Which one is the best for living donation: a multiple artery left kidney or a right one?

Abstract Introduction The current approach in living-donor kidney transplant is to preserve the best kidney for the donor and harvest the contralateral one. Due to a shorter renal vein and a greater incidence of venous thrombosis, left kidneys are more frequently elected. Notwithstanding, arterial anatomy may be complex and thus render the transplantation procedure more difficult and prone to complications. Objectives To analyse the outcomes after multiple-artery left kidney nephrectomy (MALKN) and right kidney nephrectomy (RKN). Results Seventy-three cases were performed from 1999 to 2017 in our institution: 34 MALKN and 39 RKN. The mean operative time was significantly longer in MALKN. Warm ischemia time, donor and receptor hospital stay and post-operative complications did not differ between groups. There was a positive correlation between renal arteries’ ostia distance in MALKN and the duration of warm ischemia period. There was no significant difference in the incidence of Acute Tubular Necrosis, first year variations in serum creatinine and in glomerular filtration rate between groups. Long-term graft survival did not significantly differ between groups too. Three cases of vein thrombosis after RKN were reported with graft loss. Conclusion The safety and efficacy of MALKN does not differ from RKN although there appears to be a higher incidence of vein thrombosis after right kidney transplantation. Despite being technically more demanding, particularly in cases with distant artery ostia, MALKN could be a better option than RKN for living donation, expanding the available donor pool, although more studies are needed to affirm this conclusion.