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?

Mehmet Ali Ikidag,Erdal Uysal

doi:10.5334/jbsr.1719

Abstract

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.

Highlights

Renal transplantation is the most efficient treatment method in end-stage renal disease
The aim of our study is to determine the efficacy of preoperative single-phase early arterial Computed tomography angiography (CTA) in donor nephrectomy to assess the renal vascular variations, anomalies, and parenchymal pathologies of donor kidneys
Fifteen candidates were excluded from the operation, five according to CTA findings and another 10 for other reasons, such as positive serum cross-match and resignation of candidates

Summary

Introduction

Renal transplantation is the most efficient treatment method in end-stage renal disease. Transplant surgeon’s preoperative precise information about donor’s renal vasculature is crucial for a successful graft nephrectomy, to reduce the risk of vascular injury and to shorten the ischemia duration [2]. Computed tomography angiography (CTA) has become the first choice among noninvasive radiological modalities for the evaluation of donor’s renal vessels. It can reveal the concomitant pathological conditions of kidneys and other abdominal structures at the same investigation [1, 3]. The aim of our study is to determine the efficacy of preoperative single-phase early arterial CTA in donor nephrectomy to assess the renal vascular variations, anomalies, and parenchymal pathologies of donor kidneys

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Methods

Results

Conclusion