Intravenous pyelography is unnecessary for the preoperative evaluation of living renal donors

Background Many transplant centers utilize intravenous pyelography (IVP) in their preoperative evaluation of potential living renal donors. IVP howeve r is associated with adverse reactions to the contrast material, as well as exposure to radiation. At our institution, prospective donors are evaluate d with ultrasonography (US) and digital subtraction angiography (DSA) or ma gnetic resonance angiography (MRA), but NP is not employed. Methods. We reviewed the charts of our most recent 100 living donor and rec ipient pairs to determine whether complications related to donor renal stru ctural or collecting system abnormalities encountered during nephrectomy or transplantation could have been foreseen and/or prevented by preoperative IVP Results. Of the 100 living donors, 84% were related to their recipient, 41% were male, 64% underwent left nephrectomy, and 10% had minor structural ab normalities (predominantly simple cysts) diagnosed on preoperative US. No r enal or collecting system abnormalities were identified at the rime of dono r nephrectomy. Furthermore, no recipient complications at any time after tr ansplant were found to be due to donor structural abnormalities. Performing US during preoperative evaluation and omitting NP therefore, produced a 0. 0-0.3% risk (95% confidence interval) of a significant donor structural abn ormality being identified;PA nt the time of transplant or in the post-trans planted period. Conclusions The risk of missing a significant donor-related structural abno rmality using US and DSA or MRA during the preoperative evaluation is very low. NP is unnecessary for the preoperative evaluation of prospective livin g renal donors when routine US is used.