title: Multiphase whole-body CT angiography before multiorgan retrieval in clinically brain dead patients: Role and influence on clinical practice.
abstract: OBJECTIVE
  To evaluate the contribution of multiphase whole-body CT angiography (CTA) for identifying the contra-indications to multiorgan retrieval (MOR) and improving the preoperative organ harvesting strategy.
  
  
  METHODS
  One hundred and eleven consecutive patients who were clinically brain dead underwent multiphase whole-body CTA to confirm the diagnosis of brain death and for assessment of MOR. The CTA protocol included volumetric acquisitions of the brain and abdominopelvic cavity without IV administration of iodinated contrast material, then images of the thorax-abdomen-pelvis 25s after IV contrast administration, of the brain at 60s and finally an abdominopelvic CT acquisition at 90s. The diagnosis of brain death was based on well-established criteria. The assessment of thorax, abdomen and pelvis was based on a systematic checklist. Post-processing imaging techniques were used in all patients.
  
  
  RESULTS
  No organs were retrieved from 21 patients due to patient refusal (19%). Twenty-two potential MOR were denied because of general contra-indications including 12/22 (54%) based on CTA criteria alone. Finally, 68 patients were eligible for MOR and 160 organs were harvested. The exclusion of specific organs was based on CTA alone for 2/16 livers, 4/70 kidneys and 5/55 lungs. Fifty hearts and 58 pancreases were not harvested, none based on CTA results alone. Hepatic abnormalities and vascular anatomical variants were identified in 10% of patients. At least one renal artery variant was found in 28% of patients, 13% presented with a double renal vein and 8% with a hepato-mesenteric artery.
  
  
  CONCLUSIONS
  Multiphase whole-body CTA for MOR is based on the simultaneous association of cerebral CTA to determine brain death with CTA of the thorax, abdomen and pelvis. This rapid, standardized and easily accessible procedure has no harmful effects on harvested kidneys. It makes it possible to select the donors and the organs to be harvested and allows the retrieving surgeon to identify and anticipate technical difficulties.
authors.affiliation: Service de radiologie viscérale, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
authors.forename: A
authors.initials: A
authors.lastname: Tache
authors.affiliation: Service de radiologie viscérale, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
authors.forename: N
authors.initials: N
authors.lastname: Badet
authors.affiliation: Service de radiologie viscérale, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
authors.forename: A
authors.initials: A
authors.lastname: Azizi
authors.affiliation: Service de radiologie viscérale, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
authors.forename: J
authors.initials: J
authors.lastname: Behr
authors.affiliation: Service de coordination hospitalière des prélèvements et des tissus, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
authors.forename: S
authors.initials: S
authors.lastname: Verdy
authors.affiliation: Service de radiologie viscérale, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France. Electronic address: edelabrousse@chu-besancon.fr.
authors.forename: E
authors.initials: E
authors.lastname: Delabrousse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000000981:diagnostic imaging*; D002648:Child; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D051598:Whole Body Imaging; D055815:Young Adult
keywords: Brain death; Multiorgan harvesting; Multiphase whole-body CT angiography