Background: To assess the feasibility and outcome of performing laparoscopic living donor nephrectomy (LLDN) in patients with anomalous renal vasculature.
Methods: All LLDN cases were retrospectively reviewed to identify three groups of patients. Group 1 has multiple renal arteries (33 patients), group 2 has circumaortic or retroaortic renal veins (15 patients), and group 3 is a contemporary cohort of patients with conventional single renal artery and single vein in the donated kidney (180). Parameters such as age, sex, race, body mass index, and laterality were noted. Measured clinical outcomes include operative time, estimated blood loss, warm ischemia time, and day of discharge. Renal function was assessed by measuring serum creatinine at a 1 month, 3 month, 6 month, and 1 year period.
Results: The operative time in minutes (210, 200, 285), median warm ischemia times in minutes (4, 3, 4.3), estimated blood loss in mL (150, 100, 125) were similar between all three groups. The recipient serum creatinine (mg/dL) at one month (1.3, 1.3, 1.4), six months (1.4, 1.3, 1.6), and one year (1.4, 1.0, 1.6) were similar between all three groups.
Conclusions: This is the first study that addresses circumaortic renal veins and multiple renal arteries in laparoscopic donor nephrectomies, showing that there is a low complication rate and excellent one-year renal function in the recipient. Furthermore, this preliminarily data suggest that in healthy donors who have a left-sided kidney that contains several renal arteries or circumaortic renal veins and a normal right kidney, the left kidney can be preferentially taken. This gives the transplant surgeon a longer renal vein which is usually the technically limiting structure.

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