Use of Spiral Computerized Tomography in Lieu of Angiography for Preoperative Assessment of Living Renal Donors

Abstract

Spiral CT is a reasonably good alternative to renal angiography for living renal donor assessment but there is a profound learning curve for performance and interpretation. Renal angiography is still the gold standard with respect to the identification of arterial multiplicity and fibromuscular dysplasia, and it should be used adjunctively in cases with spiral CT ambiguity. Neither spiral CT nor renal angiography is ideal for the assessment of early renal artery division which is seldom an issue. The benefits of spiral CT over renal angiography are potentially lower morbidity, improved donor convenience and reduced cost.

Rapid Progression of Native Renal Artery Fibromuscular Dysplasia Following Kidney Donation

“…It is likely that rapid increase in live kidney donation may lead to relaxation in acceptance criteria, and introduction of less invasive and more cost-effective means of evaluation of the potential donors. Currently magnetic renal angiography (MRA), computed tomographic angiography (CTA) and digital subtraction angiography are all considered as acceptable alternatives to conventional resonance angiography (5)(6)(7). Occasionally, failure to recognize mild-to-moderate and mostly mid-todistal renal arterial stenosis, particularly fibromuscular dysplasia (FMD), in donor kidneys can cause hypertension, renal insufficiency and ischemic renal failure, both in the recipient if transplanted with lesion and in the donor if the remaining artery has stenosis postdonation (8-11).…”

Living Renal Donors: Optimizing the Imaging Strategy—Decision- and Cost-effectiveness Analysis

“…Since results in studies in the literature are contradictory as to the ability of CT angiography to depict or exclude fibromuscular dysplasia (22,26,34,(62)(63)(64), one can argue that a specificity of 100% will not be attainable. However, researchers in all studies used single-detector row spiral CT angiographic equipment, and one might argue that with multi-detector row spiral CT angiography, a higher specificity of CT angiography could be deter- Figure 2.…”

“…As has been stated, however, performing no test at all in donors would be unethical, since the transplantation team relies on the findings on the images in planning and performing the surgery (28) and because the team should not compromise its care for the safety of the donors (22).…”

Assessment of donor kidney anatomy

“…Twenty‐nine studies published from 1995 to 2006 compared operative findings with CT angiographic findings 3,5,6,8,9,12–35 . The sensitivity in detecting accessory renal arteries ranged from 40%‐100% (mean 84%).…”