Is the Reluctance for the Implantation of Right Donor Kidneys Justified?

Abstract

BackgroundThe lengths of right renal veins are shorter when compared to their left counterparts. Since the implantation of kidneys with short renal veins is considered more challenging, many surgeons prefer left kidneys for transplantation. Therefore, our hypothesis is that the implantation of right kidneys from living and deceased donors is associated with more technical graft failures as compared to left kidneys.MethodsTwo consecutive cohorts of adult renal allograft recipients of living (n = 4.372) and deceased (n = 5.346) donor kidneys between January 1, 2000 and January 1, 2013 were analyzed. Data were obtained from the prospectively maintained electronic database of the Dutch Organ Transplant Registry. Technical graft failure was defined as failure of the renal allograft within 10 days after renal transplantation without signs of acute rejection.ResultsIn the living donor kidney transplantation cohort, the implantation of right donor kidneys was associated with a higher incidence of technical graft failure (multivariate analysis p = 0.03). For recipients of deceased donor kidneys, the implantation of right kidneys was not significantly associated with technique-related graft failure (multivariate analysis p = 0.16).ConclusionsOur data show that the implantation of right kidneys from living donors is associated with a higher incidence of technique-related graft failure as compared to left kidneys.

Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries

“…It is a well-known fact that the location of the kidney plays an important role when making decisions regarding its transplantation. A study by Özdemir-van Brunschot et al [ 15 ] on an impressive amount of material consisting of 9718 patients confirmed that transplantation of the left kidney results in significantly fewer complications in recipients compared with transplantation of the right kidney. This is clearly related to the difference between the length of the right and left renal veins and also to the relationship between the length of the left renal veins and arteries.…”

Hand‐assisted retroperitoneoscopic donor nephrectomy offers more liberal use of right kidneys: lessons learned from 565 cases – a retrospective single‐center study

“…Currently, there is an ongoing discussion about substandard outcomes of transplanting right kidneys due to the technical challenges of right DN and transplanting a kidney with shorter right renal vein. A recent paired Organ Procurement and Transplantation Network analysis revealed a notably higher delayed graft function (DGF) and graft loss within the first 6 months after right‐sided DDKT [9]. Analysis of Australia and New Zealand Dialysis and Transplant registry revealed 46% higher adjusted odds for DGF, and 72% higher adjusted risk for graft failure during the first year of right‐sided DDKT [10].…”

“…On the other hand, deceased donor right kidneys offered similar patient and graft outcome compared to left side in different countries [12,13]. In regard to living donor kidney transplantation, some studies reported a possible association between venous thrombosis through the use of right living donor kidneys [3,9,14], whereas other studies did not confirm this [15][16][17][18]. A retrospective US national registry on living donors found statistical difference in graft thrombosis as a cause of graft failure and inferior graft survival for right DN [19].…”

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“…Despite evidence correlating use of right kidneys and vascular thrombosis [8], other series could not identify laterality as a risk factor [9,10]. A retrospective cohort study from the Netherlands analyzed 4,372 living and 5,346 deceased donor kidney transplants and found the use of right kidneys increased the incidence of technical graft failure only when using living donors (multivariate analysis p=0.03) [11].…”