Gadolinium-enhanced Three-dimensional Magnetic Resonance Angiography in the Evaluation of Potential Renal Donors for Laparoscopic Donor Nephrectomy: Is it Alternative or Supplementary Tools to Intraarterial Digital Subtraction Angiography?

Park, Ja Yong; Kim, Jun Chul; Lee, Hyun Chul; Choi, Ji Young; Hyun, Seung Hye; Park, Sung Won; Bae, Ho Sang; Kim, Chan Duck; Park, Sun Hee; Kim, Yong Lim

Abstract

BACKGOUND: The assessment of renal vasculature should be performed by an appropriate imaging technique before kidney transplantation. The current standard technique is intra-arterial digital subtraction angiography. Digital subtraction renal angiography (DSA) is associated with multiple problems. Three dimensional (3D) gadolinium enhanced magnetic resonance angiography (Gd-enhanced MRA) has been suggested as a potential technique due to its noninvasive nature. The aim of this study was to evaluate the accuracy of Gd-enhanced MRA of potential live donors before renal transplantation.
METHODS
From September 2002 to September 2004, forty potential live kidney donors were evaluated using Gd-enhanced MRA and intraarterial DSA. Concordance rate and kappa were calculated in 38 transplantations except 2 patients who could not be operated after preoperative evaluation. Gd-enhanced MRA findings were compared with conventional DSA and surgical findings as the reference method respectively.
RESULTS
In five donors, the findings at surgery were discrepant with Gd-enhanced MRA findings (concordance rate=86.8%) and conventional DSA findings (concordance rate=86.8%). Two accessory arteries initially were missed by Gd-enhanced MRA. They were depicted retrospectively by discussion with a radiologist, which was radiologic reporting error. There were no adverse events during the Gd-enhanced MRA procedure. None of the findings missed by Gd-enhanced MRA resulted in deleterious consequences at laparoscopic nephrectomy for the donor and graft.
CONCLUSION
We demonstrated that Gd-enhanced MRA is an accurate, minimally invasive technique for assessing the live donors before renal transplantation. Clinical feedback and optimization of imaging techniques should be continued to improve accuracy rate in preoperative assessment of potential live donors who are candidates for laparoscopic nephrectomy.