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Transplanting a left or right donor kidney into the left or right iliac fossa: importance of laterality and site of venous anastomosis

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Abstract

Data on the impact of donor-to-recipient laterality on kidney transplantation are lacking. This study evaluated the impact of donor-to-iliac fossa laterality and the site of venous anastomosis on operating time and surgical outcome. This retrospective single-center study analyzed 1262 deceased donor adult kidney transplants into pristine iliac fossa. Multivariable linear and logistic regression analyses were used to identify variables with an impact on operating time and surgical complications. Operating time was shorter by 11 min in median for transplantations into the right iliac fossa compared to the left iliac fossa (p < 0.001). Operating time in left-to-right donor-to-recipient combination was shorter by 17 min in median if venous anastomoses were performed on the caval vein or common iliac vein as compared to anastomoses to the external iliac vein (p < 0.001). Overall, the shortest operating times (median 112.5 min) were achieved in left-to-right donor-to-recipient combinations with venous anastomosis to the caval or common iliac vein, without an increase in surgical complications. Kidney transplantation into the right iliac fossa with anastomosis to the caval vein or the common iliac vein saves operating time and reduces thrombotic complications. Acceptance of a left donor kidney is likely to further reduce operating time.

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Data Availability

The datasets generated during and/or analysed during the current study are not publicly available due to European General Data Protection Regulation (EGDPR), but are available from the corresponding author on reasonable request.

Abbreviations

LL:

Left donor kidney to left recipient’s iliac fossa

LR:

Left donor kidney to right recipient’s iliac fossa

RL:

Right donor kidney to left recipient’s iliac fossa

RR:

Right donor kidney to right recipient’s iliac fossa

AT:

Anastomosis time

OT:

Operating time

CV:

Caval vein

CIV:

Common iliac vein

EIV:

External iliac vein

VIF:

Variance inflation factor

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Authors and Affiliations

  1. General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

    Nikos Emmanouilidis, Ali Abdullah Bani Hashem, Bastian Paul Ringe, Jürgen Klempnauer & Harald Schrem

  2. Department of Transplant Surgery, Medizinische Universität Graz, Graz, Austria

    Philipp Stiegler & Harald Schrem

  3. Department of Radiology, Hannover Medical School, Hannover, Germany

    Tim Alexander Alten

  4. Core Facility Quality Management & Health Technology Assessment in Transplantation, Hannover Medical School, Hannover, Germany

    Harald Schrem

  5. General, Visceral, Thoracic and Minimalinvasive Surgery, St. Elisabeth Hospital, Stadtring Kattenstroth 130, 33332, Gütersloh, Germany

    Nikos Emmanouilidis

  6. Department of Radiology, St. Vincenz Hospital Paderborn, Paderborn, Germany

    Tim Alexander Alten

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  1. Nikos Emmanouilidis
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  2. Ali Abdullah Bani Hashem
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Contributions

NE: participated in research design, writing of the paper and interpretation of data, performance of the research, data acquisition, and data analysis. AABH: participated in the writing of the paper and interpretation of data, performance of the research, data acquisition, and data analysis. PS: participated in the writing of the paper and interpretation of data. BPR: participated in research design and performance of the research. TAA: participated in the performance of the research and data acquisition. JK: participated in the performance of the research. HS: participated in the writing of the paper and interpretation of data, performance of the research, and in data acquisition.

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Correspondence to Nikos Emmanouilidis.

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All authors declare that they have no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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All patients provided informed consent for study participation at the time of hospital admission. Patient records and patient data were anonymized prior to analysis.

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Emmanouilidis, N., Hashem, A.A.B., Stiegler, P. et al. Transplanting a left or right donor kidney into the left or right iliac fossa: importance of laterality and site of venous anastomosis. Updates Surg 75, 1243–1257 (2023). https://doi.org/10.1007/s13304-023-01512-9

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