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Renal measurements on CT angiograms: correlation with graft function at living donor renal transplantation
Motoyo Yano1, Michael F Lin, Kelsey A Hoffman
1Mallinckrodt Institute of Radiology, Washington University/Barnes Jewish Hospital, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110, USA. yanom@mir.wustl.edu
Insights
Donor kidney size, including cortical volume, correlates with transplant recipient kidney function up to 36 months. A smaller kidney-to-recipient weight ratio, especially for cortical volume, indicates diminished function post-transplant.
Area of Science:
- Nephrology
- Radiology
- Transplant Surgery
Background:
- Accurate assessment of donor kidney size is crucial for predicting transplant outcomes.
- Computed tomographic (CT) angiography is a standard imaging modality for evaluating donor kidneys.
Purpose of the Study:
- To identify the optimal donor renal size measurement on CT angiography for predicting renal function in both donors and transplant recipients.
- To correlate preoperative donor renal measurements with postoperative recipient renal function.
Main Methods:
- Retrospective analysis of 111 donor CT angiograms.
- Measurements included renal length, total volume, and cortical volume.
- Correlation with donor preoperative and recipient postoperative estimated glomerular filtration rate (eGFR) up to 36 months.
Main Results:
- Renal volumes and length showed significant correlation with donor eGFR.
- Adjusted renal measures correlated with recipient renal function up to 36 months post-transplant.
- A low cortical volume-to-recipient weight ratio was significantly associated with diminished renal function at 36 months.
Conclusions:
- Donor renal length and volumes are valuable predictors of transplant recipient renal function.
- The ratio of cortical volume to recipient weight is a key indicator of long-term renal function post-transplant.
Purpose:
To determine which measurement of donor renal size on computed tomographic (CT) angiograms has the greatest correlation with renal function preoperatively in the donor and postoperatively in the transplant recipient.
Materials And Methods:
Informed consent was waived for this retrospective HIPAA-compliant study approved by the institutional review board. Renal length, total volume, and cortical volume were measured on renal donor CT angiograms in 111 patients. Preoperative serum creatinine values for donors and postoperative creatinine values for recipients at hospital discharge and 6, 12, 24, and 36 months after transplant were collected, and estimated glomerular filtration rate (eGFR) was calculated. Correlation coefficients with 95% confidence intervals (CIs) were obtained for renal measures and donor eGFR and for renal measures adjusted to recipient body habitus and posttransplant creatinine level in the recipient. Thresholds were set for adjusted length and volumes, and the odds ratio (OR) for creatinine level less than 1.5 mg/dL at 36 months was calculated.
Results:
Renal volumes and length were correlated with donor eGFR (r=0.58 [95% CI: 0.44, 0.69] for cortical volume, 0.56 [95% CI: 0.42, 0.68] for total volume, and 0.43 [95% CI: 0.27, 0.57] for renal length). All three measures, adjusted to recipient body habitus, were correlated with recipient renal function from discharge (r=-0.41 to -0.43) up to 36 months after transplantation (r=-0.33 to -0.41). By using a threshold of 1.5 for cortical volume to recipient weight, 2.25 for total volume to recipient weight, and 0.175 for renal length to recipient weight, the odds of creatinine level greater than 1.5 mg/dL were four times as great for smaller kidney-to-recipient weight ratios, a statistically significant pattern for cortical volume (OR, 4.07; 95% CI: 1.10, 15.09) but not total volume (OR, 4.24; 95% CI: 0.90, 20.01) or renal length (OR, 4.08; 95% CI: 0.48-34.29).
Conclusion:
Renal length and volumes correlated with recipient renal function up to 36 months after transplant. A low ratio of cortical volume to recipient weight was associated with diminished renal function at 36 months after transplant.
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