*Purpose: In an effort to maximize living donor kidney utilization, we describe the use of deceased donor vein extension grafts for right sided living donor kidneys and report our single center experience using this technique.

*Methods: A single-center review of kidney transplant recipients (KTR) who received a right living donor kidney transplant with renal vein extension using ABO compatible deceased donor iliac veins from 2017-2021. Patient demographics, comorbidities, and labs were retrospectively queried. Postoperative follow-up and evaluation were performed per institutional protocol. Extension grafts were obtained from recent deceased donor procurements (less than 7 days). Living donor nephrectomies were performed laparoscopically. End-to-end anastomosis of the iliac graft to the right renal vein was performed prior to implantation (Figure 1).

*Results: Thirty-eight KTR received a right kidney transplant with deceased donor extension grafts. The median recipient age and BMI were 53.5 years of age (interquartile range (IQR) 46,66) and 28.6 kg/m² (IQR 23.4,32.5). Sixty-eight percent were male. Prior to transplant, 52.6% required dialysis. The 2 most common causes of renal disease were diabetes (23.6%) and focal segmental glomerulosclerosis (16%). Postoperatively, there were no graft thrombosis. Ninety-five percent (36/38) of grafts displayed immediate graft function, with 2 recipients requiring temporary dialysis due to anaphylaxis from induction therapy. Median serum creatinine at 2 weeks was 1.55 mg/dL (IQR 1.3,2.0), and at 6 months was 1.4 mg/dL (IQR 1.2,1.7). One year graft survival was 93.3% (28/30), with 1 graft failure from acute tubular necrosis following infection and 1 patient death due to a fall.

*Conclusions: Utilization of deceased donor iliac vein extension grafts for short right renal veins in living kidney transplantation is a simple technique that expands the donor pool for living donor renal transplantation. Our experience showed no technical complications and excellent graft function.

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