Why Living Kidney Donor Candidates Are Turned Down? A Single-Center Cohort Study

Venous vascular reconstruction of a robotically procured right kidney with two renal veins transplanted into a pediatric recipient

BACKGROUND

Right versus left kidney donor nephrectomy remains a controversial topic in renal transplantation given the increased incidence of right kidney vascular anomalies and associated venous thrombosis. We present the case of a 3-year-old pediatric recipient with urethral atresia and end-stage kidney disease who received a robotically procured living donor right pelvic kidney with two short same-size renal veins and a short ureter.

METHODS

We utilized a completely deceased iliac vein system (common iliac vein with both external and internal veins) to extend the two renal veins. Due to the distance between both renal veins, the external iliac vein was anastomosed to the upper hilum renal vein, and the internal iliac vein was anastomosed to the lower hilum renal vein. The donor's short ureter was anastomosed to the recipient's ureter end-to-side.

RESULTS

The patient had immediate graft function and there were no post-operative complications. Renal ultrasound was unremarkable at 48 hours post-transplant. Serum creatinine was 0.5 mg/dL at 3 months post-transplant.

CONCLUSION

We demonstrate the successful transplantation of a robotically procured right pelvic donor kidney with two short renal veins using a deceased donor iliac vein system for venous reconstruction without increasing technical complications. This technique of venous reconstruction can be used in right kidneys with similar anatomical variations without affecting graft function.

Renal Transplantation from a Deceased Donor with Polycystic Kidney Disease

Renal transplantation is the gold standard treatment for patients with end-stage renal disease (ESRD) as it demonstrates improved long-term survival compared to patients who remain on renal replacement therapy. The widening gap between the demand and supply of organs warrants the expansion of donor criteria for renal transplantation. Kidneys with multiple cysts are often rejected for transplantation. Here, we present our recent experience of a 72-year-old patient with ESRD due to a biopsy-proven diabetic nephropathy who received a deceased donor kidney with adult polycystic kidney disease (APKD). At 31-month posttransplant, he had a serum creatinine of 1.6 mg/dL. Deceased donors affected by APKD should be considered an acceptable option for successful renal transplantation in select recipients, as well as an alternative kidney source to increase the donor pool.