Ionizing Radiation Exposure among Kidney Transplant Recipients Due to Medical Imaging during the Pretransplant Evaluation

Abstract

SummaryBackground and objectives Kidney transplant recipients are at increased risk for malignancies. One recognized risk for malignancy is ionizing radiation. The purpose of this study was to determine, among kidney transplant recipients, the medical imaging procedures that contribute to radiation exposure and their cumulative radiation exposure, as a result of their pretransplant evaluation.Design, setting, participants, & measurements Medical records of patients who received a first, kidney-alone transplant during 2008 at a single transplant center were examined. This study identified medical imaging procedures that were performed as prerequisites for deceased donor wait-listing or receipt of live donor kidney transplants and to maintain active status on the wait list. Frequencies of medical imaging procedures and cumulative effective doses of radiation were calculated.Results Among the 172 kidney transplant recipients, 905 procedures were performed. Seventy patients (40.7%) were exposed to low dose (0-20 mSv), 51 (29.7%) were exposed to moderate dose (.20-50 mSv), 28 (16.3%) were exposed to high dose (.50-100 mSv), and 23 (13.4%) were exposed to very high dose (.100 mSv) cumulative effective radiation. Nuclear stress tests accounted for 82.9% of the total radiation exposure. In multivariate analysis, older age, diabetes, and black race were associated with exposure to .20 mSv radiation during the pretransplant evaluation.Conclusions Kidney transplant recipients are exposed to large amounts of ionizing radiation from medical imaging during the pretransplant evaluation. The effects of radiation upon malignancy risk and strategies to reduce this radiation exposure warrant further investigation.

Radiation Exposure from Diagnostic Imaging in a Cohort of Pediatric Transplant Recipients

“…A mean of 161 DI studies and 138 mSv effective radiation exposure were documented during a mean of 6.5 years follow-up for 107 lung transplant recipients [3]. A study of 202 heart transplant recipients followed for up to 10 years reported a mean of 66 DI studies and 84 mSv effective radiation exposure post-transplant [14].…”

“…One study estimated that 1% of malignancies in Canada and the United States (US) are attributable to radiation from DI [2]. The maximum permissible occupational radiation exposure in the US is 50 millisievert (mSv) per year or 100 mSv over 5 years [3] while background radiation is about 3 mSv annually [4]. The lifetime excess risk of death from cancer has been estimated to increase by approximately 0.4% with 100 mSv of cumulative radiation exposure [5] and to be 5% per sievert [6].…”

Cardiovascular risk assessment in kidney transplantation

“…[75][76][77][78][79][80] Even radiation, instinctively disliked by many patients, may pose a risk. Indeed, Nguyen et al 81 found in a cohort of transplanted patients, already at higher risk for malignancy, that 29% were exposed to high or very high levels of radiation in their pretransplant evaluations, and that nuclear medicine studies accounted for 83% of that exposure. The lower specificity of noninvasive testing in patients with ESRD and CKD often results in coronary angiograms without evidence of CAD.…”

Renal Relevant Radiology

“…However, because ionizing radiation poses a recognized risk for malignancies, the effects of multiple pre-and posttransplant radiation in the setting of immunosuppression may enhance this risk (43).…”