Semiautomated CT-Based Quantification of Donor Kidney Volume Applied to a Predictive Model of Outcomes in Renal Transplantation

Juluru, Krishna; Rotman, J; Masi, Paul; Spandorfer, Robert; Ceraolo, Carl; Giambrone, Ashley E.; Serur, David; Hartono, Choli

doi:10.2214/ajr.14.13454

Cited by 18 publications

(8 citation statements)

References 23 publications

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“…Longer term renal function would be useful as an outcome; however, given the relatively new requirement to collect postdonation renal function, our study is limited to the 2-year postdonation mark. In addition, one reader assessed kidney volumes; however, previous studies that investigated intraand interobserver variability did not find major interobserver discrepancies with the CT volumetric method used for this study (15,26). In addition, multiple CT scanners with variable protocols and section thicknesses were used.…”

Section: Discussionmentioning

confidence: 99%

“…A board-certified radiologist (G.F., with 4 years of post-abdominal imaging fellowship experience) used commercially available semiautomatic volumetric analysis to retrospectively measure image volumes (IntelliSpace Portal, V7.02.60020; Philips Healthcare, High- land Heights, Ohio). The nephrographic phase images were used to measure whole kidney volume, and the arterial phase images were used to measure cortical volume of the remnant kidney (15). With use of the axial, sagittal, and coronal images, a pointer was placed over the remnant kidney (either the cortex and medulla to provide whole kidney volume or just the cortex to provide cortical volume) with a growing region of interest (Fig 1a and 1b).…”

Section: Methodsmentioning

confidence: 99%

“…None of the published risk projection models, however, has been used to investigate whether the volume of the donor's remnant kidney might further enhance the quality of the prognostication of the donor's postdonation renal function. The potential clinical relevance of that approach is underscored by the observation that living donor kidney graft volume derived from predonation computed tomography (CT) is directly related to short-and long-term kidney function in the recipient (14)(15)(16)(17).…”

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confidence: 99%

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Predonation Volume of Future Remnant Cortical Kidney Helps Predict Postdonation Renal Function in Live Kidney Donors

et al. 2018

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Purpose To determine whether the predonation computed tomography (CT)-based volume of the future remnant kidney is predictive of postdonation renal function in living kidney donors. Materials and Methods This institutional review board-approved, retrospective, HIPAA-compliant study included 126 live kidney donors who had undergone predonation renal CT between January 2007 and December 2014 as well as 2-year postdonation measurement of estimated glomerular filtration rate (eGFR). The whole kidney volume and cortical volume of the future remnant kidney were measured and standardized for body surface area (BSA). Bivariate linear associations between the ratios of whole kidney volume to BSA and cortical volume to BSA were obtained. A linear regression model for 2-year postdonation eGFR that incorporated donor age, sex, and either whole kidney volume-to-BSA ratio or cortical volume-to-BSA ratio was created, and the coefficient of determination (R) for the model was calculated. Factors not statistically additive in assessing 2-year eGFR were removed by using backward elimination, and the coefficient of determination for this parsimonious model was calculated. Results Correlation was slightly better for cortical volume-to-BSA ratio than for whole kidney volume-to-BSA ratio (r = 0.48 vs r = 0.44, respectively). The linear regression model incorporating all donor factors had an R of 0.66. The only factors that were significantly additive to the equation were cortical volume-to-BSA ratio and predonation eGFR (P = .01 and P < .01, respectively), and the final parsimonious linear regression model incorporating these two variables explained almost the same amount of variance (R = 0.65) as did the full model. Conclusion The cortical volume of the future remnant kidney helped predict postdonation eGFR at 2 years. The cortical volume-to-BSA ratio should thus be considered for addition as an important variable to living kidney donor evaluation and selection guidelines. RSNA, 2018.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Predonation Volume of Future Remnant Cortical Kidney Helps Predict Postdonation Renal Function in Live Kidney Donors

et al. 2018

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“…Thus, there remains an issue of difficulty to interpret the number of nephrons in an individual based solely on knowledge of cortical volume. In fact, previous reports of cortical volume did not consistently find correlations with either nephron number or renal outcomes 19,20 .…”

Section: Discussionmentioning

confidence: 58%

Estimation of nephron number in living humans by combining unenhanced computed tomography with biopsy-based stereology

Sasaki

Tsuboi

Okabayashi

et al. 2019

Sci Rep

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Methods for estimating nephron number in a clinical setting may be useful for predicting renal outcomes. This study aimed to establish such a method using unenhanced computed tomography (CT) and biopsy-based stereology. Patients or living kidney donors simultaneously subjected to enhanced and unenhanced CT examinations were randomly assigned to development and validation groups. The enhanced CT-measured arterial phase and the venous phase images of kidneys were regarded as the true values for cortical volume and parenchymal volume, respectively. Linear multiple regression analysis was used to create models for estimating cortical volume using explanatory variables including unenhanced CT-measured parenchymal volume. Nephron number was determined as the product of cortical volume and the glomerular density in biopsies of donors. Five equations for estimating cortical volume were created and verified. In donors, estimated nephron number by unenhanced CT was consistent with that by enhanced CT, with minimal errors in all models (636–655 ± 210–219 vs. 648 ± 224 × 103/kidney). Clinical characteristics combined with parenchymal volume did not improve the equation over parenchymal volume alone. These results support the feasibility of estimating nephron number by a combination of unenhanced CT and biopsy-based stereology, with a possible application for renal disease patients who are often not suitable for contrast media.

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“…A recent study evaluated renal cortical volume using computed tomography (CT) to predict graft function in living donor kidney transplants, although that was not necessarily correlated with graft survival [7,8]. Another study showed that US measurements, especially cortical thickness, were good for evaluating renal function [9].…”

Section: Discussionmentioning

confidence: 99%

Primary non-function in a deceased donor kidney transplant even with a Kidney Donor Risk Index less than 1.0: a case report

Yun

Kim

Lee

et al. 2022

Korean J Transplant

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Donations from deceased donors have been increasing since the introduction of expanded criteria for donor kidney selection. Several studies have shown that patients receiving deceased donor kidneys using these expanded criteria have improved survival compared to those remaining on the waiting list during hemodialysis. It is important, however, to consider that some of the kidneys classed as usable under the expanded criteria may in fact be unacceptable. To address this concern, preoperative biopsy and imaging of deceased donor kidneys are increasingly being used to assess candidate kidneys. We present the case of a 44-year-old female patient who underwent deceased donor kidney transplantation with negative complement-dependent cytotoxicity and flow cytometry crossmatch. Hours after graft reperfusion, given clinical evidence of primary nonfunction in the kidney, the patient underwent nephrectomy. Despite negative tests for blood type difference and crossmatch, and although the main artery and vein were well perfused, the kidney graft was never functional, and pathologic findings showed thrombotic microangiopathy and diffuse acute tubular necrosis. We conclude that further work on ideal criteria for identifying acceptable donor kidneys is needed.

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Semiautomated CT-Based Quantification of Donor Kidney Volume Applied to a Predictive Model of Outcomes in Renal Transplantation

Abstract: The CT-derived ratio between donated kidney cortical volume and recipient pretransplant weight is a noninvasively and readily obtained reproducible biomarker that is predictive of 12- and 24-month renal transplant outcomes.

Cited by 18 publications

References 23 publications

Predonation Volume of Future Remnant Cortical Kidney Helps Predict Postdonation Renal Function in Live Kidney Donors

Predonation Volume of Future Remnant Cortical Kidney Helps Predict Postdonation Renal Function in Live Kidney Donors

Estimation of nephron number in living humans by combining unenhanced computed tomography with biopsy-based stereology

Primary non-function in a deceased donor kidney transplant even with a Kidney Donor Risk Index less than 1.0: a case report

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