Transplantation of Horseshoe Kidneys: Surgical Strategies and 15‐Year Functional Outcomes From a Tertiary Center Experience

Background Horseshoe kidney (HSK) is a rare congenital fusion anomaly that poses distinct anatomical and surgical challenges in kidney transplantation. Owing to its low incidence, evidence on long-term outcomes remains limited. This study reports a 20-year single-center experience with HSK transplantation, comparing en bloc and split grafts.Methods A retrospective analysis was conducted on six HSK transplants from deceased donors performed since January 2005. All recipients had end-stage renal disease and were undergoing dialysis at transplantation. The choice between en bloc or split implantation was based on vascular, isthmic, and collecting system anatomy. Primary outcomes included graft function, patient survival, and postoperative complications; secondary outcomes were delayed graft function (DGF) and long-term renal function. Descriptive statistical analysis was applied to perioperative and follow-up data, including serum creatinine (SCr) and graft survival up to 20 years.Results Among six recipients (three en bloc, three split), one en bloc recipient died on postoperative Day 3 due to bowel infarction. The remaining five patients showed immediate graft function, except one with DGF. At a mean follow-up of 14 years, all surviving recipients maintained satisfactory renal function (mean SCr = 130 mu mol/L). No graft loss or major surgical complications were observed.Conclusion HSK transplantation, though technically demanding, represents a viable strategy to expand the donor pool. With careful anatomical assessment and surgical planning, both en bloc and split grafts can achieve excellent long-term outcomes. However, en bloc transplantation may entail greater procedural and spatial challenges, emphasizing the need for accurate recipient selection and size matching.