To explore the clinical effect of three-dimensional (3D) reconstruction technology for optimizing donor nephrectomy in open living donor kidney transplantation.

Living kidney transplantation recipients who completed in the First Affiliated Hospital of Xi′an Jiaotong University from January 2017 to January 2020 were selected and divided into 3D reconstruction group (60 cases) and traditional operation group (60 cases) according to whether 3D reconstruction technology was used preoperatively. The 3D reconstruction group obtained the medical digital imaging and communication data of the donor′s kidney for 3D reconstruction, and the operation plan or simulated operation were made according to the reconstruction model. In the traditional operation group, conventional arteriovenous CT angiography (CTA), ureteral CTA and ultrasound were used to detect the anatomical structure of the surgical site. The age, sex, body mass index, time of operation, intraoperative blood loss, vascular variation, warm ischemia time of donor kidney, complications, intraoperative serum creatinine level, postoperative recovery time of transplanted kidney, the incidence of delayed graft function (DGF) and postoperative serum creatinine level of donors in two groups were observed. The measurement data of normal distribution were compared by paired t test. Enumeration data were compared by Chi-square test. P<0.05 indicates that the difference is statistically significant.

Vascular variation was found in 22 cases (36.7%) in the 3D reconstruction group before surgery, 11 cases (18.3%) in the conventional operation group after CTA and other routine examinations before surgery. The difference in the diagnostic rate of vascular variation between the two groups was statistically significant (χ²=5.06, P<0.05). In the 3D reconstruction group, 24 cases with vascular variation who were needed to be treated were found intraoperatively, with a consistent rate of 91.7% (22/24). Twenty cases with vascular variation were found in the traditional operation group, and the diagnostic consistency rate was 55.0% (11/20), the difference between the two groups was statistically significant (χ²=7.82, P<0.05). The operation time of donor kidney resection in the 3D reconstruction group [(88±7)min] was shorter than that in the traditional operation group [ (101±11) min]; the amount of intraoperative blood loss was less than that of the traditional operation group [(80±18) mL vs (93±19) mL], and the differences were statistically significant (t=6.50, 3.55, all P<0.05). The serum creatinine level of donors in 3D reconstruction group and traditional operation group were (69±14) and (87±13) μmol/L, respectively (t=6.82, P<0.05). The recovery time of transplanted kidney function in the 3D reconstruction group was shorter than that in the traditional operation group [(3.7±2.4)d vs (5.1±1.7)d] (t=2.43, P<0.05). The serum creatinine level of the 3D reconstruction group decreased faster than that of the traditional operation group on the first day after operation, respectively [(427±21) vs (531±31) μmol/L] (t=4.45, P<0.05).

3D reconstruction technology can further optimize donor nephrectomy of living kidney transplantation, which can better protect the donor kidney and reduce the risk of surgery.