Right Versus Left Laparoscopic Donor Nephrectomy and Its Effects on Transplant Outcomes: Experience From Saudi Arabia

<b>Background:</b> Live kidney donation is increasingly common due to the shortage of organs. Surgeons prefer the left kidney due to easier access and longer renal vein. There are conflicting reports about the outcomes of right versus left kidney transplants. The objective of this study was to compare the immediate and long-term outcomes of right and left kidney recipients in live donor kidney transplants. <b>Methods:</b> A retrospective analysis of 215 live kidney donors from 2021 to 2023 was conducted to compare outcomes between the recipients of right and left kidneys. Data were collected on donor and recipient demographics, surgical outcomes, and complications. Baseline values were summarized using descriptive statistics, with the quantitative and qualitative data reported as means, medians, interquartile ranges, standard deviations, and frequencies. Differences between the groups were analyzed using the Chi-square test and <i>t</i>-test. <b>Results:</b> Among the 215 donors, 141 (65.6%) were male and 74 (34.4%) were female, with a mean nuclear GFR of 105.89 ± 10.91 mL/min. Left kidneys were donated in 176 cases (81.9%), and right kidneys in 39 cases (18.1%). The most common complications were delayed graft function (DGF) in 15 cases (6.9%), hematoma in six cases (2.7%), seroma in nine cases (4.2%), and rejection in 10 cases (4.7%). There were no significant differences between the groups for gender, cold ischemia time, operation time, hospital stay, intraoperative hemorrhage, blood transfusion, re-exploration, hematoma, seroma, urine leak, or the presence of donor-specific antibodies (DSA), BK or cytomegalovirus viremia, rejections, or death-censored graft loss. Right nephrectomies and re-exploration were identified as independent predictors of DGF. Creatinine levels and estimated glomerular filtration rates at discharge, 6 months, 1 year, and 2 years did not differ significantly between the recipients of the right and left kidneys. <b>Conclusion:</b> Laparoscopic left and right donor nephrectomies show comparable long-term outcomes with no significant differences in creatinine levels at 6 months, 1 year, and 2 years post-transplantation. Despite more DGF in right kidney recipients, both kidneys are suitable for transplantation without compromising long-term outcomes. These findings highlight the feasibility of utilizing the right kidney for donation when required.