Laterality of Hand-Assisted Laparoscopic Donor Nephrectomy in Adult Kidney Transplantation

Living-donor kidney transplantation is widely performed because of shortage of deceased donors. The left kidney is generally preferred for donor nephrectomy because its longer renal vein facilitates venous anastomosis during recipient surgery. However, comprehensive evaluation of donor and recipient outcomes according to donor nephrectomy laterality remains limited. Therefore, we compared the short- and long-term outcomes of right hand and left hand-assisted laparoscopic donor nephrectomy (HALDN) in living kidney donors (LKDs) and recipients.

This single-center retrospective cohort study included 1209 LKDs and recipients who underwent living-donor kidney transplantation (January 2008-December 2021). Donors and recipients were classified into right and left HALDN groups (87 and 1122 donors, respectively). Short- and long-term outcomes were compared between the two groups for donors-surgical details, postoperative estimated glomerular filtration rate changes, end-stage renal disease rates, and mortality-and for recipients, including surgical details, postoperative estimated glomerular filtration rate changes, graft survival, and mortality.

No significant differences in surgical complications were observed between the two HALDN groups for LKDs or recipients. Graft survival among recipients and mortality among donors and recipients were not significantly different between the two HALDN groups. End-stage renal disease was identified in one LKD in the left HALDN group (0.1%).

HALDN laterality was not associated with significant differences in perioperative complications, long-term donor kidney function, donor mortality, recipient graft survival, or recipient mortality. These findings suggest that right HALDN may be a feasible alternative in appropriately selected LKDs when right kidney donation is preferred to preserve the better-functioning kidney.