Computerized tomographic angiography for renal donor evaluation leads to a higher exclusion rate

Area of Science:

• Nephrology
• Radiology
• Transplant Surgery

Background:

• Living kidney donation is crucial for addressing organ shortages.
• Accurate donor evaluation is essential to ensure donor safety and graft success.
• Traditional imaging modalities may miss subtle abnormalities.

Purpose of the Study:

• To compare the exclusion rates of potential living renal donors using two different imaging protocols.
• To assess the impact of multidetector row computerized tomography angiography (MDCT) versus excretory urogram, renal scan, and renal arteriography on donor exclusion.

Main Methods:

• A retrospective study comparing two groups of potential living renal donors (n=603) evaluated between March 2004 and February 2006.
• Group 1 (n=270): Excretory urogram, renal scan, and renal arteriography (with CT for 16 patients).
• Group 2 (n=333): Computerized tomography angiography and renal scan.

Main Results:

• The exclusion rate due to radiographic findings was significantly higher in the MDCT group (16%) compared to the traditional group (7%) (p=0.0016).
• Exclusion rates for medical reasons were similar between the two groups (26% vs 23%, p=0.5059).
• MDCT identified more incidental radiographic abnormalities, leading to increased donor exclusion.

Conclusions:

• MDCT angiography increases the detection of incidental radiographic abnormalities and raises the renal donor exclusion rate.
• The high sensitivity of MDCT poses a challenge in determining donor eligibility due to the unclear clinical significance of many detected abnormalities.
• Further studies are required to understand the clinical impact of these incidental findings and prevent unnecessary donor exclusions.