Anesthesiological care for donor nephrectomy and possibilities of its optimization

Background. Living related donor (LRD) kidney transplantation is the most effective strategy of renal replacement therapy for patients with stage 5 chronic kidney disease. LRD organs are used due to the shortage of organs from deceased donors. One of the key problems still remained is the anesthetic management of laparoscopic donor nephrectomy (LDNE) and its impact on the graft condition.

Objective. Analysis and generalization of the results obtained in the studies of anesthetic management of LDNE and its impact on the graft condition.

Material and methods. The literature search was performed in the PubMed, eLibrary, The Cochrane Library, MedLine, EMBASE databases using the search queries: "laparoscopic donor nephrectomy", "nephrectomy", "anesthesia for donor nephrectomy and kidney transplantation", "renal graft condition during anesthesia", which made it possible to find and analyze 445 works published in foreign and Russian journals from 2020 to 2025. As a result of the selection, 51 publications were included in the review, including 10 randomized clinical trials, 1 experimental study, 16 observational studies, 2 meta-analyses, 10 systematic reviews, 1 single-center retrospective controlled study, 5 single-center prospective controlled studies, 4 clinical guidelines, 2 clinical case reports.

Conclusion. In the world literature over the recent five years, we have hardly found a large number of reports covering the issue of perioperative anesthetic management of LDNE. The available data indicate that general, combined and regional anesthesia are of interest and can be effectively used in LDNE.

1. Efremov EA, Bekov RR, Dudareva AA, Krasnyak SS, Perlin DV. Epidemiology and etiological factors of erectile dysfunction in patients on dialysis and after renal transplantation. Russian Journal of Transplantology and Artificial Organs. 2011;13(1):50–55. (In Russ.). https://doi.org/10.15825/1995-1191-2011-1-50-55

2. Kadyrov ZA, Odilov AYu, Sadulloev FS. Erectile dysfunction in kidney diseases: a review of the literature. Andrologiya i genital’naya khirurgiya=Andrology and Genital Surgery. 2021;22(1):13–20. (In Russ.). https://doi.org/10.17650/1726-9784-2021-22-1-13-20

3. Calzo JP, Austin SB, Charlton BM, Missmer SA, Kathrins M, Gaskins AJ, et al. Erectile dysfunction in a sample of sexually active young adult men from a U.S. cohort: demographic, metabolic and mental health correlates. J Urol. 2021;205(2):539–544. PMID: 32935616 https://doi.org/10.1097/JU.0000000000001367

4. Miron A, Nistor I, Moroșanu C, Sirițeanu L, Pricop C, Puia D, et al. Prevalence, risk factors, and severity of erectile dysfunction following renal transplantation. Int Urol Nephrol. 2025;57(4):1151–1173. PMID: 39623195 https://doi.org/10.21203/rs.3.rs-5202315/v1

5. Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13:37. PMID: 25928197 https://doi.org/10.1186/s12958-015-0032-1

6. Pan J, Zheng Z, Wang W, Hu D, Yao R, Chen Y, et al. Time-dependent analysis of erectile dysfunction in kidney transplant recipients: insights from four distinct time periods. BMC Infect Dis. 2024;24(1):728. PMID: 39048969 https://doi.org/10.1186/s12879-024-09611-7

7. Popov SV, Orlov IN, Grin EA, Malevich SM, Gulko AM, Topuzo TM, et al. Erectile dysfunction: new technologies and approaches in diagnostics and treatment. Urology Herald. 2020;8(2):78–92. (In Russ.). https://doi.org/10.21886/2308-6424-2020-8-2-78-92

8. Pizzol D, Xiao T, Yang L, Demurtas J, McDermott D, Garolla A, et al. Prevalence of erectile dysfunction in patients with chronic kidney disease: a systematic review and meta-analysis. Int J Impot Res. 2021;33(5):508–515. PMID: 32358511 https://doi.org/10.1038/s41443-020-0295-8

9. Miron A, Nistor I, Morosanu C, Siriteanu L, Covic A. Clinical implications and risk factors for erectile dysfunction in kidney transplant: a single-center assessment. Cureus. 2023;15(4):e38088. PMID: 37252513 https://doi.org/10.7759/cureus.38088

10. Tekkarismaz N, Tunel M, Ozer C. Dialysis modality and sexual dysfunction in male patients. Andrologia. 2020;52(10):e13735. PMID: 32627887 https://doi.org/10.1111/and.13735

11. Kamalov AA, Perlin DV, Yefremov EA, Dudareva AA. Osobennosti diagnostiki i lecheniya erektil'noy disfunktsii u patsiyentov s khronicheskoy pochechnoy nedostatochnost'yu posle transplantatsii pochki. Trudnyy patsiyent. 2006;4(8–1):13–15. (In Russ.).

12. Kamalov AA, Matskeplishvili ST, Chaliy ME, Okhobotov DA, Sorokin NI, Strigunov AA, et al. Vascular erectile dysfunction: a comprehensive approach to diagnosis. Experimental and Clinical Urology. 2021;14(1):68–76. (In Russ.). https://doi.org/10.29188/2222-8543-2021-14-1-68-76

13. De Leonardis F, Colalillo G, Finazzi Agrò E, Miano R, Fuschi A, Asimakopoulos AD. Endothelial dysfunction, erectile deficit and cardiovascular disease: an overview of the pathogenetic links. Biomedicines. 2022;10(8):1848. PMID: 36009395 https://doi.org/10.3390/biomedicines10081848

14. Behr-Roussel D, Chamiot-Clerc P, Bernabe J, Mevel K, Alexandre L, Safar ME, et al. Erectile dysfunction in spontaneously hypertensive rats: pathophysiological mechanisms. Am J Physiol Regul Integr Comp Physiol. 2003;284(3):R682–R688. PMID: 12611393 https://doi.org/10.1152/ajpregu.00349.2002

15. Mirone V, Longo N, Fusco F, Verze P, Creta M, Parazzini F, et al. Renal transplantation does not improve erectile function in hemodialysed patients. Eur Urol. 2009;56(6):1047–1053. PMID: 18835084 https://doi.org/10.1016/j.eururo.2008.09.020

16. Selvi I, Sarikaya S, Atilgan KG, Ayli MD. Is dialysis adequacy a useful predictor for sexual function in males and females with end-stage renal disease? Rev Int Androl. 2021;19(3):164– 176. PMID: 32591287 https://doi.org/10.1016/j.androl.2020.01.001

17. Abarca-Durán X, Fernández-Medina IM, Jiménez-Lasserrotte MDM, Dobarrio-Sanz I, Martínez-Abarca AL, Fernández-Sola C. Sexuality in kidney transplant recipients: a qualitative study. Healthcare (Basel). 2021;9(11):1432. PMID: 34828479 https://doi.org/10.3390/healthcare9111432

18. Efremov EA, Shekhovtsov SYu, Kastrikin YuV, Butov AO, Edoyan TA. Diagnosis of Erectile Dysfunction. Current State of the Problem. Effective Pharmacotherapy. 2019;15(16):38–45. (In Russ.). https://doi.org/10.33978/2307-3586-2019-15-16-38-44

19. Silva ACP, Campos TS, Gonçalves RR, Tavares JMAB, Lins SMSB, Oliveira TM. Risk behaviors after kidney transplant that influence the adherence to treatment. Research, Society and Development. 2022;11(4):e31311427343. https://doi.org/10.33448/rsd-v11i4.27343

20. Alaoui AC, Omari M, Quarmich N, Kouiri O, Chouhani BA, Berraho M, et al. Prevalence and determinant factors of depression and anxiety in people with chronic kidney disease: a Moroccan cross-sectional study. Pan Afr Med J. 2024;48:15. PMID: 39184851 https://doi.org/10.11604/pamj.2024.48.15.42881

21. Chou J, Kiebalo T, Jagiello P, Pawlaczyk K. Multifaceted sexual dysfunction in dialyzing men and women: pathophysiology, diagnostics, and therapeutics. Life (Basel). 2021;11(4):311. PMID: 33918412 https://doi.org/10.3390/life11040311

22. Bautovich A, Katz I, Smith M, Loo CK, Harvey SB. Depression and chronic kidney disease: a review for clinicians. Aust N Z J Psychiatry. 2014;48(6):530– 541. PMID: 24658294 https://doi.org/10.1177/0004867414528589

23. Swindle RW, Cameron AE, Lockhart DC, Rosen RC. The psychological and interpersonal relationship scales: assessing psychological and relationship outcomes associated with erectile dysfunction and its treatment. Arch Sex Behav. 2004;33(1):19–30. PMID: 14739687 https://doi.org/10.1023/B:ASEB.0000007459.48511.31

24. Salonia A, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al.; EAU Working Group on Male Sexual and Reproductive Health. European Association of Urology Guidelines on Sexual and Reproductive Health-2021 Update: Male Sexual Dysfunction. Eur Urol. 2021;80(3):333–357. PMID: 34183196 https://doi.org/10.1016/j.eururo.2021.06.007

25. Neijenhuijs KI, Holtmaat K, Aarson NK, Holzner B, Terwee CB, Cuijpers P, et al. The International Index of Erectile Function (IIEF) – a systematic review of measurement properties. J Sex Med. 2019;16(7):1078–1091. PMID: 31147249 https://doi.org/10.1016/j.jsxm.2019.04.010

26. Jabali SS, Saleem ZM, Mohammed A, Mahmood NM. Erectile dysfunction pre and post kidney transplant recipients in Duhok city; cross sectional study. Ann Med Surg (Lond). 2020;55:107– 110. PMID: 32477507 https://doi.org/10.1016/j.amsu.2020.04.038

27. Tang Z, Li D, Zhang X, Yi L, Zhu X, Zeng X, et al. Comparison of the simplified International Index of Erectile Function (IIEF-5) in patients of erectile dysfunction with different pathophysiologies. BMC Urol. 2014;14:52. PMID: 24996819 https://doi.org/10.1186/1471-2490-14-52

28. Wang Q, Guo Y, Zhang H, Qin X, Zhang C, Zhou W. The value of shear wave elastography combined with red blood cell distribution width in evaluating arterial erectile dysfunction. BMC Urol. 2024;24(1):205. PMID: 39300493 https://doi.org/10.1186/s12894-024-01579-5

29. Zhang DK, Li YL, Guan JB, Li ZX, Sun M. The feasibility study of shear wave elastography in the diagnosis of erectile dysfunction. Sci Rep. 2024;14(1):28111. PMID: 39548229 https://doi.org/10.1038/s41598-024-78849-7

30. Perri A, Izzo G, Lofaro D, La Vignera S, Brunetti A, Calo gero AE, et al. Erectile dysfunction after kidney transplantation. J Clin Med. 2020;9(6):1991. PMID: 32630390 https://doi.org/10.3390/jcm9061991

31. Lundy SD, Vij SC. Male infertility in renal failure and transplantation. Transl Androl Uro. 2019;8(2):173–181. PMID: 31080778 https://doi.org/10.21037/tau.2018.07.16

32. Antonucci M, Palermo G, Recupero SM, Bientinesi R, Presicce F, Foschi N, et al. Male sexual dysfunction in patients with chronic end-stage renal insufficiency and in renal transplant recipients. Arch Ital Urol Androl. 2016;87(4):299–305. PMID: 26766802 https://doi.org/10.4081/aiua.2015.4.299

33. El Hennawy HM, Safar O, Faifi ASA, Shalkamy O, Alqahtani Y, Nazer WE, et al. Does kidney transplantation help young patients on dialysis with erectile dysfunction? A single-center study. Urology. 2022;169:120–124. PMID: 35944654 https://doi.org/10.1016/j.urology.2022.07.042

34. Ahmed AF, Shaban M, Daoud A, Mohamed N, Solyman A, Fahim A. Erectile function and gonadal hormones levels in men with end-stage renal disease: It's relevance to duration of haemodialysis. Andrologia. 2018;50(8):e13073. PMID: 29917254 https://doi.org/10.1111/and.13073

35. Cigarrán S, Coronel F, Florit E, Calviño J, Villa J, Gonzalez Tabares L, et al. Testosterone deficiency in dialysis patients: difference between dialysis techniques. Nefrologia. 2017;37(5):526– 530. PMID: 28946965 https://doi.org/10.1016/j.nefro.2017.03.014

36. Dell'Atti L. Current treatment options for erectile dysfunction in kidney transplant recipients. Sex Med Rev. 2024;12(3):442–448. PMID: 38724235 https://doi.org/10.1093/sxmrev/qeae028

37. Spirito L, Manfredi C, Carrano R, Trinchieri A, Salemi F, Sciorio C, et al. Impact of kidney transplantation on male sexual function: results from a ten-year retrospective study. J Sex Med. 2020;17(11):2191–2197. PMID: 32800739 https://doi.org/10.1016/j.jsxm.2020.07.014

38. Deebel NA, Matthew AN, Loloi J, Bernstein AP, Thirumavalavan N, Ramasamy R. Testosterone deficiency in men with end stage renal disease and kidney transplantation: a narrative review. Int J Impot Res. 202;37(4):271–277. PMID: 38615112 https://doi.org/10.1038/s41443-024-00890-x

39. Rahman IA, Rasyid N, Birowo P, Atmoko W. Effects of renal transplantation on erectile dysfunction: a systematic review and meta-analysis. Int J Impot Res. 2022;34(5):456–466. PMID: 34103695 https://doi.org/10.1038/s41443-021-00419-6

40. Matheus WE, Reis LO, Ferreira U, Mazzali M, Denardi F, Leitao VA, et al. Kidney transplant anastomosis: internal or external iliac artery? Urol J. 2009;6(4):260-266. PMID: 20027554

41. Zagitov AR, Mukhamedyanov FN, Izmailov AA, Kutliyarov LM, Pavlov VN. Treatment of erectile dysfunction in patients after kidney transplantation depending on type of vascular anastomosis: results of shortterm follow up study. Urology Herald. 2018;6(4):21–26. (In Russ.). https://doi.org/10.21886/2308-6424-2018-6-4-21-26