Managing the Loss of Right Renal Venous Tissue in Deceased-Donor Organ Procurement.

BACKGROUND: Procurement-related injury to the right renal vein (RRV) or renal-caval vein complex (RCVC) may preclude transplantation of an otherwise usable right kidney. We report an expanded single-center experience with the previously described York Plastic technique, focusing on technical feasibility and short-term outcomes. METHODS: We retrospectively reviewed deceased-donor right kidneys assessed at our center between January 2018 and January 2025. Of 334 kidneys, 17 (5.1%) sustained procurement-related RCVC injury; 15 underwent York Plastic reconstruction and transplantation, whereas 2 were not used because of severe associated graft damage. Of the 15 transplanted cases, 10 were included in our preliminary 2023 technical report and 5 are newly reported. RESULTS: All 15 reconstructed grafts were transplanted successfully. No intraoperative bleeding, renal vein thrombosis, or Doppler evidence of venous stenosis occurred. Mean bench reconstruction time was 35 minutes (range, 20-51), and mean cold ischemia time was 16.4 ± 2.5 h. Median serum creatinine among functioning grafts was 1.58 mg/dL at 1 month, 1.49 mg/dL at 3 months, and 1.36 mg/dL at 12 months. At 12 months, 13 of the 14 surviving recipients had functioning grafts. One recipient died at 3 months with a functioning graft; one surviving recipient returned to dialysis before 12 months because of antibody-mediated rejection associated with severe cytomegalovirus infection. CONCLUSIONS: The York Plastic technique appears to be a feasible bench-salvage option for selected procurement-related RCVC injuries and may support organ preservation in carefully chosen cases.