Which One Is the Best for Living Donation: A Multiple-Artery Left Kidney Nephrectomy or a Right Kidney Nephrectomy? D. Nunes-Carneiro a, *, A. Marques-Pinto a , C. Veiga b , I. Braga c , J.F. Cabral c , M. Almeida d , V. Cavadas c , A. Castro-Henriques d , R. Almeida b , A. Fraga c , and M. Silva-Ramos c a Urology Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; b Angiology and Vascular Surgery Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal; c Urology Department, Instituto Português de Oncologia do Porto, Porto, Portugal; and d Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal ABSTRACT Introduction. The current approach in living-donor kidney transplant is to preserve the best kidney for the donor and harvest the contralateral one. Due to a shorter renal vein and a greater incidence of venous thrombosis, left kidneys are more frequently elected. Notwithstanding, arterial anatomy may be complex and thus render the transplantation procedure more difficult and prone to complications. Objectives. To analyze the outcomes after multiple-artery left kidney nephrectomy (MALKN) and right kidney nephrectomy (RKN). Results. Seventy-three cases were performed from 1999 to 2017 in our institution: 34 MALKN and 39 RKN. The mean operative time was significantly longer in MALKN. Warm ischemia time, donor and receptor hospital stay, and postoperative complications did not differ between groups. There was a positive correlation between renal arteries’ ostia distance in MALKN and the duration of warm ischemia period. There was no significant difference in the incidence of acute tubular necrosis, first-year variations in serum creatinine, and glomerular filtration rate between groups. Long-term graft survival did not significantly differ between groups. Three cases of vein thrombosis after RKN were reported with graft loss. Conclusion. The safety and efficacy of MALKN does not differ from RKN, although there appears to be a higher incidence of vein thrombosis after right kidney trans- plantation. Despite being technically more demanding, particularly in cases with distant artery ostia, MALKN could be a better option than RKN for living donation, expanding the available donor pool, although more studies are needed to affirm this conclusion. K IDNEY transplantation is the treatment of choice for patients with end-stage renal disease. Living donor renal transplantation is superior to cadaveric donor trans- plantation, demonstrating higher patient and graft survival rates [1]. As the demand for donor organs continues to exceed the supply, issues related to organ donation are becoming increasingly important. Living kidney donation is a procedure that implies a clear damage to the donor and in which the surgeon has the duty of harvesting the organ in the best conditions [2]. Laparoscopic donor nephrectomy was found to be associ- ated with reduced analgesia use, shorter hospital stay, and faster return to normal physical functioning. On the other side, open donor nephrectomy was associated with shorter duration of procedure [3]. *Address correspondence to Diogo Nunes-Carneiro, Urology Department, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 1, 4050-318 Porto, Portugal. E-mail: diogocarneiro.urologia@chporto.min-saude.pt ª 2019 Published by Elsevier Inc. 230 Park Avenue, New York, NY 10169 0041-1345/19 https://doi.org/10.1016/j.transproceed.2019.01.045 Transplantation Proceedings, 51, 1559e1562 (2019) 1559