Purpose: In living donor renal transplantation, the left kidney is usually chosen for anatomical reasons. The right kidney is sometimes chosen if it is believed to have significant abnormalities or believed to be “inferior” (negatively selected), to maintain the principle of leaving the best kidney with the donor. The long-term outcome of a negatively selected right kidney (NRK) is not known.

Materials and Methods: We retrospectively reviewed the medical records of 1744 living donor renal transplantations in our institution between 1999 and 2015. We compared the short-/long-term outcomes of recipients who received NRK, normal right kidney or left kidney using Kaplan-Meier and log-rank tests.

Results: Among 1744 donors, 362 (20.8%) right kidneys were used. Of these, 96 (26.5%) were NRK and 266 (73.5%) were normal right kidneys. The four reasons given for NRK were tumors or large cysts (n=35), inferior size or function compared to left kidney (>10% difference, n=24), minor arterial abnormalities (n=23) and anatomical abnormalities (n=14). Comparison of the three groups showed that long-term GPS was similar for normal right kidneys and left kidneys, but was considerably lower for the NRK (5y GPS: NRK 79.2% vs normal right kidney 89.7% vs left kidney 91.2%, p=0.002; 10y GPS: NRK 67.6% vs normal right kidney 79.6% vs left kidney 82.2%, p=0.008, figure 1). Within the NRK group, the reason for NRK designation did not appear to impact 10y GPS (p=0.97).

Conclusion: NRK, regardless of the reason, had decreased long-term GPS than normal kidneys. The impact of NRK should be factored into the living donor selection process.

CITATION INFORMATION: Yamanaga S, Posselt A, Freise C, Niemann C, Rosario A, Fernandez D, Kobayashi T, Ahearn A, Tavakol M, Kang S.-M. Inferior Graft and Patient Survival After Living Donor Renal Transplantation of Negatively Selected Right Kidneys. Am J Transplant. 2017;17 (suppl 3).

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