Therapeutic Living Kidney Donation for Symptomatic Nutcracker Syndrome: A Multicenter Experience Using Kidney Paired Exchange

Therapeutic living kidney donation (TLKD), in which a nephrectomy is performed as definitive treatment for a donor condition, remains uncommon. This multicenter study reports outcomes of seven patients from three centers with symptomatic nutcracker syndrome (NCS) who underwent TLKD through kidney paired exchange between 2022-2024. Among the seven donors, the majority were female (n = 6). Median age was 38 y (range: 23-55 y), and median BMI was 22.9 (range: 19.0-32.6). Nephrectomies were performed via laparoscopic (n = 2), laparoscopic hand-assisted (n = 4), or open (n = 1) technique. All kidneys were transplanted successfully through national paired kidney exchange. Donor creatinine levels increased from a mean of 0.71 mg/dL preoperatively to 1.08 mg/dL at six months. All donors reported symptom relief, with no perioperative complications. Recipient outcomes showed stable renal function, with mean creatinine of 1.1 mg/dL at 6 months and 1.2 mg/dL at 1 year. TLKD offers symptom resolution for appropriately selected donors and access to transplantation for recipients. Further longitudinal data will clarify patient selection and long-term outcomes, but these data suggest TLKD in refractory NCS is feasible.