Laparoscopic Donor Nephrectomy Guidelines
Primary Recommendations
- The American Journal of Kidney Diseases recommends that in the absence of vascular, urological, or other abnormalities, the left kidney should be procured in laparoscopic donor nephrectomy because of the relative technical ease associated with a longer venous pedicle 1, 3, 4
- The left renal vein's significantly greater length (6-10 cm compared to 2-4 cm for the right) facilitates easier anastomosis during transplantation 2
When to Select the Right Kidney Instead
- The right kidney should be chosen when it is clearly smaller than the left 1
- The right kidney should be chosen when it has lower function than the left based on split kidney function studies 1
- The right kidney should be chosen when the left kidney has anatomical abnormalities such as large cysts 1
- The right kidney should be chosen when the left kidney has significantly more complicated vascular anatomy (e.g., 3 or more arteries) 1, 3, 4
Safety Considerations for Right Donor Nephrectomy
- Early studies showed increased rates of venous thrombosis with right kidney use due to the very short right renal vein length 1, 2
- The anatomic location of the right kidney increases potential risk of vascular injury to the inferior vena cava and small venous branches 1, 2
- Higher conversion rates to open procedure have been reported when operating on the right kidney 1
- With adequate surgeon training and experience, right laparoscopic donor nephrectomy can be performed safely with comparable outcomes to left-sided procedures 1, 3, 4
Technical Considerations
- Do not use nontransfixing clips (e.g., Weck Hem-O-lok) to ligate the renal artery in donor nephrectomy; instead, use renal artery transfixation by suture ligature or anchor staple within the vessel wall 1, 3, 4
- Procurement of a living donor kidney with 3 or more arteries should only be undertaken by surgeons with adequate experience 1, 3, 4