*Purpose: Combined heart and kidney transplants (cHKT) have increased in recent years. Standard procurement practice often necessitates kidney extraction and packaging after the heart team leaves the donor center. This results in increased transportation costs and kidney cold ischemia time. We report a technique for early retrieval of the right kidney, which reduces transportation costs by allowing both organs to leave the donor center at the same time and facilitates implantation of both organs in a single operation.

*Methods: Retrospective review of procurements for cHKT. Primary outcomes were time from crossclamp to extraction for the right kidney and heart and transportation costs. Actual costs were obtained from the transplant center, and projected costs of separate transportation of the kidney using standard retrieval were calculated.

Right kidney retrieval was performed as follows: 1) Cattell-Braasch maneuver; 2) Removal of tissue overlying the inferior vena cava (IVC) and aorta; 3) Dissection from lateral to medial under gonadal vessels and ureter to lift structures from the retroperitoneum; 4) Cranial dissection in the same plane to mobilize the right kidney; 5) Standard cannulation of aorta and crossclamp; 6) Transection of the suprarenal IVC, IVC above the iliac veins, and the left renal vein; 8) After completion of flush, transection of the takeoff of the superior mesenteric artery (SMA) along the right side of the vessel (FIGURE 1); 9) Removal of cannula and transection of anterior aorta wall to the SMA; 10) Transection of posterior aorta wall; 11) Transection of ureter and removal of right kidney.

*Results: Twenty-three procurements for cHKT were performed using the technique for early retrieval of the right kidney from 1/2020 to 11/2021. Median times from crossclamp to retrieval for the heart and kidney were 20 min (IQR 19, 24) and 14 min (IQR 12, 16), respectively. Kidney extraction time was significantly less than the heart (p=<0.001). Median transportation costs were $13,160 (IQR 9,492, 16,907). Projected transportation costs using standard retrieval of the right kidney were $26,320 (IQR 18,984, 33,814).

*Conclusions: Early retrieval of the right kidney with the heart for cHKT is feasible, and reproducible. This technique allows both organs to leave the donor hospital at the same time, reducing transportation costs and facilitating implantation of both heart and kidney during the same operation.

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