*Purpose: Right, compared to left, living donor nephrectomy is typically more technically challenging, with respect to both the donor and recipient surgeries, and the shorter renal vein increases the possibility of vascular complications. The use of right kidneys has been suggested as a risk factor for delayed graft function (DGF) in living donor kidney transplants (LDKTx). The impact of multiple renal arteries on DGF risk has not been well defined in this context.

*Methods: We assembled a cohort of all adult living kidney donor transplants performed at our institution from 2011 to 2020. The primary exposure was right LDKTx and the primary outcome was DGF, defined as the need for dialysis in the first 7 days after transplant. We used propensity score matching to balance important baseline characteristics between groups; propensity scores were generated using probit regression. We applied a nearest neighbor matching algorithm using a caliper of 0.01, common support and replacement to create 1:5 matches between the right and left LDKTx groups. After matching, we used logistic regression to estimate odds ratios (OR) and 95% CIs for DGF.

*Results: We identified 1133 patients, of whom 166 (14.7%) received a right LDKTx and 54 (4.8%) experienced DGF. DGF was more common when a right kidney was used, the kidney was transplanted on the left side, arterial reconstruction was performed or the donor was older (see Table). In our cohort matched on the number of renal arteries, arterial reconstruction, donor BMI, donor operative time and surgical approach, DGF was significantly increased among recipients of right LDKTx (OR 2.15; 95%CI 1.07-4.3).

*Conclusions: Right LDKTx are associated with an increased risk of DGF, even when accounting for the number of renal arteries or need for reconstruction. Additional study is needed to elucidate additional contributors.

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