title: Computed Tomography Volumetry in Preoperative Living Kidney Donor Assessment for Prediction of Split Renal Function.
abstract: Transplant centers commonly evaluate split renal function (SRF) with Tc-99m-mercapto-acetyltriglycin (MAG3) scintigraphy in living kidney donation. Alternatively, the kidney volume can be measured based on predonation CT scans. The aim of this study was to identify the most accurate CT volumetry technique for SRF and the prediction of postdonation kidney function (PDKF).
  
  
  
  Three CT volumetry techniques (modified ellipsoid volume [MELV], smart region of interest [ROI] volume, renal cortex volume [RCV]) were performed in 101 living kidney donors. Preoperation CT volumetric SRF was determined and compared with MAG3-SRF, postoperation donor kidney function, and graft function.
  
  
  
  The correlation between donors predonation total kidney volume and predonation kidney function was the highest for RCV (0.58 with creatine clearance, 0.54 with estimated glomerular filtration rate-Cockcroft-Gault). The predonation volume of the preserved kidney was (ROI, MELV, RCV) 148.0 ± 29.1 cm, 151.2 ± 35.4 and 93.9 ± 25.2 (P < 0.005 MELV vs RCV and ROI vs RCV). Bland-Altman analysis showed agreement between CT volumetry SRF and MAG3-SRF (bias, 95% limits of agreement: ROI vs MAG3 0.4%, -7.7% to 8.6%; MELV vs MAG3 0.4%, -8.9% to 9.7%; RCV vs MAG3 0.8%, -9.1% to 10.7%). The correlation between predonation CT volumetric SRF of the preserved kidney and PDKF at day 3 was r = 0.85 to 0.88, between MAG3-SRF and PDKF (r = 0.84). The difference of predonation SRF between preserved and donated kidney was the lowest for ROI and RCV (median, 3% and 4%; 95th percentile, 9% and 13%).
  
  
  
  Overall renal cortex volumetry seems to be the most accurate technique for the evaluation of predonation SRF and allows a reliable prediction of donor's PDKF.
authors.affiliation: 1 Division of Transplantation Surgery, Department of General, Visceral and Cancer Surgery, Transplant Center Cologne, University of Cologne, Cologne, Germany. 2 Department of Radiology, University of Cologne, Cologne, Germany. 3 Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany. 4 Renal Division, Department of Medicine, Transplant Center Cologne, University of Cologne, Cologne, Germany. 5 Department of Nuclear Medicine, University of Cologne, Cologne, Germany.
authors.forename: Roger
authors.initials: R
authors.lastname: Wahba
authors.forename: Mareike
authors.initials: M
authors.lastname: Franke
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Robert
authors.initials: R
authors.lastname: Kleinert
authors.forename: Tülay
authors.initials: T
authors.lastname: Cingöz
authors.forename: Matthias C
authors.initials: MC
authors.lastname: Schmidt
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Stippel
authors.forename: Christopher
authors.initials: C
authors.lastname: Bangard
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D057286:Electronic Health Records; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000502:physiology / Q000503:physiopathology*; D007672:Kidney Cortex / Q000000981:diagnostic imaging; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009929:Organ Size; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D014057:Tomography, X-Ray Computed
chemical_list: D003404:Creatinine