title: Role of MDCT angiography in selection and presurgical planning of potential renal donors.
abstract: OBJECTIVE
  The purpose of this study was to determine the prevalence and types of renal and extrarenal abnormalities that preclude renal donation or lead to alteration of the surgical approach on the basis of abdominal CT angiography (CTA) in a large group of potential renal donors.
  
  
  METHODS
  In this retrospective study, 654 potential renal donors undergoing dual-phase CTA were identified from January 2005 to January 2009. The CT reports were systemically reviewed by two radiologists to determine the presence of renal and extrarenal abnormalities. The operative notes of the renal donors were reviewed by one radiologist to determine whether the presence of renal pathology had affected the surgical approach. In the candidates who did not proceed to kidney donation, the reasons that precluded kidney donation were abstracted from the transplant database.
  
  
  RESULTS
  Four hundred seventeen potential donors (269 men and 385 women; mean age, 44.0 years; age range, 17-79 years) proceeded to renal donation and 237 did not. The most common renal abnormalities were cysts (34%) and renal stones (4.4%). Renal artery disease was identified in 3.4% of potential donors, including renal artery stenosis, possible fibromuscular dysplasia, and renal artery aneurysm. Suspicious renal masses were incidentally found in 0.5% of potential donors. The most common extrarenal pathology was an incidental adrenal nodule (2.6%). Other significant extrarenal pathology identified included gallbladder mass (0.2%), Crohn disease (0.2%), ovarian mass (0.2%), and possible sarcoidosis (0.2%). Although renal and extrarenal abnormalities were present in 41% of potential renal donors, abnormalities seen on CT only contributed to exclusion of 27 potential donors (4.1%). The most common reason for exclusion was the presence of renal stones or scarring (1.8%). Significant CT findings also contributed to the selection of the right kidney in 29 donors, most commonly due to presence of ipsilateral vascular disease or complex left vascular anatomy.
  
  
  CONCLUSIONS
  Renal parenchymal and vascular abnormalities are common in asymptomatic potential kidney donors. Although most of these represent incidental CT findings, abnormalities can exclude potential renal donors and alter the surgical approach in a small minority of cases.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, JHOC 3254, Johns Hopkins Hospital, 601 North Caroline St, Baltimore, MD 21287, USA.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Chu
authors.forename: Sheila
authors.initials: S
authors.lastname: Sheth
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007674:Kidney Diseases / Q000000981:diagnostic imaging*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D018579:Patient Selection; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*