Background/Objectives: Double ureter kidney grafts raise concerns about increased urologic complications. Limited data exist on optimal surgical management due to small sample sizes in previous reports. This study evaluated outcomes using pantaloon ureteroneocystostomy in the largest reported cohort worldwide. Research Questions: Does pantaloon ureteroneocystostomy achieve comparable outcomes to single ureter transplants? Are long-term graft survival and function equivalent? Should this technique be adopted as standard practice? Methods: This retrospective matched cohort study involves 2210 kidney transplantations (2010–2024). Twenty-six double ureter grafts underwent pantaloon ureteroneocystostomy with dual stenting. Controls matched 1:1 for donor type, era, and recipient characteristics. The primary outcome was urologic complications. Statistical analysis included Kaplan–Meier survival curves and Mann–Whitney U tests. Results: Groups were well matched (median age: 51 vs. 52 years, 50% living donors each). Urologic complications occurred in 3.8% double ureter versus 7.7% control grafts (p = 1.000), markedly lower than 15.4% reported in recent literature. The single complication was early urinary leak, surgically repaired. No late strictures developed. The 5-year graft survival was 96.0% vs. 92.3% (p = 1.000). The final creatinine was comparable (1.25 vs. 1.28 mg/dL, p = 0.891). Conclusions: The pantaloon technique achieves superior outcomes in the largest reported double ureter cohort, with complication rates lower than previously published series. These findings support adopting this standardized approach globally to expand donor criteria while maintaining excellent outcomes.

Background/Objectives: Orchialgia following kidney donation is an underrecognized complication with reported incidence varying dramatically between retrospective (2–3%) and prospective (44–55%) studies, suggesting significant underreporting. This study aimed to determine the incidence, characteristics, and clinical relevance of orchialgia in male kidney donors within 2 years post-donation using direct patient assessment. Methods: This is a cross-sectional study of 100 male donors (64.5% response rate) from 155 eligible donors approached who underwent left laparoscopic donor nephrectomy between February 2021 and 2023. Donors completed a literature-based 15-item questionnaire at routine follow-up visits assessing testicular pain characteristics, timing, and impact. Results: Orchialgia occurred in 48% (48/100) of donors. Early onset (≤14 days) occurred in 47%, with median onset at day 2 (range 1–14). At 3-month follow-up, 37% reported persistent pain; by 1 year, only 0.8% experienced persistent pain based on our 10-year institutional database. No significant difference in incidence between altruistic (54%) and related donors (33%), though pain severity was lower in altruistic donors (mean 3.6 vs. 4.2, p = 0.04, independent t-test). Conservative management was effective in all cases; no invasive interventions were required. Conclusions: Orchialgia affects nearly half of male kidney donors when directly assessed, though it follows a benign, self-limiting course with minimal long-term clinical impact. These findings support enhanced preoperative counseling while reassuring donors about favorable outcomes.

Background: Uncontrolled donation after circulatory death (uDCD) remains underutilized globally, despite critical organ shortages. We report outcomes from Israel’s uDCD kidney transplant program compared with the matched donation after brain death (DBD) recipients. Methods: This retrospective cohort study analyzed all uDCD kidney transplants performed at the Rabin Medical Center between January 2018 and December 2024, compared with DBD transplants during the same period. Propensity score matching (1:3 ratio) was performed using recipient demographics, comorbidities, and donor characteristics. Primary outcomes included delayed graft function (DGF), graft failure, and patient survival. Results: Among 92 kidney transplants, 21 (22.8%) were from uDCD donors. After propensity-matching (21 uDCD, 63 DBD), significant baseline differences persisted: uDCD recipients were younger (47.2 ± 11.8 vs. 57.5 ± 10.9 years, p < 0.001) despite a similar dialysis vintage (7.2 ± 3.2 vs. 7.7 ± 3.7 years, p = 0.569). Warm ischemia time was 58.5 ± 12.3 vs. 3.0 ± 0.0 min (p < 0.001), and cold ischemia time was longer in uDCD (13.7 ± 5.9 vs. 8.4 ± 2.5 h, p < 0.001). DGF occurred in 90.5% of uDCD versus 54.1% of DBD recipients (p = 0.006). Graft failure was markedly higher in uDCD (28.6% vs. 1.6%, p = 0.001), yet mortality was lower (14.3% vs. 27.9%, p = 0.339). After a median follow-up of 60 months (IQR 48–72) for both groups, the death-censored 5 year graft survival rate was 71.4% for uDCD versus 98.4% for DBD (p < 0.001). Conclusions: Despite higher rates of DGF and graft failure, uDCD kidney transplantation demonstrated an acceptable 5 year patient survival rate in carefully selected younger recipients. These findings support cautious expansion of uDCD programs with rigorous recipient selection criteria and realistic outcome expectations.

Coronavirus disease 2019 (COVID-19) has affected tens of millions of people globally since it was declared a pandemic by the World Health Organization on 11 March 2020. Since its outbreak in December 2019, the ongoing coronavirus COVID-19 pandemic has led to global social, economic and healthcare crises affecting millions of people and causing the death of hundreds of thousands of people worldwide. As with other fields of healthcare, the pandemic with its heavy workload imposed on hospital services and personnel significantly affected solid organ transplantation. Concerns for potential exposure to the virus and its related severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) have profoundly altered the process of organ donation and recovery, acceptance of organ offers, management of potential recipients and living donors, and above all transplanted and immunosuppressed patients. All those issues required prompt implementation of new practice measures and guidelines as well as continuous adaptations to the fluid and rapidly changing situation. Herein we describe a single transplant center experience with kidney transplantation during the COVID-19 pandemic; we review the national and institutional measures and restrictions undertaken in different phases of the ongoing event as well as the outcomes.

Background: Native nephrectomy is frequently required in autosomal-dominant polycystic kidney disease (ADPKD) before or during transplantation, but the optimal minimally invasive approach is unsettled, and it is unclear whether the pattern of post-operative complications tracks with operative technique. We report a retrospective single-centre experience of hand-assisted laparoscopic (HAL) native nephrectomy and, alongside it, a technique-stratified scoping review of complications. Methods: We retrospectively reviewed all consecutive adults undergoing HAL native nephrectomy—with an infra-umbilical midline hand-port and free intraperitoneal cyst rupture—in preparation for transplantation in the period between December 2019 and December 2025. In parallel, we performed a PRISMA-ScR-compliant scoping review (MEDLINE, Embase, Scopus) of minimally invasive ADPKD nephrectomy, with duplicate independent screening and extraction, stratifying complications by operative approach and cyst-decompression method. No quantitative pooling was undertaken. Results: Twenty-three patients (mean age 52.8 ± 9.9 years; 87% dialysis-dependent; 78% for transplant preparation) were included. Median operative time was 102 min (IQR 90–122) with minimal blood loss, one transfusion (4%), and no open conversion. Complications occurred in 8/23 (35%) and were bowel-predominant: one small-bowel perforation, two obstructions, and one ileus—three of Clavien–Dindo grade IIIb, all in right-sided nephrectomies and independent of specimen weight. Peri-operative mortality was 1/23 (4%), from a non-technique-related mycotic aortic dissection. Of 481 records screened, 19 studies met inclusion; the cyst-decompression method was reported in only 7 (37%). Bowel events clustered in series using free intraperitoneal cyst rupture or puncture and were largely absent where decompression was contained, a pattern crossing platform boundaries and that is mechanistically consistent with intraperitoneal spillage of cyst contents. Conclusions: HAL native nephrectomy is a rapid and feasible means of removing massively enlarged polycystic kidneys before transplantation but, in our experience, carries a bowel-predominant morbidity that clustered in right-sided procedures and was independent of specimen weight. The sparse literature is consistent with—but cannot confirm—a relationship to intraperitoneal cyst spillage rather than to the hand-assisted approach itself. Whether contained cyst decompression can preserve operative efficiency while reducing bowel morbidity is a hypothesis warranting prospective study.