Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 18, 2025; 15(1): 97598
Published online Mar 18, 2025. doi: 10.5500/wjt.v15.i1.97598
Comparative study of living donor kidney transplants: Right vs left
Taqi Khan, Nadeem Ahmad, Qaisar Iqbal, Muneeb Hassan, Lajward Asnath, Naveed Khan, Sajid Shakeel
Taqi Khan, Qaisar Iqbal, Muneeb Hassan, Lajward Asnath, Naveed Khan, Sajid Shakeel, Kidney Transplant Unit, Rehman Medical Institute, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan
Nadeem Ahmad, Department of Surgery, Princess Noura Binti AbdulRehman University, Riyadh 84428, Saudi Arabia
Author contributions: Khan T and Ahmad N designed the study and concept, and wrote the manuscript; Khan T, Ahmad N, and Asnath L analyzed the data; Ahmad N performed the statistical analysis; Iqbal Q, Hassan M, Khan N, and Shakeel S collected the data; Iqbal Q, Hassan M, and Asnath L contributed to reviewing and editing of the manuscript; All of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study was reviewed and approved by Rehman Medical Institute Institutional Review Board, No. RMI/RMI-REC/Article Approval/106.
Informed consent statement: All study participants or their legal guardians provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: No other data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/.
Corresponding author: Taqi Khan, FRCS (Ed), MBBS, MD, Professor, Surgeon, Kidney Transplant Unit, Rehman Medical Institute, Phase V, Hayatabad, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan. taqi.toufeeq@rmi.edu.pk
Received: June 3, 2024
Revised: October 3, 2024
Accepted: October 15, 2024
Published online: March 18, 2025
Processing time: 176 Days and 23.4 Hours
Abstract
BACKGROUND

Transplant teams often hesitate to use the right kidney (RK) in living donor (LD) transplants due to the complexities of anastomosing the short, thin-walled right renal veins, which can potentially lead to graft loss or graft dysfunction. Nevertheless, circumstances may arise where selecting the RK over the left kidney (LK) is unavoidable. Consequently, it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.

AIM

To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.

METHODS

We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023. We included all kidney donors who were over 18, fit to donate, and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry. The variables examined comprised donor and recipient demographics, and outcome measures included technical graft loss (TGL), delayed or slow graft function (SGF), and post-transplant serum creatinine (SC) trends. We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.

RESULTS

Of the 250 transplants performed during the period, 56 (22%) were RKs. The recipient demographics and transplant factors were comparable for the right and LKs, except that the donor warm and cold ischemia time were shorter for RKs. TGL and SGF each occurred in 2% (n = 1) of RKs and 0.5% (n = 1) of LKs, the difference being insignificant. These complications, however, were not related to the venous anastomosis. One RK (2%) developed delayed graft function after 48 hours, which was attributable to postoperative hypoxia rather than the surgical technique. The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.

CONCLUSION

The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants, provided that careful patient selection and precise surgical techniques are employed.

Keywords: Living donor; Right kidney; Right renal vein; Venous anastomosis; Technical graft loss; Early graft function

Core Tip: Donor right kidneys (RKs) are associated with technical difficulty, and have a higher incidence of delayed graft function and peri-operative graft loss. Short length and thin wall of the renal vein makes the venous anastomosis challenging. We focus on the selection criteria for RKs and how to manage short veins during bench work, analyze our experience with RKs, and compare outcomes with left kidneys in living donor transplantation.