Retrocaval renal artery bifurcation is not a contraindication to laparoscopic right donor nephrectomy

Laparoscopic donor nephrectomy is preferentially performed on the left side vs the right, even in instances where more complex arterial vasculature is present on the left. This finding is significant given the observation that living donor kidneys with multiple arteries are associated with increased incidence of ureteral complications in the recipient. One common anatomic variant, retrocaval bifurcation of the right renal artery, has potential risks that prompt the decision to procure left-sided kidneys with more complex arterial anatomy. However, these risks may be mitigated by the surgical approaches that can successfully procure right kidneys with this type of arterial variant.

Of 321 total nephrectomies performed, there were 44 right-sided laparoscopic donor nephrectomies. Nineteen of these 44 patients had retrocaval bifurcation and were compared with a cohort of 25 patients without this variant. Standardized parameters were collected including demographics, donor and recipient outcomes, graft function, and renal artery anastomotic velocity. The Mann-Whitney U test and Fisher's exact test were used to show statistical significance.

Donor and recipient outcomes and complication rates were not significantly different between the retrocaval bifurcation group and the nonbifurcation group. Notably, graft anastomotic velocity and rates of delayed graft function (DGF) were the same between recipients in the 2 study groups. Comparisons between left-sided nephrectomies and kidneys from the retrocaval bifurcation group showed a slower reduction in immediate creatinine clearance in the retrocaval group; however, both groups had similar outcomes 30 days post-transplantation.

This study provides a detailed, technical laparoscopic methodology for procurement of right-sided kidneys with retrocaval arterial bifurcation, which was associated with outcomes similar to right and left kidneys with single arteries.