title: Pre-donation assessment of kidneys by magnetic resonance angiography and venography: accuracy and impact on outcomes.
abstract: Reports on the accuracy of magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) in evaluating living donor renovasculature employ few patients or omit the consequences of inaccurate scans. We retrospectively compared intraoperative findings to MRA/MRV scans in 146 donor-recipient pairs. For detecting accessory arteries and early branching, MRA sensitivity was 57.6%, specificity 96.5%, false positive rate 3.5%, false negative rate 42.4%, positive predictive value 82.6%, negative predictive value 88.6% and overall accuracy 87.7%. By excluding clinically inconsequential accessory arteries, MRA sensitivity rose to 73.1%, specificity to 96.7% and overall accuracy to 92.5%. For MRVs, sensitivity was 56.2%, specificity 99%, false positive rate 1%, false negative rate 43.8%, positive predictive value 90%, negative predictive value 94.8% and accuracy 94.5%. Inaccurate scans were associated with prolonged donor and recipient operations and more frequently reconstructed arteries, but did not affect clinical outcomes. Because most missed accessory arteries are inconsequential, MRA is a useful, less invasive method for defining donor renovascular anatomy.
authors.affiliation: Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA. scott.ames@msnyuhealth.org
authors.forename: Scott A
authors.initials: SA
authors.lastname: Ames
authors.forename: Marina
authors.initials: M
authors.lastname: Krol
authors.forename: Kartik
authors.initials: K
authors.lastname: Nettar
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Goldman
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Quinn
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Herron
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Bromberg
mesh_terms: D000328:Adult; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation / Q000502:physiology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012079:Renal Circulation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014019:Tissue Donors; D016896:Treatment Outcome