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

Laugharne, Matthew; Haslam, Elizabeth; Archer, Lesley; Jones, Lyn; Mitchell, David C.; Loveday, Eric; Lear, P. A.; Thornton, Mark

doi:10.1111/j.1432-2277.2006.00417.x

Cited by 21 publications

(26 citation statements)

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“…Risk stratification based on most radiographic findings is largely opinion-based and may be influenced by the type of imaging modality used (42). We found that 132 (6.7%) of 1957 of our potential donors had radiographic abnormalities of the renal arteries or kidneys that were perceived as contraindications for kidney donation, compared with 38 (11%) of 333 (42), 5 (4.0%) of 126 (16), and 3 (1.9%) of 159 (43) in other studies that used CT angiography/urography. This discrepancy between centers suggests a need for further research on the clinical relevance of these abnormalities.…”

Section: Discussionmentioning

confidence: 88%

Prevalence of Renal Artery and Kidney Abnormalities by Computed Tomography among Healthy Adults

Lorenz¹,

Vrtiska²,

Lieske³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Management of incidental renal artery and kidney abnormalities in patients undergoing computed tomography scans is a clinical challenge because their frequency in healthy subjects has not been precisely estimated. Therefore, the prevalence and management of these abnormalities were determined among a large cohort of potential kidney donors undergoing protocol evaluations.Design, setting, participants, & measurements: All patients at the Mayo Clinic who underwent computed tomographic angiography and urography as part of their kidney donor evaluation between 2000 and 2008 were identified. Radiographic reports were abstracted for abnormalities of the renal arteries and kidneys. The prevalence of radiographic abnormalities was stratified by age and gender, and the effect on approval for kidney donation was determined.Results: Among 1957 potential kidney donors, the mean ؎ SD age was 43 ؎ 12 years, and 58% were women. The most common abnormalities were kidney stones (11%), focal scarring (3.6%), fibromuscular dysplasia (2.8%), and other renal artery narrowing or atherosclerosis (5.3%). Fibromuscular dysplasia, focal scarring, parenchymal atrophy, and upper tract dilation were more common in women. Renal artery narrowing, focal scarring, and indeterminate masses increased with age. Overall, 25% of potential donors had at least one abnormality. However, these incidental radiographic abnormalities contributed to exclusion from donation in only 6.7% of potential donors.Conclusions: Incidental radiographic abnormalities of the renal arteries and kidneys are common. The majority of imaging findings are not perceived to be harmful enough to prevent kidney donation, but future studies are needed to determine their clinical relevance.

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Section: Discussionmentioning

confidence: 88%

Prevalence of Renal Artery and Kidney Abnormalities by Computed Tomography among Healthy Adults

Lorenz¹,

Vrtiska²,

Lieske³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…CT angiography is a proven tool in this domain. It also has the ability to detect parenchymal abnormalities and calculi; however, its use of ionising radiation is a disadvantage that should be considered when evaluating a donor population [11,12].Balanced steady-state free precession (SSFP) MRA provides a high signal-to-noise ratio (SNR) of blood and a unique T 1 /T 2 weighting [13]. SSFP MRA is a noncontrast technique that has been used for the imaging of renal vasculature in several studies [14][15][16].…”

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confidence: 99%

mentioning

confidence: 99%

Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study

Laurence

Ariff²,

Quest³

et al. 2012

The British Journal of Radiology

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Objective: Accurate pre-operative evaluation of renal vascular anatomy is essential for successful renal harvest in live donor transplantation. Non-contrast renal MR angiographic (MRA) techniques are potentially well suited to the screening of donors; however, their restricted imaging field of view (FOV) has previously been an important limitation. We sought to assess whether the addition of a large FOV balanced fast field echo (BFFE) steady-state free precession (SSFP) sequence to non-contrast SSFP MRA could overcome this problem. Comparison with contrast-enhanced MRA (CE MRA) and findings at surgery were performed. Methods: 22 potential renal donors each underwent SSFP and CE MRA. 11 out of 22 potential donors subsequently underwent a donor nephrectomy. Results: All images were diagnostic. Both SSFP MRA and CE MRA identified an equal number of arteries. Surgery confirmed two accessory renal arteries, both demonstrated with both imaging techniques. A third accessory vessel was identified with both techniques on a kidney contralateral to the donated organ. 6 out of 11 procured kidneys demonstrated early branch arteries at surgery, 5 out of 6 of which had been depicted on both SSFP and CE MRA. The median grading of image quality for main renal arteries was slightly better for CE MRA (p50.048), but for accessory vessels it was better for SSFP MRA. Conclusion: This pilot study indicates that by combining free-breathing SSFP MRA with large-FOV bFFE images, an accurate depiction of renal vascular anatomy without the need for intravenous contrast administration can be obtained, as compared with surgical findings and CE MRA. Living donor transplantation is becoming an increasingly important treatment option for end-stage renal failure (ESRF). The high prevalence of anatomical variants in renal vascular anatomy underscores the importance of accurate pre-operative evaluation of the vascular anatomy [1, 2], particularly in patients undergoing a laparoscopic approach, as the surgical field of view (FOV) is limited. Multiple renal arteries in the donor kidney result in a substantial increase in the risk of complications. Moreover, the presence of accessory arteries and early branches of the renal arteries, as well as variants in venous anatomy, can all affect the surgical decision for suitability for donor harvest [3,4].Although there has been some debate about the optimal imaging strategy for potential renal donors [5][6][7], with concerns raised over the ability of contrast-enhanced MR angiography (CE MRA) to detect all renal arteries [8], there is evidence to support the sole use of CE MRA for this purpose [9]. Non-contrast MRA techniques have been used for several years, but have been generally overshadowed by the more popular contrast-enhanced techniques [10]. CT angiography is a proven tool in this domain. It also has the ability to detect parenchymal abnormalities and calculi; however, its use of ionising radiation is a disadvantage that should be considered when evaluating a donor population [11,12].Balanced steady-...

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“…MSCT provides a tool for the CT examination of the renal artery, and improves the accuracy and sensitivity of the detection of renal artery variation (Laugharne et al, 2007). However, the MSCT scanning technique and post-processing procedures are not uniform, and this reduces the advantages of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Application value of multislice spiral computed tomography angiography in the evaluation of renal artery variation in living donor kidney transplantation

Xiu-yi¹,

Tian²,

Ru³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. This study aims to investigate the accuracy and value of multislice spiral computed tomography (MSCT) angiography in the evaluation of renal artery variation in living donor kidney transplantation. Two hundred seventy-three kidney transplantation donors underwent preoperative MSCT scanning. Two doctors determined the running direction and variation of the renal artery through joint analysis of the preoperative original MSCT image and the recombination image using the blind reading method, compared the imaging results with the intraoperative results, and evaluated the accuracy and application value of MSCT angiography in the evaluation of renal artery variation in living donor kidney transplantation. CT angiography (CTA) can better show the renal artery and its variation. A total of 52 accessory renal arteries were found in the 273 kidney transplant operations, whereas 55 accessory renal arteries were found in preoperative MSCT. Four accessory renal arteries indicated in the MSCT were not found during the operation, and one accessory renal artery found during the operation Renal artery variation in donor kidney transplantation was not indicated in the preoperative MSCT. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MSCT in the diagnosis of accessory renal arteries were 98.1, 98.2, 92.7, 99.5, and 98.2%, respectively. MSCT angiography can sensitively and accurately show the renal artery and its variation in living donor kidney transplantation, and has important clinical value for the formulation of the operative scheme before the transplantation.

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

Cited by 21 publications

References 50 publications

Prevalence of Renal Artery and Kidney Abnormalities by Computed Tomography among Healthy Adults

Prevalence of Renal Artery and Kidney Abnormalities by Computed Tomography among Healthy Adults

Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study

Application value of multislice spiral computed tomography angiography in the evaluation of renal artery variation in living donor kidney transplantation

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