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Right renal vein elongation using gonadal vein during retroperitoneoscopic living donor kidney transplantation: a single‐center experience

To the Editor, Here, we report our experience of eight cases of elongation of the right renal vein using donor gonadal vein during retroperitoneoscopic living donor kidney transplantation in our hospital. In living donor kidney transplantation, the left kidney is preferred as the right renal vein is shorter. Transplantation of the right kidney is technically more challenging for reimplantation of the graft due to higher venous anastomosis tension and also has a higher risk of complications. Elongation of the right renal vein is a key step in improvement of the success rate and reduction of operative complications of living donor nephrectomy. This report enrolled eight healthy donors, who were admitted between August 2013 and April 2014. Donors aged 45 9.5 yr old, including three men and five women. All donors were confirmed with single artery and vein in right kidney by MRI or CT 3-D vascular reconstruction. Donors and recipients were matched with satisfaction. All organ donations were on voluntary basis, and written informed consents were signed. The donor’s right kidney and gonadal vein were extracted through standard hand-assisted laparoscopic nephrectomy. The gonadal vein was cut longitudinally and trimmed into a patch of 6–8 cm long and 0.8–1.2 cm wide (Fig. 1). A 3to 4-cm long vessel was formed by spiral anastomosis of the patch with a similar diameter as the right renal vein, which was then anastomosed with the renal vein (Fig. 2). Conventional kidney implantation surgery was performed. Patients were followed for six months. Color Doppler ultrasound test showed the blood flow was patent in vena profunda without renal vein related complications such as hemorrhage, thrombosis, or angusty, etc. All eight donor kidneys were successfully transplanted to recipients. The perioperative parameters for donor kidney nephrectomy are shown in Table 1. The right renal vein was elongated by an average of 2.9 cm. Donors had no obvious postoperative complications. Recipients’ creatinine levels all dropped to normal range within one wk post-operation, and good graft functions were observed. In the past years, a variety of techniques have been developed for lengthening of the right renal vein, which range from iliac vein transposition to donor vein elongation (1). For deceased donors, renal vein could be elongated with postcava (2). For living donors, the elongation material included linear cutting anastomat (3), polytetrafluoroethylene graft and a variety of veins, for example, the great saphenous vein (1). Mikhalski et al. (4) first reported lengthening the right renal vein with gonadal vein. We simultaneously extracted the donor’s right kidney and gonadal vein through retroperitoneoscopy and significantly increased the length of the right renal vein, which ultimately led to good organ function without increased perior postoperative morbidity during living donor kidney transplantation. Fig. 1. A longitudinally incised gonadal vein.