BACKGROUND: Horseshoe kidney is a rare congenital anomaly, occurring in approximately 1 in 400 to 1 in 1800 individuals. When considering transplantation, horseshoe kidneys present unique challenges due to vascular and urinary tract anomalies. They can be transplanted either as a whole, en bloc unit or as 2 separate, split fragments. The complexities in vascular and urinary reconstruction require careful consideration to ensure successful transplantation.

CASE REPORT: We present a case involving the transplantation of a horseshoe kidney from a deceased 36-year-old male donor with confirmed brain death due to intracerebral bleeding. The kidney had a complex vascular arrangement, with 7 arteries, 2 veins, and 2 ureters. A surgical division and vascular reconstruction were performed. The kidney fragments were successfully transplanted into 64- and 65-year-old male recipients. Both grafts exhibited excellent reperfusion, and at 2-month follow-up, both patients demonstrated satisfactory graft function, without dialysis or acute rejection episodes.

CONCLUSIONS: In light of the ongoing shortage of kidney grafts, horseshoe kidneys represent a valuable yet challenging option for transplantation. While vascular and urinary tract anomalies can complicate their use, this case illustrates that, with meticulous surgical technique, horseshoe kidney transplantation can be both viable and safe. Nevertheless, the absence of standardized guidelines for splitting techniques and pre-procurement anatomical assessment underscores the need for further research and consensus in this area.

Keywords: Kidney Transplantation, horseshoe kidney, Splitting Kidney