Comparative study of living donor kidney transplants: Right vs left

Transplant teams often hesitate to use the right kidney (RK) in living donor (LD) transplants due to the complexities of anastomosing the short, thin-walled right renal veins, which can potentially lead to graft loss or graft dysfunction. Nevertheless, circumstances may arise where selecting the RK over the left kidney (LK) is unavoidable. Consequently, it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.

To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.

We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023. We included all kidney donors who were over 18, fit to donate, and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry. The variables examined comprised donor and recipient demographics, and outcome measures included technical graft loss (TGL), delayed or slow graft function (SGF), and post-transplant serum creatinine (SC) trends. We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.

Of the 250 transplants performed during the period, 56 (22%) were RKs. The recipient demographics and transplant factors were comparable for the right and LKs, except that the donor warm and cold ischemia time were shorter for RKs. TGL and SGF each occurred in 2% (n = 1) of RKs and 0.5% (n = 1) of LKs, the difference being insignificant. These complications, however, were not related to the venous anastomosis. One RK (2%) developed delayed graft function after 48 hours, which was attributable to postoperative hypoxia rather than the surgical technique. The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.

The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants, provided that careful patient selection and precise surgical techniques are employed.