Surgical management of multiple donor veins in renal transplantation

The surgical aspects of renal transplantation have been standardized for decades regarding normal anatomy of donor kidneys. In certain situations, as in multiple donor veins, there are still challenges regarding the technical management. In > 95%, there is only one renal vein, or the additional vein/veins are so small that they can be ligated without hesitation. In < 5%, there are two main draining veins, and they can be similar in diameter. The management of these cases varies. Some surgeons implant both veins separately, leave them on a common caval patch, or implant the smaller vein into the larger vein as an end-to-side anastomosis, allowing for one venous anastomosis in the recipient. We describe two cases of donor kidneys with two similar-sized veins and conclude that ligation of the smaller vein, even if its size is substantial (up to 1 cm), can be the safest option to avoid surgical complications.