*Purpose: To assess the relationship between craniocaudal renal diameters and renal volumes, as well as the frequency of appropriate renal selection for transplant using conventional renal diameters and the impact on long term outcome in the donor.

*Methods: 240 renal donors (42.8 years ± 11.1; 157 F, 83 M) were retrospectively identified between 2010-2017 and demographic data was collected. Renal size was assessed by measuring renal diameters in three dimensions as well as volume (Figure 1). Glomerular filtration rate (GFR) was documented before surgery, within 24 h after surgery, and at 6, 12 and 24 months. Demographic and patient characteristics were summarized using means with standard deviation (SD), median with interquartile range (IQR), or frequency with percentage. Differences between left and right average kidney volume were compared using a Paired Sample T-test. Correlations between craniocaudal renal diameters and renal volumes were assessed using Spearman’s rank correlation tests adjusted for multiple testing. A linear mixed effects model was postulated to evaluate the effect of the transplantation of the larger kidney on post-transplantation renal function (GFR) as a function of time since surgery. Subjects were taken as a random effect to account for the repeated measures on the same subjects.

*Results: Left kidneys had larger average volume (162.9 ± 33.1 vs 155.2 ± 33.1 cm3; p<0.0001) than right but craniocaudal lengths were statistically not significantly different (11.1 ± 0.9 vs 10.9 ± 1.1 cm). GFR recovered from of 55.2 ± 14.5 mL/min/1.73 m2 directly after to 58.6 ± 11.8 mL/min/1.73 m2 24 months after surgery. There was a strong correlation between craniocaudal diameters and volume (correlation coefficient: 0.62, p<0.01). The larger kidney was transplanted in 70.8% of cases but this had no statistically significant impact on long term renal function when adjusting for age, sex and race (AIC: 5774.62, p<0.01).

*Conclusions: Renal volume correlates well with craniocaudal diameter and transplanting the larger donor kidney had no long term detrimental effect on donor kidney function.

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