Who should have pelvic vessel imaging prior to renal transplantation?

Current guidelines are vague in their recommendations as to which patients should be imaged prior to renal transplantation and the optimal imaging modality for this purpose. Data on 112 patients who underwent pre-transplant vascular imaging (magnetic resonance angiography or contrast angiography), from a total of 167 evaluated between January 2005 and October 2006, were scrutinized to see whether abnormal results altered clinical management. Several variables were analyzed to determine possible predictors of an abnormal scan result. Sixty-nine patients (61.6%) were either diabetic or aged over 60. Fifty-nine (52.7%) were normal scans, and 53 (47.3%) were abnormal. In the abnormal group, 21 (18.8%) clinical decisions were made. Multivariate analysis revealed that age (OR: 1.1, 1.03-1.13) and diabetes (OR: 3.2, 1.13-9.2) were significant predictors of an abnormal scan. Imaging delayed transplant listing by 83 days. Imaging for all potential transplant recipients is not required and results in unnecessary delay. Risk factors including age and diabetes can be utilized to rationalize imaging via clinical guidelines to target to high-risk groups. The choice of imaging modality in patients with renal insufficiency is not clear cut, but risks and benefits should be addressed on an individual basis and preventative strategies used whenever possible.