Preoperative Evaluation of Living Renal Transplant Donors Using Helical CT Angiography: Comparison with Conventional Angiography

Roh, Jin Rae; Park, Chang Myon; Hyun, Ji Hwan; Ryu, Jeong Ah; Kim, Bohyun; Lee, Sang Ik; Choi, Han Yong; Lee, Sung Won

Abstract

PURPOSE
This study evaluated the accuracy of helical CT angiography (HCTA) in a preoperative evaluation of living renal transplant donors (LRTDs) for visualizing the renal vascular anatomy with an emphasis on identifying the number of renal arteries and the presence of small branches and venous anomalies.
MATERIALS AND METHODS
From Jan. 2000 to Feb. 2001, a total of 50 potential LRTDs were evaluated with conventional renal angiography (CRA) and HCTA. All candidates then underwent a donor nephrectomy. The HCTA was done according to a standard HCTA protocol. The intraoperative findings on the number of renal vessels were compared with those of the CRA and HCTA respectively.
RESULTS
There was an overall agreement on the number of renal arteries and veins between the CRA findings and 3-D reconstruction of the HCTA (91%, 95%). The overall accuracies for predicting the number of renal arteries and veins relative to the intraoperetive findings were 84%, 94% for CRA and 80%, 94% for HCTA respectively. The CRA missed 8 accessory renal arteries while HCTA missed 10. In HCTA, cases with an accessory renal artery with a diameter < or =5 Fr. (1.65mm) and two cases of an early branching single vessel simulating dual arteries, were misdiagnosed. Despite the misdiagnosed cases, there was no significant intraoperative morbidity. The HCTA revealed another lesion of a renal parenchyme, the urinary collecting system and other viscera. There were no significant complications in the process of both techniques. The cost of HCTA was 48% less than the CRA plus the excretory urography (EU) for imaging the potential LRTDs.
CONCLUSIONS
A HCTA appears to be as accurate as a CRA for visualizing the renal vascular anatomy in the preoperative assessment of potential LRTDs. A HCTA has the potential to be a good alternative to a CRA plus EU for assessing potential LRTDs.