Inferior Early Outcomes for Recipients of Right Versus Left Deceased-Donor Kidneys

Abstract

The impact of donor kidney side, right versus left kidney, has long been subject of debate with suggestions that anatomical differences between right and left kidneys could influence transplant outcome. The Aim of this registry-based study was to compare graft function and survival for left and right kidney recipients transplanted from the same deceased organ donor. Methods: Adult recipients of 4792 single kidneys procured from 2396 heart beating deceased donors in Australia and New Zealand from 1973 to 2007 were included in a paired analysis and thus, eliminating donor factors other than kidney anatomy as potential sources of bias. Results: Right kidneys were associated with more delayed graft function (DGF) (21% versus 17% for left kidneys, p< 0.001) and, if not affected by DGF, a slower fall in serum creatinine. One year graft survival was lower for right kidneys (88.5% versus 91.2% for left kidneys, p< 0.01), primarily attributed to surgical complications (37 versus 25% of failures for left kidneys, p< 0.02). Beyond the first the year after transplantation, kidney side was not associated with eGFR, graft or patient survival. Conclusions: Receipt of a deceased donor right kidney is a risk factor for inferior outcomes in the first year after transplantation. A higher incidence of surgical complications implicates the shorter right renal vein and/or longer renal artery as contributory factors. Potentially, the higher susceptibility of right kidneys to injury could be considered in organ allocation. More important however, may be the need to allocate the more experienced surgeons to the right-sided donor kidneys.