Additional findings with CT when assessing suitability for living kidney donation

M. Marcel, R.C. Minnee, J.I. Roodnat, T. van den Berg, H.G.D. Leuvenink, R.A. Pol

Thursday 15 march 2018

15:20 - 15:25h at Willem Burger Foyer

Categories: Donation, Session (poster)

Parallel session: Poster session 5: Donation

Background

Potential live renal donors are thoroughly screened before they are accepted. Due to new innovations and imaging methods the radiological resolution has significantly improved, resulting in an increased incidence of additional findings. This may lead to unnecessary additional tests, overdiagnosing, negative psychological effect on the donor and higher costs.

Aim

To assess the incidence of additional findings with computed tomography (CT) and chest X-ray when assessing suitability for living renal donation. Secondary outcomes were location, aspects and consequences of these findings.

Methods

From the period 2010 - 2015 a total of 1562 consecutive potential living renal donors were retrospective analyzed in two centers on additional findings, including patients who were rejected for donation. Categorical variables were analyzed by means of χ² test or Fisher’s exact. Two-tailed P were used and significance was set on p<0.05.

Results

Additional findings were found in 50% with a median of 1 additional finding (IQR 1). The most common additional findings in accepted donors were benign cysts (65%) and hemangioma (5%), most frequently located in the kidney and liver(45% and 30% respectively). About 30% of patients who showed additional findings required further medical examination, for further characterization, of which 11% eventually were declined for donation. In accepted patients with renal incidental findings, the contralateral kidney was donated in 24%. In total 17% of patients were declined for donation after complete screening of which 31% were rejected solely based on incidental findings. Rejected patient showed significantly more incidental findings (mean 1.03 vs 1.86, p<0.01), especially due to atherosclerosis and aneurysmal disease.

Conclusions

Additional findings in potential living renal donors are very common and are often located in the kidney and liver. A third of these patient undergo additional tests which may lead to overdiagnosing. Since the impact of incidental findings is rather low on the decline rate, some reservation to perform additional tests preoperatively should be advocated.