Right vs. Left Laparoscopic Donor Nephrectomy and Its Effects on Transplant Outcomes: Experience from Saudi Arabia

Background: Live kidney donation is increasingly common due to the shortage of organs. Surgeons prefer the left kidney due to easier access and a longer renal vein. There are conflicting reports about the outcomes of right vs. left kidney transplants. The objectives of this study were to compare the immediate and long-term outcomes of right and left kidney recipients in live donor kidney transplants. Methods: A retrospective analysis of 215 live kidney donors from 2021 to 2023 was conducted to compare outcomes between 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 quantitative and qualitative data reported as means, medians, interquartile ranges, standard deviations, and frequencies. Differences between groups were analyzed using Chi-square tests and t-tests. Results: 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 6 cases (2.7%), seroma in 9 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 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 delayed graft function (DGF). Creatinine levels and estimated glomerular filtration rates at discharge, 6 months, 1 year, and 2 years did not differ significantly between recipients of the right and left kidneys. Conclusion: Laparoscopic left and right donor nephrectomies (LDN) show comparable long-term outcomes, with no significant differences in creatinine levels at 6 months, 1 year, and 2 years post-transplantation. Despite more delayed graft function (DGF) in right kidney recipients, both kidneys are suitable for transplantation without compromising long-term outcomes.