Multiple Renal Veins in Donor Nephrectomy-Preoperative Assessment of Feasibility for Safe and Selective Ligation

Abstract

The aim of the study is to provide an objective preoperative assessment protocol by computerized tomography angiography by measuring the vein volume (pr2h) instead of the vein diameter for accurate size and blood flow assessment in case of multiple renal veins during donor nephrectomy. To reduce rewarm ischemia time, smaller renal veins were safely ligated without compromising drainage due to their robust intrarenal anastomotic communications. The selection of vein for safe ligation is crucial to avoid congestion and high intrarenal pressures in the allograft venous system and was made by calculating the vein volume. Application of this formula in 343 donors with multiple veins (2003–2021) has led to uneventful intra- and postoperative course. This method prevails over the existing subjective assessment techniques, thereby ensuring the best possible perfusion and drainage of the allograft.