Computed tomography identified factors that preclude living kidney donation

Abstract

Introduction: The purpose of this study was to determine the variety and prevalence of renal and non-renal abnormalities detected on multi-detector computed tomography (MDCT) that precluded patients from donating a kidney. Methods: Institutional review board approval was obtained and the requirement for informed consent was waived. A retrospective, single-centre review of 701 patients (444 female, 257 male; age range 18-86 years; mean age 43.2±11.9 years) that underwent renal donor protocol MDCT was conducted. A systematic review of the CT report, records from multidisciplinary renal transplantation rounds, and electronic medical records was performed to determine which patients were approved or declined as live renal donors. If declined as a donor, CT-identified reasons were categorized as abnormalities of renal vasculature, renal parenchyma, collecting system, or extra-renal. Results: A total of 81 patients were excluded as renal donors on the basis of CT findings. Abnormalities of the collecting system accounted for the most frequent cause of exclusion (n=41), with asymptomatic renal calculi being detected in 39 patients. Complex vascular anatomy and vascular abnormalities resulted in the exclusion of 29 patients. Supernumerary arteries and early arterial branching resulted in the exclusion of 20 patients, while renal vein anomalies leading to exclusion were uncommon (n=2). Abnormalities of renal parenchyma resulted in the exclusion of nine patients. Three patients were diagnosed with autosomal dominant polycystic kidney disease, two patients had renal cell carcinoma, and two patients had areas of cortical scarring. A complex cystic lesion requiring surveillance imaging was encountered in one patient and a large area of renal infarction related to prior adrenalectomy was demonstrated in one patient. Extra-renal abnormalities leading to exclusion were limited to two patients with pulmonary nodules.

Three-Dimensional Visualization With Virtual Reality Facilitates Complex Live Donor Renal Transplant

“… 7 Advances in medical imaging and visualization allow for detailed understanding of discrete donor anatomy as well as planning of the donor and recipient operations. Still, on occasion, a willing donor is declined because of prohibitive anatomy demonstrated on multiphase contrast-enhanced CT. 8 …”

Correlation of preoperative imaging characteristics with donor outcomes and operative difficulty in laparoscopic donor nephrectomy

“…If the difference in GFR is higher than 10 mL/min, the candidate is excluded, as well. This scan additionally provides crucial information to the transplant surgeon for the appropriate donor selection and preoperative planning …”

“…This scan additionally provides crucial information to the transplant surgeon for the appropriate donor selection and preoperative planning. 4 Two areas where a preoperative CT scan may be helpful are in determining operative difficulty and predicting donor outcome.…”

Diameters of Arteries Supplying Horseshoe Kidneys and the Level They Branch off Their Parental Vessels: A CT-Angiographic Study

“…For normal kidneys, the vascular system is a source of numerous complications during surgical procedures involving abdominal region, such as kidney transplantation, implantation of vessel stents, kidney stone surgery or aortic aneurysm management [6,7,8]. Although procedures involving horseshoe kidneys are not as well described, their importance is likely to increase as they are affected by similar diseases as typical kidneys [9,10,11,12].…”