Retroperitoneoscopic Live Donor Nephrectomy in a Patient with a Double Inferior Vena Cava

Abstract

Vascular anomalies are considered a contraindication for laparoscopic live donor nephrectomy. We report a successful hand-assisted retroperitoneoscopic live donor nephrectomy from a donor with a double inferior vena cava. A 37-year-old woman wanted to donate a kidney to her 44-year-old boyfriend who had hypertensive nephropathy. Preoperative donor imaging showed a double inferior vena cava. Each renal vein drains into the ipsilateral inferior vena cava division, making the left renal vein short. A single renal artery, vein, and ureter were noted on both sides. A hand-assisted retroperitoneoscopic left nephrectomy was performed. Blood loss was minimal and the warm ischemia time was 2 minutes. Renal transplantation was performed with good initial perfusion and urine output. Cold ischemia and rewarming time was 25 minutes. The donor postoperative period was uneventful with infrequent need for pain relief. The donor was discharged in good condition 3 days postoperatively. The donor's kidney functions were within the normal range at follow-up 4 months postoperatively. The recipient was discharged in good condition 7 days postoperatively. The recipient is alive with good graft function and unremarkable complications at 4 month follow-up. Although vascular anomalies present a surgical challenge, we have shown the feasibility of performing hand-assisted retroperitoneoscopic live donor nephrectomy in a donor with a double vena cava and short renal vein. With comprehensive preoperative assessment, laparoscopic live donor nephrectomy can be done safely in donors with anatomical anomalies. This may increase the number of living donor kidney transplants as it offers lower postoperative morbidity and economic disincentives for potential donors.