Complex Vascular Reconstruction for Laparoscopic Right Side Donor Nephrectomy

Kidney transplant is the gold standard for the treatment of end-stage renal disease (ESRD). However, there is a significant discrepancy between donor availability and the number of potential recipients on the waiting list. Living donor kidney transplantation has been considered an alternative to increase the donor pool. Left donor nephrectomy is typically preferred due to the length of the renal vein. However, in some cases, right donor nephrectomy must be considered, which presents challenges due to the shorter renal vein and, in some cases, multiple renal arteries. For these cases, transplant surgeons must have alternative strategies to reconstruct the vasculature and ensure that graft implantation and anastomosis are as safe as possible. We present a case of a living donor right laparoscopic nephrectomy with two renal arteries, including vein elongation with an end-to-end anastomosis with a deceased donor renal vein and an end-to-side arterial anastomosis using a deceased donor iliac artery conduit.