Favi E, Morabito M. Living donor transplant: Right vs left kidney. World J Transplant 2025; 15(3): 104873 [DOI: 10.5500/wjt.v15.i3.104873]
Corresponding Author of This Article
Evaldo Favi, MD, PhD, Associate Professor, Department of General Surgery and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan 20122, Lombardy, Italy. evaldofavi@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2025; 15(3): 104873 Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.104873
Living donor transplant: Right vs left kidney
Evaldo Favi, Marika Morabito
Evaldo Favi, Marika Morabito, Department of General Surgery and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Lombardy, Italy
Author contributions: Favi E drafting the article, critical revision, language revision, and final approval; Morabito M drafting the article, reviewing the article, editing the article, and final approval.
Conflict-of-interest statement: The authors do not have any conflicting interests.
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: Evaldo Favi, MD, PhD, Associate Professor, Department of General Surgery and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan 20122, Lombardy, Italy. evaldofavi@gmail.com
Received: January 5, 2025 Revised: March 6, 2025 Accepted: March 18, 2025 Published online: September 18, 2025 Processing time: 104 Days and 1.9 Hours
Abstract
Khan et al’ single-centre, retrospective study on the use of right or left kidneys in living-donor renal transplantation, offers the opportunity to further discuss a complex and debated topic in clinical transplantation. In brief, the authors confirm that, despite the historical preference for left kidneys, attributed to their anatomical advantages during donor nephrectomy and recipient transplantation, right kidneys can provide excellent outcomes when donors and recipients are carefully selected, and a meticulous surgical technique is applied in every step of the process. Usefully, the article includes some practical tips to help less experienced surgeons address the technical challenges of right kidney transplantation, such as extended renal vein dissection or full mobilization of the iliac vein of the recipient to minimize tension during anastomosis. Although limited by the selective use of minimally invasive (MI) nephrectomy for left kidneys, this work underscores the importance of expanding the living-donor pool, challenging the traditional taboos, and facilitating access to transplantation for a wider population of patients around the globe. Properly designed studies with larger sample size, comparable MI surgical techniques, prospective data collection, and long-term donor and recipient outcomes are warranted.
Core Tip: As shown by Khan et al in their recent work, there is mounting evidence that living-donor transplants performed using right kidneys can provide recipient- and graft-related outcomes as good as the ones obtained transplanting left kidneys. Importantly, in high-volume centres with experienced surgeons, right-sided living-donor nephrectomies are not associated with increased surgical complications compared to left-sided procedures. As traditional open surgery is being replaced by minimally invasive techniques, future research should aim to conclusively validate the safety and efficacy of laparoscopic or robot-assisted donor nephrectomy also in challenging clinical scenarios, such as right or multiple-vessel kidneys.
