Vascular Anatomic Variations in Living Donor Kidney Transplantation: A Single Centre Experience

The implication of individual renal vascular anatomical variations remains an important consideration in terms of donor safety and successful graft outcomes in living kidney transplantation, and therefore requires careful preoperative assessment and accurate, personalized surgical planning. This study aimed to characterize these variations, describe their surgical management, and explore their associations with donor postoperative complications and recipient graft outcomes. We retrospectively reviewed 466 hand-assisted laparoscopic donor nephrectomies performed at Semmelweis University between March 2008 and December 2023. Vascular anatomical variations, surgical management, donor postoperative complications, and recipient outcomes were assessed. Vascular anatomical variations were identified in 149 cases (32%), while 317 donors (68%) had standard vascular anatomy. Two renal arteries were present in 86 grafts (18.5%); no grafts with 3 or more renal arteries were transplanted. Venous variations occurred in approximately 17% of cases. Postoperative complications occurred in 8 of 149 donors (5.4%) with variant anatomy and 22 of 317 donors (6.9%) with standard anatomy, without a statistically significant difference (Fisher's exact test, P = .686). Two recipients of kidneys with 2 renal arteries lost their grafts due to vascular complications in the perioperative period, whereas no perioperative graft losses occurred among recipients of single-artery kidneys. In our single-center experience, donor postoperative complication rates did not differ significantly between standard and variant vascular anatomy. Hand-assisted laparoscopic donor nephrectomy was feasible in selected donors with vascular variations. Three-dimensional vascular reconstruction may aid surgical planning, although its impact on outcomes requires further evaluation.