Background: Vascular anomalies are considered a contraindication for laparoscopic live donor
nephrectomy. We report a successful hand-assisted retroperitoneoscopic live donor nephrectomy
from a donor with a double inferior vena cava.
Materials and Methods: A 37-year-old woman wanted to donate a kidney to her 44-year-old
boyfriend who had hypertensive nephropathy. Preoperative donor imaging showed a double inferior
vena cava. Each renal vein drains into the ipsilateral inferior vena cava division, making the
left renal vein short. A single renal artery, vein, and ureter were noted on both sides. A hand-assisted
retroperitoneoscopic left nephrectomy was performed. Blood loss was minimal and the warm
ischemia time was 2 minutes. Renal transplantation was performed with good initial perfusion and
urine output. Cold ischemia and rewarming time was 25 minutes.
Results: The donor postoperative period was uneventful with infrequent need for pain relief. The
donor was discharged in good condition 3 days postoperatively. The donor's kidney functions were
within the normal range at follow-up 4 months postoperatively. The recipient was discharged in
good condition 7 days postoperatively. The recipient is alive with good graft function and unremarkable
complications at 4 month follow-up.
Conclusion: Although vascular anomalies present a surgical challenge, we have shown the feasibility
of performing hand-assisted retroperitoneoscopic live donor nephrectomy in a donor with a
double vena cava and short renal vein. With comprehensive preoperative assessment, laparoscopic
live donor nephrectomy can be done safely in donors with anatomical anomalies. This may increase
the number of living donor kidney transplants as it offers lower postoperative morbidity and economic
disincentives for potential donors.
