From the Guidelines
The left kidney is generally preferred for renal transplantation due to its longer renal vein, which facilitates vascular anastomosis and reduces technical complications. This preference is based on anatomical advantages, including a longer renal vein and ureter, which can simplify the surgical procedure and improve outcomes 1. However, both kidneys are functionally equivalent, and the right kidney is frequently used successfully in transplantation. The decision ultimately depends on various factors, including:
- Donor anatomy
- Recipient considerations
- Surgeon preference
- Presence of abnormalities, such as cysts or vascular anomalies, which may make one kidney more suitable for donation than the other 1.
In living donor transplantation, the left kidney is more commonly harvested due to its anatomical advantages, though this may vary based on individual donor assessment. According to the KDOQI commentary, in the absence of reasons to procure the right kidney, the left kidney should be procured in laparoscopic donor nephrectomy because of the relative technical ease associated with a longer venous pedicle 1. Despite the general preference for the left kidney, successful transplantation outcomes are achieved with either kidney when properly matched to the recipient. Ultimately, the choice of kidney for transplantation should be made on a case-by-case basis, taking into account the unique characteristics of the donor and recipient.
From the Research
Renal Transplantation Side Preference
- The preference for the side of renal transplantation is a topic of ongoing discussion, with some studies suggesting that the left kidney is preferred due to its longer renal vein 2, 3.
- However, other studies have found no significant difference in outcomes between left and right kidney transplants 4, 5.
- The choice of side for renal transplantation may depend on various factors, including the surgeon's preference and experience, as well as the individual patient's anatomy 2, 6.
Anatomical Considerations
- The left kidney has a longer renal vein, which can make it easier to transplant 3, 5.
- The right kidney has a shorter renal vein, which can increase the risk of thrombosis and make the transplant procedure more challenging 2, 5.
- However, techniques such as open management of the renal vein can help to maximize graft vein length and improve outcomes for right-sided transplants 5.
Surgical Techniques
- Various surgical techniques can be used for renal transplantation, including side-to-end arterial anastomosis and end-to-side venous anastomosis 6.
- The choice of technique may depend on the individual patient's anatomy and the surgeon's preference 6.
- The use of a vena cava patch graft can help to elongate the renal vein and improve outcomes for right-sided transplants 6.