Role of multidetector computed tomography for evaluation of living kidney donors

Evaluation of Vascular Structures of Living Donor Kidneys by Multislice Computed Tomography Angiography before Transplant Surgery: Is Arterial Phase Sufficient for Determination of Both Arteries and Veins?

Objectives

The aim of our study was to determine the efficacy of preoperative early arterial Computed tomography angiography (CTA) in donor nephrectomy, to assess the renal arterial and venous structures of donor kidneys.

Materials and Methods

Seventy living donor candidates were included to this study, who had CTA for the assessment of their renal vessels in our hospital between January 2011 and January 2015. Only early arterial phase images were obtained to avoid exposing the patients from high dose of radiation. Scans were reported by two radiologists independently. The number of renal arteries, veins and their tributaries were documented. The donor kidneys were removed by two consultant surgeons, and after back-table perfusion the same details were recorded and taken as the reference findings for the operation side.

Results

A total of 70 potential live kidney donors underwent renal CTA, among them fifty five patients had donor nephrectomy. A total of 140 kidneys were evaluated by CTA and the vessels of 55 harvested kidneys were compared with CTA findings. There were 40 kidneys that had at least one accessory or polar artery. There were 5 early branching renal arteries, two retroaortic and two circumaortic renal veins. Three kidneys had multiple renal veins. Operation findings were totally consistent with CTA findings in patients who underwent donor nephrectomy.

Conclusion

Arterial phase CTA is sufficient for evaluation of both arterial and venous vessels of kidneys, and precontrast, venous or late phase imaging should be preserved only for chosen circumstances to avoid high radiation exposure.

Prevalence and clinical characteristics of adrenal incidentalomas in potential kidney donors

BACKGROUND

The prevalence of adrenal incidentalomas (AIs) in asymptomatic individuals is unknown. This study evaluated the prevalence of AIs in healthy kidney donors in whom pre-operative computed tomography (CT) is performed routinely.

METHODS

All potential kidney donors evaluated at the Rabin Medical Center who had routine abdominal CT were identified and their medical records were retrospectively reviewed. Subjects who had normal CT scans were compared with those with a finding of an AI, evaluating demographic (age, body mass index, systolic and diastolic blood pressure) and laboratory variables (glucose, sodium, potassium, calcium, phosphorus, albumin and creatinine). In addition, prevalence of hypertension, rate of donation and surgical mortality were compared between the two groups.

RESULTS

CT was performed in 673 potential kidney donors. Of these, 645 had a normal CT and 28 (4.2%) had evidence of an AI. Those with AIs had a similar prevalence of hypertension, kidney donation and surgical mortality as those with a normal CT. Those with AIs were older (50.93 ± 11.1 versus 43.76 ± 11.1 years) but other demographic variables were similar; laboratory variables were also similar except for slightly lower albumin and creatinine in those with AIs.

CONCLUSIONS

The prevalence of AIs is high even in healthy asymptomatic individuals.