Renal Vascular and Ureteral Anatomic Variations in 1859 Potential Living Renal Donors

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

“…Up to 30% of potential donors have more than 1 renal artery for a kidney. [9][10][11] In a comparison of CTA vascular anatomy and intraoperative findings in 2,144 living kidney donors, CTA identified the correct number of renal arteries in 97.9% of cases. 10 While none of the patients had more arteries than predicted, 2.1% had fewer arteries found intraoperatively than were demonstrated on CTA.…”

“…18 Also, the additional vascular complexity increases the risk for converting to open surgery during the donor nephrectomy, putting the donor at higher risk. 11 Liberal use of 3D reconstruction and VR viewing may elucidate additional clinical scenarios in which 3D visualization is warranted and identify precisely which conditions, pathologies, or organ systems are most amenable to 3D VR visualization. We have begun to use 3D reconstruction at our institution routinely for the kidney donor population, which has led our team to identify extrarenal structures, such as ribs, spine, and liver or spleen, as useful reference anatomy in relation to the renal vascular anatomy.…”

“… 18 Also, the additional vascular complexity increases the risk for converting to open surgery during the donor nephrectomy, putting the donor at higher risk. 11 …”

“…Three-dimensional models can be explored on a desktop monitor without requiring a headset.technology, and our cost was only $250 for the time the biomedical engineer needed to create the model.Recipient outcomes following transplantation of a donor kidney with 2 renal arteries have been demonstrated to be acceptable compared to outcomes after transplantation of a donor kidney with a single renal artery, and reconstruction techniques are typically straightforward.5,17 Donor kidneys with more than 2 arteries have been shown to have some inferior outcomes compared to those with 2 or 1, namely longer cold times, increased delayed graft function, and increased slow graft function, but equivalent longterm graft survival 18. Also, the additional vascular complexity increases the risk for converting to open surgery during the donor nephrectomy, putting the donor at higher risk 11. Liberal use of 3D reconstruction and VR viewing may elucidate additional clinical scenarios in which 3D visualization is warranted and identify precisely which conditions, pathologies, or organ systems are most amenable to 3D VR visualization.…”

Variant renal artery anatomy in first degree relatives on MDCT angiography

“…In the literature, the presence of multiple renal arteries in patients undergoing assessment of live kidney donation ranges from 22.6% to 46.6%. 1,2 While wide variation in potential renal vascular anatomy across a large, heterogenous cohort of patients is unsurprising, given many living kidney transplantations are provided by live related donors, the question arises as to the potential variations that exist between family members.…”