Preoperative CT-Angiography Predicts Ex Vivo Vein Length for Right Kidneys After Laparoscopic Donor Nephrectomy

Introduction: Renal transplantation remains the gold standard treatment for end-stage renal disease, with living donor kidneys providing the best outcomes in terms of allograft survival. As the number of patients on the waitlist continues to grow, solutions to expand the donor pool are ongoing. A paradigm shift in the eligibility of donors with renal anomalies has been looked at as a potential source to expand the living donor pool. We sought to determine how many patients presented with anatomic renal anomalies at our transplant centre and describe the ex-vivo surgical techniques used to render these kidneys suitable for transplantation.Methods: A retrospective review was performed of all patients referred for surgical suitability to undergo laparoscopic donor nephrectomy between January 2011 and January 2015. Patient charts were analyzed for demographic information, perioperative variables, urological histories, and postoperative outcomes.Results: 96 referrals were identified, of which 81 patients underwent laparoscopic donor nephrectomy. Of these patients, 11 (13.6%) were identified as having a renal anomaly that could potentially exclude them from the donation process. These anomalies included five patients with unilateral nephrolithiasis, four patients with large renal cysts (>4 cm diameter), one patient with an angiomyolipoma (AML) and one patient with a calyceal diverticulum filled with stones. A description of the ex-vivo surgical techniques used to correct these renal anomalies is provided.Conclusions: We have shown here that ex-vivo surgical techniques can safely and effectively help correct some of these renal anomalies to render these kidneys transplantable, helping to expand the living donor pool.

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Diagnostic accuracy of CT angiography in evaluation of vascular anatomy in comparison with intraoperative findings an assessment of 392 patients

F1000Research ◽

10.12688/f1000research.7021.1 ◽

2015 ◽

Vol 4 ◽

pp. 998

Author(s):

Mohankumar Vijayakumar ◽

Sanika Ganpule ◽

Arvind P. Ganpule ◽

Vinodh Murali ◽

Shashikant Mishra ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Ct Scan ◽

Ct Angiography ◽

Renal Vein ◽

Vascular Anatomy ◽

Donor Nephrectomy ◽

Successful Outcome ◽

Laparoscopic Donor Nephrectomy ◽

Early Recovery ◽

Operative Findings

Introduction: Transplantation of kidneys from living related donors is the treatment of choice for patients with end stage renal disease. With lessmorbidity and early recovery, laparoscopy has become the standard of care for donor nephrectomies. The precise knowledge of vascular anatomy is crucial to a successful outcome. Computed tomography (CT) findings are misleading and less informative in a small number of cases. The reported accuracy of CT angiography in assessing the vascular anatomy is around 85 to 100 %. We did a prospective study to assess the diagnostic accuracy of CT angiography in the evaluation of vascular anatomy in comparison with intra operative findings.Aim: To assess the accuracy of CT in predicting the anatomy in patients who underwent laparoscopic donor nephrectomy.Materials and methods: 392 patients who underwent laparoscopic donor nephrectomy in our institute between January 2010 and December 2012 were included in our study.Results: CT scan correlated well with the intra operative findings in most of our patients with good sensitivity and specificity. CT interpreted a case of double renal vein as single and a case of circumaortic vein reported on CT was not detected intra operatively. A case of right side early branching was not detected on CT. A case of a retroaortic branch of renal vein was missed on CT scan. The incidental findings detected on CT scan such as calculi, mass and hemangioma or fibroid can be of help in managing the patient after surgery.

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