Renal angiography problems in live kidney donors

Abstract

Renal angiographic and operative findings were compared in 88 live kidney donors. Fifty patients had normal arteriograms and uneventful nephrectomies. Abnormal renal parenchymal or main artery lesions were found in 8 donors (9%). These included 4 renal artery stenoses the kidney distal to the lesion was used for transplanting. Thirty one patients (35%) had multiple renal arteries. Only 24 of these (77%) were diagnosed at pre-operative angiography, though on review angiogram accuracy could be raised to 94%. Except for 1 patient the accessory renal arteries missed at angiography were tiny twigs; the small renal infarcts caused by ligating them did not impair transplant survival. There was 1 serious misdiagnosis of multiple renal arteries, preventable on review of the abdominal aortogram. Pre-operative angiography was considered an essential step for the live kidney donor. It was the most accurate way on ensuring that his remaining kidney will be structurally sound. Finding multiple renal arteries had a decisive impact on management. Abdominal aortography rather than routine selective arteriography was the safe and therefore preferable approach to these patients.