Cryopreserved venous allografts increased cold ischemia time in living-donor kidney transplant recipients.

IntroductionLiving-donor kidney transplantation (LDKT) is the gold standard for end-stage renal disease. Traditionally, the left kidney is preferred for its longer vein. However, the “donor safety first” principle, combined with the transition to laparoscopic and robotic donor nephrectomy, has increased the frequency of using right-sided grafts or encountering “iatrogenically” shortened veins due to mechanical stapling. In this study, we report our preliminary experience evaluating the efficacy of cryopreserved vascular grafts for renal vein lengthening in LDKT to overcome anatomical vascular length limitations.MethodsAll LDKT in this series were performed using a robotic-assisted laparoscopic approach. All procedures were carried out by a dedicated and experienced surgical team thanks to a cross-institutional partnership involving two regional University Hospitals. When necessary, cryopreserved venous allografts were employed to ensure adequate renal vein length. All transplants were carried out using a standard retroperitoneal approach in the iliac fossa.ResultsFrom June 2024 to October 2025, nine living-donor kidney transplants were performed. The donor cohort included 7 females and 2 males with a median age of 58 years (IQR 51–69), while the recipient cohort included 4 females and 5 males with a median age of 39 years (IQR 23–55). Cryopreserved venous allografts were used in 5/9 LDKT (55.5%), following right kidney procurement. Cold ischemia time was higher in grafts requiring vascular extension than in those without elongation (median 139 min [IQR 130–141] vs. 115 min [IQR 107–121], respectively; p