Lulic I, Lulic D, Bacak Kocman I, Vukicevic Stironja D, Erceg G, Majurec I, Medved K, Pavicic Saric J. Expanding boundaries: The evolution and future of living donor kidney transplantation. World J Transplant 2025; 15(4): 102555 [DOI: 10.5500/wjt.v15.i4.102555]
Corresponding Author of This Article
Ileana Lulic, MD, Postdoctoral Fellow, Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zajceva 19, Zagreb 10000, Croatia. ileanalulic@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Editorial
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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/
Dec 18, 2025 (publication date) through Nov 19, 2025
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Journal Information of This Article
Publication Name
World Journal of Transplantation
ISSN
2220-3230
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lulic I, Lulic D, Bacak Kocman I, Vukicevic Stironja D, Erceg G, Majurec I, Medved K, Pavicic Saric J. Expanding boundaries: The evolution and future of living donor kidney transplantation. World J Transplant 2025; 15(4): 102555 [DOI: 10.5500/wjt.v15.i4.102555]
Ileana Lulic, Dinka Lulic, Iva Bacak Kocman, Damira Vukicevic Stironja, Gorjana Erceg, Iva Majurec, Kristina Medved, Jadranka Pavicic Saric, Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zagreb 10000, Croatia
Dinka Lulic, Immediate Medical Care Unit, Saint James Hospital, Sliema SLM-1030, Malta
Author contributions: Lulic I, Lulic D, Bacak Kocman I, Vukicevic Stironja D, Erceg G, and Pavicic Saric J designed the manuscript's original draft; Lulic I, Lulic D, Bacak Kocman I, Vukicevic Stironja D, Majurec I, Medved K, and Pavicic Saric J performed the literature review and data analysis; Lulic I, Lulic D, and Pavicic Saric J participated in the conceptualization of this manuscript and performed manuscript supervision and project administration; Majurec I and Medved K reviewed and edited the manuscript original draft; all of the authors approved the final version of the manuscript to be published.
Conflict-of-interest statement: There are no conflicts of interest to this manuscript.
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: Ileana Lulic, MD, Postdoctoral Fellow, Department of Anesthesiology, Intensive Care and Pain Medicine, Clinical Hospital Merkur, Zajceva 19, Zagreb 10000, Croatia. ileanalulic@gmail.com
Received: October 22, 2024 Revised: March 23, 2025 Accepted: April 11, 2025 Published online: December 18, 2025 Processing time: 393 Days and 17 Hours
Abstract
Living donor kidney transplantation (LDKT) has evolved into a globally adopted clinical practice, driven by improvements in donor selection, immunological compatibility, and perioperative care. These advances have contributed to enhanced donor safety and improved early graft outcomes. Still, its uptake remains limited worldwide, influenced by differences in clinical infrastructure, surgical expertise, and programmatic priorities. A central procedural consideration in LDKT is the choice of kidney for procurement, right or left. Left donor nephrectomy is generally preferred due to favorable vascular anatomy, yet right-sided procurement is often necessary in the presence of anatomical variations. While some studies report higher rates of early complications with right-sided nephrectomy, including delayed graft function and early graft loss, long-term outcomes appear comparable. The evaluation of laterality, however, varies significantly across centers and is often shaped more by institutional practice than by comparative evidence. In this editorial, we review key clinical and technical advances that have improved the safety and outcomes of LDKT, including immunological matching, donor selection, perioperative strategies, and early graft performance. We then critically examine the role of kidney laterality in donor nephrectomy, highlighting how anatomical complexity and procedural risk continue to shape clinical decision-making.
Core Tip: Living donor kidney transplantation (LDKT) offers favorable early graft outcomes and improved donor safety through advances in selection, immunologic matching, and perioperative care. Donor kidney laterality, right vs left, remains a key technical consideration, with right-sided nephrectomy linked to higher early complication rates but comparable long-term outcomes. Rather than using laterality as an isolated quality indicator, this editorial calls for its assessment within a broader surgical and clinical context, integrating anatomical complexity, procedural planning, and center-specific expertise to support informed, case-specific decision-making in LDKT.
