Implementation of a pediatric kidney transplantation program in Uzbekistan: Feasibility and early outcomes

Figure 1 Positioning and port placement for hand-assisted laparoscopic donor nephrectomy. The patient is placed in a modified lateral decubitus position with flexion at the level of the iliac crest to increase the working space between the costal margin and the iliac spine. The upper arm is supported with an armrest, and all extremities are padded and secured. The hand-assist port is placed via a periumbilical incision. Additional laparoscopic ports are positioned under direct vision: One working port in the upper quadrant, and another in the lower quadrant for the camera. This setup allows optimal access for kidney mobilization, vascular dissection, and safe extraction through the hand-assist site.

Figure 2 Trends in kidney function markers and urine output before and during the first postoperative week. A: Median serum creatinine and urea levels on postoperative days 1, 3, 5, and 7. Both markers demonstrated a progressive decline, reflecting early recovery of graft function; B: Median daily urine output over the same period. Urine output peaked on day 3, consistent with the expected polyuric phase, and gradually decreased by day 7 while remaining above the normal range.

Figure 3 Kaplan–Meier survival curves for patient and graft survival. The orange curve represents overall patient survival, and the green curve shows graft survival during the follow-up period. One death and two cases of graft loss occurred. Both survival rates remained above 90% at 24 months.

Figure 4 Duration of donor nephrectomy by surgical approach. The graph compares operative duration between open donor nephrectomy (n = 16) and laparoscopic hand-assisted donor nephrectomy (n = 4). Median operative times were 182.5 minutes and 198.5 minutes, respectively. Differences were not statistically significant due to the limited sample size.