title: CT volumetry is superior to nuclear renography for prediction of residual kidney function in living donors.
abstract: Living kidney donor evaluation commonly includes nuclear renography to assess split kidney function and computed tomography (CT) scan to evaluate anatomy. To streamline donor workup and minimize exposure to radioisotopes, we sought to assess the feasibility of using proportional kidney volume from CT volumetry in lieu of nuclear renography. We examined the correlation between techniques and assessed their ability to predict residual postoperative kidney function following live donor nephrectomy. In a cohort of 224 live kidney donors, we compared proportional kidney volume derived by CT volumetry with split kidney function derived from nuclear renography and found only modest correlation (left kidney R(2) =26.2%, right kidney R(2) =26.7%). In a subset of 88 live kidney donors with serum creatinine measured 6 months postoperatively, we compared observed estimated glomerular filtration rate (eGFR) at 6 months with predicted eGFR from preoperative imaging. Compared to nuclear renography, CT volumetry more closely approximated actual observed postoperative eGFR for Chronic Kidney Disease Epidemiology Collaboration (J-test: P=.02, Cox-Pesaran test: P=.01) and Mayo formulas (J-test: P=.004, Cox-Pesaran test: P<.001). These observations support the use of CT volumetry for estimation of split kidney function in healthy individuals with normal kidney function and morphology.
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada. andrew.barbas@gmail.com.|Division of General Surgery, University Health Network, Toronto, Canada. andrew.barbas@gmail.com.|Department of Surgery, University of Toronto, Toronto, Canada. andrew.barbas@gmail.com.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Barbas
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.
authors.forename: Murtuza
authors.initials: M
authors.lastname: Zair
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Van
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.
authors.forename: Olusegun
authors.initials: O
authors.lastname: Famure
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.|Division of General Surgery, University Health Network, Toronto, Canada.|Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Dib
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.|Division of General Surgery, University Health Network, Toronto, Canada.|Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Laurence
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.|Division of Nephrology, University Health Network, Toronto, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.|Division of General Surgery, University Health Network, Toronto, Canada.|Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Anand
authors.initials: A
authors.lastname: Ghanekar
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009929:Organ Size; D011237:Predictive Value of Tests; D011866:Radioisotope Renography / Q000379:methods*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT volumetry; donor nephrectomy; kidney transplant; living donor; preoperative evaluation