*Purpose: Horseshoe kidney is one of the most common urinary congenital abnormalities, with an incidence of 1 in 400 to 800. Because of complexity, the use of a horseshoe kidney in renal transplant remains controversial. Several deceased donor kidney transplantation already has been performed and the recent reports showed good long term results in the recipients from living donors with horseshoe kidney.

*Methods: This case reports our experience of a successful transplantation of a horse kidney from living donor for the first time in our country.

*Results: The recipient was a 23-year-old man, and the donor was 55-year-old father of the recipient with an uncomplicated horseshoe kidney. They are ABO incompatible. Kidney were fused in the inferior pole and CT showed 1 renal artery and 2 veins on right side , 1 artery and 1 vein on left side , and 1 isthmic renal artery. And a 1.6cm renal cyst in the isthmic portion of left kidney was seen. There was no urinary abnormality. A laparotomy was performed by midline incision. The isthmus of kidney was divided using an endo-GIA stapler and the left segment was used. The isthmic artery was preserved on the right side. Single renal artery and vein were anastomosed to the right external iliac artery and vein. There were no intra- or post-operative complications in donor and recipients. Recipients discharged at postoperative 10 days with sCr of 1.04mg/dL and donor discharged with sCr of 1.45mg/dL. After 1 months of surgery, renal function has remained stable with 1.06mg/dl in recipients and 1.28mg/dL in donors.

*Conclusions: In renal transplantation, there are only several horseshoe kidney reports around the world from living donor. However, if we performed detailed preoperative evaluation and selection, we may consider the use of horseshoe kidneys from living donors.

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