patients and Methods 2.1. Patients A retrospective analysis was performed on 219 consecutive patients undergoing LLDN from April 2008 to November 2012. Three donors were converted from laparoscopic surgery to an open procedure due to a complication during surgery; however all 3 conversions were carried out before heparin was administered and these cases were consequently excluded from the study.

Thirty patients were also excluded due to lack of completed documentation. Therefore, 186 LDN were analysed in this study. All LDN were performed by the same consult transplant surgeon (MLN). Patient’s notes and computerised records were manually assessed for donor and recipient complications, including complications throughout the operative procedure and graft function of the recipient. Graft outcome measures were collected up until 12 months after transplant. All donors who underwent LDN between April 2008 and December 2010 received systemic heparin (n = 109). From December 2010 the remaining donors in the series did not receive intraoperative systemic heparin (n = 77). 2.2. Donor Management All donors received the same postoperative care.

In brief this involved 15-minute blood pressure monitoring for the first 2 hours post operatively, followed by 30-minute observations for the next hour and then hourly for the next 4 hours. Subsequently observations were then taken 4 hourly until discharge. Haemoglobin levels were measured preoperatively and then daily until discharge. 2.3. Surgical Techniques and Systemic Heparinisation Protocol The surgical team made a decision about which kidney to remove based on the result of the split function renal test and the vascular anatomy of the kidney, as demonstrated by spiral Ct angiography computed tomography (CT scan). The laparoscopic surgical procedure was consistent throughout this cohort of 186 patients. A pure laparoscopic, nonhand assisted procedure was used throughout. A 4-port transperitoneal access was used.

Kidneys were extracted via a pfannenstiel incision (6�C8cm), using a fully transperitoneal approach. Two 10mm Brefeldin_A ports were used; one placed close to the umbilicus and the other in the ipsilateral iliac fossa. Fivemm ports were placed in the epigastrium and the lumbar region. The renal artery was secured with a linear cutting stapler or lockable silastic clips (Weck, Hem-o-lok Closure System, Teleflex medical, NC, USA). The renal vein was divided after controlling with Hem-o-lok clips.