Rescue of Short Right Renal Vein with Posterior Renal Vein Disposition in Renal Transplant
Varun Mittal, Venkatesh Chander Singhal, Kunal Vinayak, Abhinandan Mukhopadhyay, Rahul BhanIntroduction and Objective:
Venous anastomosis with a short right renal vein (SRRV) remains a technical challenge in living donor kidney transplantation. Although various manoeuvres are routinely employed to address this, they may occasionally fail to provide adequate venous length. The present study evaluates the role of posterior right renal vein disposition (PRVD), with or without external iliac vein transposition (EIVT), as a rescue technique in such critical situations.
Materials and Methods:
All living donor renal transplant recipients receiving right renal grafts between January 2023 and July 2025 were included in prospective series. Standard manoeuvres to achieve tension-free venous anastomosis included IVC cuff inclusion, intra-sinus vascular dissection, external iliac vein (EIV) mobilization, and/or internal iliac vein ligation. Failing these manoeuvres PRVD with or without EIVT was used to achieve venous anastomosis. Renal vein length from venous confluence to IVC on CT angiography, available vein length beyond the renal sinus on bench, and apparent vein prolongation after PRVD on bench were measured.
Results:
Total 61 recipients received right renal grafts. Donor nephrectomy was performed via an open approach in 22 cases (36.1%), laparoscopic with open extraction in 19 cases (31.1%), and total laparoscopic technique in 20 cases (32.8%). A tension-free venous anastomosis was achieved in all transplants. Rescue techniques were employed in selected cases to optimize venous length. PRVD was performed in 20 cases (32.8%)—including 4 open, 5 laparoscopic with open extraction, and 11 total laparoscopic donor grafts. PRVD with EIVT was used in 4 cases (6.6%), while gonadal vein interposition grafting was performed in 1 case (1.6%). Mean renal vein length on CT angiography, mean available vein length beyond the renal sinus on bench were 20.1 ± 3.6 mm and 15.4 ± 1.7 mm respectively. In cases where PRVD or PRVD with EIVT was performed, the mean apparent vein prolongation was 14.8 ± 2.3 mm. Early graft function was satisfactory in all recipients.
Conclusion:
Posterior renal vein disposition with or without lateral EIV transposition is an effective rescue manoeuvre to tackle SRRV in critical situations in living donor transplantation. This technique also facilitates total laparoscopic approach to right donor nephrectomy.