Renal angiography problems in live kidney donors

Area of Science:

• Nephrology
• Radiology
• Transplant Surgery

Background:

• Live kidney donation requires thorough pre-operative assessment to ensure donor safety and graft viability.
• Renal angiography is a key diagnostic tool in evaluating potential kidney donors.

Purpose of the Study:

• To compare pre-operative renal angiographic findings with operative outcomes in live kidney donors.
• To assess the diagnostic accuracy of angiography in identifying renal parenchymal and arterial abnormalities, particularly multiple renal arteries.

Main Methods:

• Retrospective review of renal angiographic and operative findings in 88 live kidney donors.
• Analysis of diagnostic accuracy for various renal vascular conditions, including stenosis and multiple arteries.
• Comparison of outcomes based on angiographic findings and surgical management.

Main Results:

• Nine percent of donors had abnormal findings, including renal artery stenosis and multiple renal arteries (35%).
• Pre-operative angiography missed 23% of multiple renal arteries, but review improved accuracy to 94%.
• Missed accessory arteries were small and did not impact transplant survival; one serious misdiagnosis was preventable with abdominal aortography.

Conclusions:

• Pre-operative angiography is crucial for live kidney donors to ensure the remaining kidney is structurally sound.
• Identifying multiple renal arteries significantly impacts surgical management and donor selection.
• Abdominal aortography is recommended over selective arteriography for comprehensive evaluation of live kidney donors.