Nine studies were included in the review (n=1,038): one RCT (n=100); four prospective comparisons (n=489); and four studies with retrospective control groups (n=449). Non-randomised studies received between two and seven stars. There was a suggestion of publication bias for hospital stay, total donor complications and postoperative in-hospital complications for MODN compared to SODN and for operative time with MODN compared to LDN.
MODN versus SODN: Operative time, warm ischaemia time and blood loss were not significantly different between treatment groups. Hospital stay was shorter by 1.67 (95% CI -2.35 to -0.99, p=0.001) days for patients treated with MODN (based on seven studies with statistically significant heterogeneity, p = 0.001)). Time to return to work was shorter by five weeks (95% CI -9.38 to -0.62, p=0.03), but this was based on one study only. Analgesia requirement (also based on one study) was 96mEq less in the MODN group (95% CI -149.81 to -42.19mEq, p<0.001). There were fewer overall complications for the MODN group (OR 0.47, 95% CI 0.24 to 0.93, p =0.03; five trials). Data on recipient parameters was very limited, but suggested no differences between treatments.
MODN versus LDN: Operative time was statistically significantly shorter by 55 minutes for MODN (95% CI - 93.46 to -16.36 min, p = 0.005; three studies). Warm ischaemia times were also significantly shorter by 147 seconds (95% CI -205.10 to -88.23 seconds, p<0.001; two studies). Other intra-operative parameters were not statistically significant. Total quantity of analgesia was significantly less by 9.6mEq of morphine (95% CI 0.36 to 18.87mEq, p=0.04; two studies) in the LDN group. There were no other statistically significant differences in any of the postoperative parameters and donor complication rates. No statistically significant differences were noted for recipient parameters.
Details of sensitivity analyses and their effect on donor and recipient parameters were provided in the report.