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The horseshoe kidney is the most common anatomic renal variation, with an incidence of 1 in 600 to 800. It represents a fusion anomaly, usually of the lower poles. Horseshoe kidneys can be transplanted en bloc or after division of the renal isthmus. However, the great variation in origin, number, and size of renal arteries and veins leads to some reluctance to use horseshoe kidneys for transplantation. The aim of this study is to assess the results of horseshoe kidney transplantation.All data concerning horseshoe kidney transplantations within the Eurotransplant region were collected and were divided into en bloc and split transplantations. A matched control group was defined, and the three groups were analyzed with respect to the occurrence of primary nonfunction, graft survival, patient survival, and finally posttransplant serum creatinine values.From 1983 to 2000, 8 horseshoe kidneys were transplanted en bloc and 26 were split and transplanted into 47 recipients. The results of these transplantations were compared with 110 transplantations in the control group. No significant differences among the three groups could be found, either in the short- or long-term posttransplant results.The results of horseshoe kidney transplantation, either en bloc or split, are equal to the posttransplant results of kidneys with a normal anatomy. Bearing in mind the shortage of donors, horseshoe kidneys should certainly be used for transplantation.