Living donor transplant: Right vs left kidney

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.

Keywords: Kidney transplantation; Living donation; Organ procurement; Surgical technique; Surgical complications; Outcomes

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.