Laterality of live-donor nephrectomy: does it have a urologic impact on post-donation pregnancy?

Our center policy is to promote right nephrectomy for pre-menopausal live donor donors. This is based on the traditional belief that ureteral obstruction and subsequent urinary tract infections (UTIs) of post-donation pregnancies would be more frequent among female donors with a solitary right (compared to left) kidney. Studies that support or dismiss our policy are lacking. Therefore, we conducted this study. 100 donors who had post-donation pregnancy were included. They underwent an updated clinical, laboratory and ultrasound assessment. They were classified into two groups: right and left nephrectomy groups. Both groups were compared relative to pre- and post-donation data, urinary troubles during or after post-donation pregnancies as well as their current kidney function. Right nephrectomy was carried-out in 60 donors (60%). Post-donation acute pyelonephritis was not reported in either group. Unexpectedly, right nephrectomy group had a slightly higher (yet insignificant) lower UTIs during post-donation pregnancy. Furthermore, obstructive uropathy {two donors) and end stage renal disease (one donor) were only reported among right nephrectomy group. Both groups were comparable in terms of their current kidney function. Despite that the endeavor to retrieve the right rather than the left kidney among premenopausal women could give them the benefit of doubt in regard to possible obstructive uropathy and UTIs during their subsequent pregnancies, this policy is likely an overdoing practice. Larger-scale studies are needed.