Double Inferior Vena Cava with Renal Angiomyolipoma in a Living Kidney Donor: A Rare Vascular and Parenchymal Anomaly with Surgical Implications

Abstract

Background: Duplication of the inferior vena cava (IVC) and renal angiomyolipoma (AML) are uncommon findings in living kidney donors and rarely coexist. Both anomalies may influence donor nephrectomy and graft implantation strategy. Case Presentation: We report a 72-year-old female living kidney donor who underwent ABO-incompatible transplantation for her 32-year-old son with end-stage renal disease (donor: B positive; recipient: A negative). Preoperative contrast-enhanced CT angiography demonstrated a duplicated IVC with a left-sided cava crossing anterior to the aorta and joining the right IVC (pre-aortic confluence), along with an accessory left renal vein. A small lower pole AML measuring 8 × 7.5 × 12 mm was identified in the donor kidney. Bilateral single renal arteries were present. The anticipated technical challenge was reduced left renal vein length due to early drainage into the duplicated cava, potentially complicating venous anastomosis. Following multidisciplinary evaluation and immunological optimization, donor nephrectomy and transplantation were completed successfully without vascular compromise or graft-related complications. Conclusion: This case underscores the importance of meticulous preoperative vascular mapping and individualized operative planning in donors with complex venous anatomy. Small, asymptomatic AMLs should not represent an absolute contraindication to donation when appropriately assessed. Even in the presence of ABO incompatibility and dual anatomical anomalies, successful transplantation is achievable with structured multidisciplinary management.