DIGITAL SUBTRACTION ANGIOGRAPHY IN POTENTIAL LIVE-KIDNEY DONORS - A STUDY OF 1000 CASES

Intravenous digital subtraction angiography (IV-DSA) combined with exc retory urography (IVU) were utilized to study the renal anatomy of 100 0 potential live-kidney donors. In the entire series, 712 donors (71.2 %) had bilateral single renal arteries, whereas 255 (25.5%) had unilat eral multiple, 26 (2.6%) had bilateral multiple, and 7 (0.7%) had unil ateral hypoplastic or absent renal arteries determined by IV-DSA. Majo r renal abnormalities that might be potentially significant for safe r enal donation were detected in 76 donors (7.6%) by combined IV-DSA and IVU studies. In 10% of the potential donors, intraarterial digital su btraction angiography (IA-DSA) was required because of the equivocal r esults of IV-DSA. Of the 1000 potential donors, 700 underwent nephrect omy and the number of renal arteries at nephrectomy was compared with both IV-DSA and IA-DSA reports. Analysis of data revealed a sensitivit y of 96% vs 95%, a specificity of 57% vs 75% and an overall accuracy 9 3% vs 90% for IV-DSA and IA-DSA, respectively. both IV-DSA and IA-DSA were accurate enough in identification of single renal arteries. Howev er, the accuracy of IA-DSA was better than that of IV-DSA in visualiza tion of double (84% vs 64%) and triple (66% vs 33%) renal arteries. It is concluded that IV-DSA combined with IVU is an effective technique for the evaluation of potential kidney donors. In cases where IV-DSA i s equivocal, we recommend confirming IA-DSA.