Renal angiography problems in live kidney donors

We compared renal angiographic and operative findings in 88 live kidney donors. Fifty patients had normal arteriograms and uneventful nephrectomies. Abnormal renal parenchymal or main artery lesions were found in eight donors (9%). These included four renal artery stenoses; the kidney distal to the lesion was used for transplanting. Thirty one patients (35%) had multiple renal arteries. Only 24 of these (77%) were diagnosed at pre-operative angiography, though on review angiogram accuracy could be raised to 94%. Except for one patient the accessory renal arteries missed at angiography were tiny twigs; the small renal infarcts caused by ligating them did not impair transplant survival. There was one serious misdiagnosis of multiple renal arteries, preventable on review of the abdominal aortogram. We condiser pre-operative angiography an essential step for the live kidney donor. It is the most accurate way of ensuring that his remaining kidney will be structurally sound. Finding multiple renal arteries has a decisive impact on management. Abdominal aortography rather than routine selective arteriography is the safe and therefore preferable approach to these patients.