Renal Computed Tomography With 3-Dimensional Angiography and Simultaneous Measurement of Plasma Contrast Clearance Reduce the Invasiveness and Cost of Evaluating Living Renal Donor Candidates1

Abstract

Renal computed tomography (CT), 3-dimensional CT angiography (3D-CTA), and simultaneous measurement of glomerular filtration rate (GFR) by x-ray fluorescence determination of plasma contrast clearance (PCC) are alternatives to intravenous urography (IVU), renal arteriography (RA), and 24-hr urine creatinine clearance (CrCl) for evaluation of renal structure and function in living renal donor (LRD) candidates. To determine if CT, 3D-CTA, and PCC provide data comparable to IVU, RA, and CrCl, both methods were used to evaluate 23 LRD candidates. Costs were also compared. Conventional RA identified 19 accessory arteries and one case of medial fibroplasia. Each of these anomalous vessels was recognized on 3D-CTA. Venous anatomy was more clearly delineated on 3D-CTA than the venous phase of conventional RA. CT demonstrated 3 benign cysts and a single, small intraparenchymal calcification in 3 renal units. GFRs measured by PCC and CrCl were 91 +/- 4 and 132 +/- 7 ml/min/1.73m2, respectively (r = 0.64, P < 0.05). Total cost for CT/3D-CTA/PCC was 46% less than that of IVU/RA/CrCl and 40% less than RA/CrCl. CT/3D-CTA/PCC provided reliable structural and functional data at substantially less cost, discomfort, and inconvenience to the living renal donor candidate. As such, CT/3D-CTA/PCC is superior to conventional methods for evaluation of the living renal donor candidate.

Helical computed tomography angiography in the evaluation of Chinese living renal donors

“…This study is the first to evaluate the efficacy of CTA in assessing Chinese LRD subjects; the results agree with those obtained elsewhere [ 8–11]. CTA not only generated comparable anatomical information, but also had distinct medical, social and economic advantages over CRA.…”

Two Hundred One Consecutive Living-Donor Nephrectomies

“…It is less invasive with fewer complications; less expensive; gives renal parenchymal, ureteral, and venous anatomy; and it may also be used to provide functional data. 4 Al- though angiography has been the criterion standard for the evaluation of living renal donors, the incidence at our center of "missed" accessory renal arteries between CTA and DSA is comparable. Moreover, although the number was small, fewer accessory renal arteries missed by CTA were significant and required reimplantation compared with those missed by DSA.…”

“…In addition, advances in radiological imaging have led to changes in the preoperative assessment of potential living donors. 4 We reviewed 201 consecutive living-donor kidney transplantations during the past decade at our institution (Beth Israel Deaconess Medical Center, Boston, Mass) to assess donor surgical morbidity, the results of preoperative imaging of donor renal artery anatomy, recipient outcome, and changing trends during this period.…”

Multidetector CT angiography in live donor renal transplantation: experience from 156 consecutive cases at a single centre

“…in the detection of accessory renal arteries and earlybranching renal arteries [4][5][6][7][8][9][10][11][12][13][14][15]. At donor nephrectomy, SDCTA has been demonstrated to have accuracy for arterial anatomy in the range 80-100% [4][5][6][7][8][9][10][11][12][13][15][16][17][18][19][20][21][22]. SDCTA may miss more venous anomalies than accessory arteries at operation, but it is still more accurate than conventional angiography [6][7][8][12][13][15][16][17]22].…”