title: Multidetector CT angiography in live donor renal transplantation: experience from 156 consecutive cases at a single centre.
abstract: The performance of multidetector computed tomography (CT) angiography was assessed in the pre-operative evaluation of live renal donors. Between July 1998 and March 2006, 156 consecutive patients underwent open donor nephrectomy following pre-operative multidetector CT angiography (MDCTA). Operative notes were compared with radiological reports and discrepancies identified. MDCTA missed five of 28 accessory arteries (four visible with hindsight), accuracy of 96%. Of 30 early-branching renal arteries, eight were missed (all visible with hindsight), accuracy 95%. MDCTA missed only one of 13 venous anomalies (accuracy 97%) and also missed the only duplicated collecting system: both were undetectable with hindsight. Following modifications to image acquisition and interpretation sensitivity, negative-predictive value and accuracy were significantly increased. The results were compared with pooled data from published studies of live donor imaging. This study and previous studies of MDCTA had improved sensitivity for arterial and venous anomalies over single detector CT angiography and MR angiography. We conclude that multidetector CT angiography is an accurate modality in the pre-operative evaluation of live renal donors. Regular communication between the transplant surgeon and the radiologist is paramount to improve reporting of surgically relevant anatomy. Mechanisms should exist for auditing and improving pre-operative imaging in any live donor programme.
authors.affiliation: Department of Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. matt.laugharne@bristol.ac.uk
authors.forename: Matthew
authors.initials: M
authors.lastname: Laugharne
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Haslam
authors.forename: Lesley
authors.initials: L
authors.lastname: Archer
authors.forename: Lyn
authors.initials: L
authors.lastname: Jones
authors.forename: David
authors.initials: D
authors.lastname: Mitchell
authors.forename: Eric
authors.initials: E
authors.lastname: Loveday
authors.forename: Paul
authors.initials: P
authors.lastname: Lear
authors.forename: Mark
authors.initials: M
authors.lastname: Thornton
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging*; D012082:Renal Veins / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods