Donor renal angiography: its influence on the decision to use the right or left kidney

The left kidney from a living, related donor is preferred for kidney transplantation because it has a longer renal vein and thus is easier to implant in the recipient. However, anatomic variations in the renal arteries occasionally dictate the choice of the right kidney instead. To determine the influence of angiographic findings on the decision to use the right or the left kidney for transplantation, we assessed the role of preoperative angiography in the evaluation of living, related kidney donors. The records of 81 potential renal donors who underwent arteriography were reviewed. Three patients did not undergo donor nephrectomy, for reasons unrelated to the results of arteriography. Of the remaining 78 patients, two-thirds (52) underwent left nephrectomy as planned. A right nephrectomy was performed in the other 26 donors. In 19 of these 26 patients (24% of the 78 who underwent nephrectomy), the right kidney was chosen because of anatomic variations in the renal arteries seen on arteriography. Right donor nephrectomy was performed in the remaining seven of the 26 patients because of venous or collecting-system variants in the left kidney in three and because of better anatomic compatibility with the recipient in the other four. We conclude that donor angiography will dictate the choice of kidney in approximately one-fourth of prospective renal donors.