Renal arterial anatomy exhibits significant variation, which holds important implications for donor nephrectomy,
deceased donor retrieval, transplantation, and other surgical procedures. Among these, accessory renal arteries
and precaval courses represent clinically relevant anomalies that may complicate surgical dissection and graft
revascularization. We describe a rare vascular anomaly identified during deceased donor organ retrieval in a
70-year-old female. In addition to the normal right renal artery, an accessory renal artery was noted arising from the
abdominal aorta at the level of L2 and coursing anterior to the inferior vena cava (precaval) to enter the renal hilum.
The left kidney demonstrated a single renal artery in its usual anatomical position. Both kidneys were successfully
retrieved and transplanted, with both recipients showing immediate graft function and no early postoperative
complications. Multiple renal arteries occur in 25–30% of individuals, whereas a precaval course is reported in
only 0.8–5%. The simultaneous presence of precaval and postcaval renal arteries on the same side is exceedingly
rare. Although accessory renal arteries are associated with higher surgical complexity and increased risk of vascular
complications, meticulous procurement and reconstruction techniques enable favorable outcomes: This case
highlights the importance of recognizing renal arterial variations during donor retrieval to ensure safe procurement
and optimize transplantation success.
Keywords: Renal artery variant, cadaveric kidney donor, renal transplant