Computerized tomographic angiography for renal donor evaluation leads to a higher exclusion rate.
OBJECTIVE
We compared the exclusion rate for potential living renal donors evaluated with computerized tomography angiography and radionuclide renal scintigraphy (renal scan) vs excretory urogram, renal scan and renal arteriography.


METHODS
From March 2004 through February 2006, 603 consecutive patients were evaluated as potential living renal donors. From March 2004 through February 2005, 270 consecutive patients underwent evaluation with excretory urogram, renal scan and renal angiography (group 1). Of these patients 16 underwent computerized tomography to evaluate abnormalities detected on excretory urogram. From March 2005 through February 2006, 333 consecutive patients underwent evaluation with computerized tomography angiography and renal scan (group 2). The number of patients excluded for medical reasons and/or radiographic abnormalities was determined for the 2 groups.


RESULTS
More than twice as many patients evaluated with computerized tomography were excluded. In group 1, 7% of patients (20 of 270) were excluded from donation due to radiographic findings vs 16% (53 of 333) in group 2 (p=0.0016). Of the patients 26% and 23% were excluded from renal donation for medical reasons in groups 1 and 2, respectively (p=0.5059).


CONCLUSIONS
Multidetector row computerized tomography angiography increases the detection of incidental radiographic abnormalities as well as the renal donor exclusion rate. The increased sensitivity of computerized tomography angiography has created a dilemma for those determining patient eligibility for kidney donation because the clinical significance of many of these findings is unclear. Additional studies should address the significance of these incidental findings so that patients are not needlessly excluded from kidney donation.
Strang
Andrew M
AM
Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama 35294-3296, USA.
Lockhart
Mark E
ME
Kenney
Philip J
PJ
Amling
Christopher L
CL
Urban
Donald A
DA
El-Galley
Rizk
R
Burns
John R
JR
Colli
Jan L
JL
Hammontree
Lee N
LN
Kolettis
Peter N
PN
D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000000981:diagnostic imaging*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014567:Urography