Radiographic Evaluation

Radiologic imaging is a crucial component of the preoperative assessment of potential live renal donors. Precise preoperative mapping of the number and location of the main renal vessels, and the presence of accessory vessels is crucial for obtaining safe hilar dissection and minimizing vascular complications.

Assessment of the kidneys and renal vasculature will identify some unsuitable donors and dictate which renal unit should be chosen for transplantation in others.

The traditional role of excretory urography, intravenous pyelography, and renal arteriography in the evaluation of potential kidney donors has been challenged by helical computed tomography with three-dimensional arteriography. Helical computed tomography arteriography can be employed as a single imaging modality to evaluate the entire region of the kidney and obtain relatively noninvasive arteriogram-like images of the renal vasculature. In addition, these images can be reformatted to provide the surgeon with a three-dimensional display of the data and allow improved vascular imaging.

Computed tomography angiography is highly accurate and specific for the delineation of renal vascular anatomy in these patients, including detection of multiple renal vessels (Fig. 1) (17).

The presence of multiple vessels is not a contraindication to laparoscopic live donor nephrectomies, but preoperative identification will optimize patient safety and

FIGURE 1 ■ Helical computed tomography with three-dimensional arteriographic images demonstrating (A) left renal artery outlined cephalad to the left renal vein and (B) accessory renal artery (arrow) off the aorta and supplying the left upper renal pole.

FIGURE 1 ■ Helical computed tomography with three-dimensional arteriographic images demonstrating (A) left renal artery outlined cephalad to the left renal vein and (B) accessory renal artery (arrow) off the aorta and supplying the left upper renal pole.

possibly recipient outcome. The entire surgical transplant team should review the films together, because a clear picture of renal vascular anatomy is mandatory in helping to plan both the donor and recipient procedures.

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