Financial Impact of Incidental Radiologic Findings During Living Kidney Donor Evaluation

Living kidney donor (LKD) transplantation is an important alternative for the end-stage renal disease population and is preferred due to superior outcomes when compared with dialysis or deceased donor transplantation. LKD evaluation includes a computed tomography angiogram (CTA) for assessment of renal and renovascular anatomy. Incidental nonrenal findings are frequently noted during the CTAs, and these may have variable clinical significance. These incidental findings lead to further testing, procedures, and referrals, which incur additional cost. We conducted a retrospective analysis of the incidental findings noted during CTA of 632 LKDs evaluated at our institution from 2008 to 2013. All extrarenal findings were categorized as pulmonary, hepatic, pancreatic-biliary, adrenal, bowel, gynecologic, and miscellaneous. Further testing, diagnostic procedures, referrals, and management were determined based on chart review. Our results showed that there were 525 extrarenal incidental findings in 632 potential living donors. Appropriate clinical follow-up was required in 20% at an additional cost of US dollars (USD) 63,035. Additional cost per incidental finding requiring follow-up was USD 407 ± 818. The median cost for follow-up was USD 168 (168-317). The detection of findings during imaging leads to apprehension for the donor and contribute to additional costs. Appropriate counseling is warranted prior to evaluation of the LKD.