Comparing outcomes in right versus left kidney transplantation: A systematic review and meta-analysis

Clin Transplant. 2021 Nov;35(11):e14475. doi: 10.1111/ctr.14475. Epub 2021 Sep 23.


Introduction: Transplantation of right kidneys can pose technical challenges due to the short right renal vein. Whether this results in inferior outcomes remains controversial.

Method: Healthcare Database Advanced Search (HDAS) was used to identify relevant studies. Two authors independently reviewed each study. Statistical analyses were performed using random effects models and results expressed as HR or relative risk (RR) with 95% confidence intervals. Subgroup analyses were performed in kidneys from deceased donors (DD) and living donors (LD).

Results: A total of 35 studies (257,429 participants) were identified. Both deceased and living donor right kidneys were at increased risk of delayed graft function (DGF; RR = 1.12[1.06-1.18] and RR = 1.33[1.21-1.46] respectively; both p < .0001). In absolute terms, for each 100 kidney pairs of DD kidneys transplanted there are 2.72 (1.67-3.78, p < .00001) excess episodes of DGF in right kidneys. Graft thromboses and graft loss due to technical failure was also significantly more likely in right kidneys, in both DD and LD settings. There was no evidence that laterality alters long term graft survival in LD or DD.

Conclusion: Right kidneys have inferior early outcomes, with higher rates of DGF, technical failure and graft thrombosis. However, these differences are small in absolute terms, and long-term graft survival is equivalent.

Keywords: deceased donor; graft; kidney; living donor; recipient outcomes; right versus left; transplant.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Graft Survival
  • Humans
  • Kidney
  • Kidney Transplantation* / adverse effects
  • Tissue Donors