Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Abstract

Introduction: Transplantation of right kidneys can pose technical challenges due to the short right renal vein. Whether this results in inferior outcomes remains controversial.Method: Healthcare Database Advanced Search (HDAS) was used to identify relevant studies. Two authors independently reviewed each study. Statistical analyses were performed using random effects models and results expressed as HR or relative risk (RR) with 95% confidence intervals. Subgroup analyses were performed in kidneys from deceased donors (DD) and living donors (LD).Results: A total of 35 studies (257,429 participants) were identified. Both deceased and living donor right kidneys were at increased risk of delayed graft function (DGF; RR = 1.12[1.06-1.18] and RR = 1.33[1.21-1.46] respectively; both p < .0001). In absolute terms, for each 100 kidney pairs of DD kidneys transplanted there are 2.72 (1.67-3.78, p < .00001) excess episodes of DGF in right kidneys. Graft thromboses and graft loss due to technical failure was also significantly more likely in right kidneys, in both DD and LD settings. There was no evidence that laterality alters long term graft survival in LD or DD. Conclusion:Right kidneys have inferior early outcomes, with higher rates of DGF, technical failure and graft thrombosis. However, these differences are small in absolute terms, and long-term graft survival is equivalent.

Management and Outcome After Early Renal Transplant Vein Thrombosis: A French Multicentre Observational Study of Real-Life Practice Over 24 Years

“…In our series, grafts from marginal donors (18) represented approximately 51% of our cohort, which is comparable to the data from the French Biomedicine Agency (43). It has also been reported that there is an increased risk of thrombosis in the case of a right kidney, as in our study (44,45). In conclusion, our study confirms the severity of early venous thrombosis of the renal graft, which is responsible for graft loss in the vast majority of cases, particularly in the case of postoperative thrombosis.…”

“…In our series, grafts from marginal donors ( 18 ) represented approximately 51% of our cohort, which is comparable to the data from the French Biomedicine Agency ( 43 ). It has also been reported that there is an increased risk of thrombosis in the case of a right kidney, as in our study ( 44 , 45 ).…”

Renal vessel extension with cryopreserved vascular grafts: overcoming surgical pitfalls in living donor kidney transplant

“…To achieve this aim, it is essential to address surgical pitfalls in living donor procurement, such as the shortness of renal vein in right donor nephrectomy and the increased WIT in grafts with anomalous vascularization. Although reports on renal vein thrombosis and arterial kinking after right LDKT are limited and often come from older studies, [2][3][4][5] right donor nephrectomy still has a prevalence around 20% in most series of living donor nephrectomies and is often in uenced by transplant centers expertise [13,24,25] Also grafts with multiple vessels still raise concern, as the necessity of multiple arterial anastomoses implies a longer WIT, whose association with delayed graft function is well established both in deceased and living donor KT. [26][27][28][29][30][31][32] In the eld of LDKT, renal vessel lengthening may represent a technical solution both for right kidney grafts with short veins and for grafts with anomalous vascularization, although most of the reports in literature are anecdotal and only few focus on technical and surgical outcomes of the procedure.…”

“…[1] Right donor nephrectomy has been discouraged in the past, as the shorter renal vein increases the risk of renal vein thrombosis and subsequent graft loss, as well as the risk of bleeding from the inferior vena cava during procurement. [2][3][4] A parallel surgical issue in the eld of LDKT is represented by grafts with multiple arteries or veins, whose utilization has raised concerns over increased di culty in performing more vascular anastomoses, prolonged ischemia time to at least a portion of the graft when performing more than one arterial anastomosis, poorly controlled hypertension in the post-transplant period after segmental graft ischemia or infarctions and increased rates of ureteral complications. [5] Therefore, as short-term outcomes of multiple vessel renal grafts have been demonstrated worse due to higher complication and DGF rates, [6] the presence of anomalous vascularization still represents a common reason to defer an organ for living donor nephrectomy.…”

Renal Vessel Extension With Cryopreserved Vascular Grafts: Overcoming Surgical Pitfalls in Living Donor Kidney Transplant

“…Although the choice of the kidney to procure should be based on "leaving the better kidney to the donor," left donor nephrectomy is still largely predominant and often represents the default option (1). Right donor nephrectomy has been discouraged in the past, as the shorter renal vein increases the risk of renal vein thrombosis and subsequent graft loss, as well as the risk of bleeding from the inferior vena cava during procurement (2)(3)(4). A parallel surgical issue in the field of LDKT is represented by grafts with multiple arteries or veins, whose utilization has raised concerns over increased difficulty in performing more vascular anastomoses, prolonged ischemia time to at least a portion of the graft when performing more than one arterial anastomosis, poorly controlled hypertension in the posttransplant period after segmental graft ischemia or infarctions and increased rates of ureteral complications (5).…”