Interactive 3-dimensional computerized tomography reconstruction in evaluation of the living renal donor

We evaluated the efficacy of helical computerized tomography and a software program capable of 3-dimensional (D) reconstruction in assessment of the living renal donor.

A total of 20 consecutive patients (40 renal units) were evaluated using computer software and anatomical findings were assessed. Patient time and charges were compared with renal angiography and excretory urography (IVP).

A total of 25 anomalies were identified in 21 kidneys using 3-D imaging. Accessory arteries were seen in 13 kidneys. Abnormal venous anatomy was found in 7 kidneys, including circumaortic renal veins in 2, multiple veins in 4 and a renal vein that drained into the gonadal vein in 1. Collecting system anomalies included a bifid pelvis and a duplicate ureter in 1 case each. Benign cysts were noted in 3 kidneys. Three patients were excluded from study due to persistent hypertension, death of the recipient before transplantation and bilateral aberrant vasculature, respectively. Intraoperative findings of the 17 kidneys removed for transplantation correlated with those demonstrated on 3-D reconstruction. Total preoperative imaging charges were decreased 50% compared to renal angiography and IVP, and the procedure related discomfort and potential morbidity were reduced significantly. Procedure time was reduced from 7 hours to 30 minutes with no resultant mandatory time off work or periprocedure restrictions in patient diet and/or activity.

The enhanced 3-D computerized tomography reformation and reconstruction process appears to be as accurate as renal angiography for arterial anatomy, and more sensitive than renal angiography and IVP in evaluating venous and parenchymal anatomy. This software program provides superior and interactive imaging at substantially lower cost with minimal patient time, discomfort and morbidity.