Abstract / Summary
Abstract Background: Vascular anomalies in living kidney donors pose technical challenges. Double inferior vena cava (D-IVC) occurs in 0.2%–0.7%, and multiple renal veins in 3%–14%. Their combination is exceptionally rare. Case Report: We report successful living donor transplantation from a 49‑year‑old male with D‑IVC and three left renal veins, donated to his daughter with End-stage renal disease (ESRD). Preoperative Computed tomography angiography (CTA) suggested a prominent gonadal vein; intraoperatively, D‑IVC was confirmed. Three short, distant veins could not be merged; each was individually anastomosed to the external iliac vein. Cold ischemia was 20 minutes. Both recovered uneventfully with excellent graft function. Literature Review: We synthesized 15 high‑quality publications (2020–2025) on epidemiology, surgical strategies, and outcomes. CTA with 3D reconstruction is the gold standard (sensitivity 98%). Options include vein grafts or individual anastomoses. One‑year graft survival (94.2% vs. 95.1%) and donor outcomes are comparable to conventional anatomy. Conclusions: D‑IVC with triple renal veins is not an absolute contraindication. With meticulous imaging and tailored techniques, excellent outcomes are achievable.