Incidental Finding of Situs Inversus Totalis in Cadaveric Kidney Transplant Donor: Surgical Challenge and Short-Term Evolution of Recipients

Background: Kidney transplantation is the treatment of choice for patients with end-stage chronic kidney disease. In the first six months post-transplantation, surgical complications represent a significant cause of graft loss. Situs Inversus Totalis (SIT) is a rare anatomical anomaly that poses technical challenges in organ procurement and transplantation. Evidence regarding the viability of organs from donors with SIT is scarce. Methods: We report the successful procurement of both kidneys from a cadaveric donor with SIT, a finding that was detected intraoperatively. The right kidney showed a longer renal artery and vein, while the left kidney showed three converging arteries and one vein. Both kidneys were transplanted into different recipients. The first recipient evolved favorably, while the second recipient with multiple arteries in the graft presented acute graft dysfunction secondary to renal infarction, massive hemorrhage, and death. Results: SIT is not an absolute contraindication for organ donation. However, anatomical variants such as the presence of multiple arteries increase surgical complexity and the risk of postoperative complications, highlighting the importance of an adequate anatomical evaluation and surgical planning before transplantation. Kidney grafts from donors with SIT can be used successfully, provided that an adequate selection and individualized management of the recipients is performed. Conclusion: This report emphasizes the need for more rigorous imaging protocols and consideration of graft vascular anatomy in perioperative decision making.