Anatomical Perspective on Kidney Transplantation: A Narrative Review

Abstract

Context: Chronic Kidney Disease (CKD) is a progressive disorder characterized by irreversible renal damage and gradual loss of function, frequently diagnosed at advanced stages leading to end‑stage renal disease (ESRD). Kidney transplantation remains the definitive treatment for ESRD, yet surgical complexity is strongly influenced by recipient anatomy.

Aim and Objectives: To review the impact of anatomical variations on kidney transplantation, highlighting their role in operative planning, technical execution, and long‑term graft outcomes.

Methodology: This narrative review synthesizes evidence on anatomical considerations in kidney transplantation, focusing on pelvic vasculature, pelvic structures, and donor‑recipient mismatches that affect surgical feasibility, complication risks, and graft survival. Perspectives from retrieval and implanting surgeons highlight the importance of preoperative anatomical assessment. A systematic search of Medline, Web of Science, PubMed, and Google Scholar was conducted using controlled vocabulary and keywords related to Anatomy of the kidney (variations on kidney blood supply, renal blood supply, kidney anomalies, pelvic anatomy) and kidney transplantation (renal transplantation, kidney transplantation, kidney allograft recipients, kidney transplant recipients). Boolean operators, complemented by manual searches were employed to fine-tune the search terms. A total of 164 articles published from 1999 to January 31, 2026, were identified and evaluated for relevance, with 46 ultimately selected for inclusion in narrative analysis.

Results: Anatomical variations in pelvic vessels and structures complicate vascular anastomosis and increase intraoperative risks. Donor‑recipient anatomical mismatches affect technical feasibility and long‑term graft survival. Anticipation of aberrant vessels by retrieval surgeons reduces implantation emergencies. Careful anatomical planning by implanting surgeons enhances safety and effectiveness of transplantation.

Conclusion: Anatomical perspectives are critical for successful kidney transplantation. Thorough preoperative assessment and anticipation of anatomical variations optimize surgical strategies, reduce complications, and improve both graft and patient survival.