Managing the Loss of Right Renal Venous Tissue in Deceased-Donor Organ Procurement

Procurement-related injury to the right renal vein (RRV) or renal-caval vein complex (RCVC) may preclude transplantation of an otherwise usable right kidney. We report an expanded single-center experience with the previously described York Plastic technique, focusing on technical feasibility and short-term outcomes.

We retrospectively reviewed deceased-donor right kidneys assessed at our center between January 2018 and January 2025. Of 334 kidneys, 17 (5.1%) sustained procurement-related RCVC injury; 15 underwent York Plastic reconstruction and transplantation, whereas 2 were not used because of severe associated graft damage. Of the 15 transplanted cases, 10 were included in our preliminary 2023 technical report and 5 are newly reported.

All 15 reconstructed grafts were transplanted successfully. No intraoperative bleeding, renal vein thrombosis, or Doppler evidence of venous stenosis occurred. Mean bench reconstruction time was 35 minutes (range, 20-51), and mean cold ischemia time was 16.4 ± 2.5 h. Median serum creatinine among functioning grafts was 1.58 mg/dL at 1 month, 1.49 mg/dL at 3 months, and 1.36 mg/dL at 12 months. At 12 months, 13 of the 14 surviving recipients had functioning grafts. One recipient died at 3 months with a functioning graft; one surviving recipient returned to dialysis before 12 months because of antibody-mediated rejection associated with severe cytomegalovirus infection.

The York Plastic technique appears to be a feasible bench-salvage option for selected procurement-related RCVC injuries and may support organ preservation in carefully chosen cases.