Evaluation of the vascular anatomy in potential living kidney donors with gadolinium-enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings.

BACKGROUND: X-ray contrast arteriography has traditionally been used for pre-operative evaluation in living kidney donors. However, magnetic resonance angiography (MRA) offers a non-invasive alternative, which has been considered to be less accurate. This study was performed to determine whether MRA in the pre-operative investigation of living kidney donors provides sufficient information. METHODS: From December 2005 to December 2007, 173 potential live donors were evaluated in this study. Donors performed digital subtraction angiography (DSA) and those with one or more accessory arteries at least on one side recruited for further evaluation with three-dimensional gadolinium-enhanced MRA. RESULTS: A total of 30 donors constituted the study population. When compared with DSA as the reference method, MRA detected 20 of 36 renal accessory arteries which indicates a sensitivity of 55.6%. The difference between MRA and DSA in identifying accessory renal arteries was significant (p-value <0.001). Considering intraoperative findings as the standard of reference, MRA depicted correctly four of six (66.7%) accessory arteries on the transplanted kidneys. CONCLUSIONS: MRA has the advantage of avoiding exposure to ionizing radiation and is non-invasive. These are important considerations in pre-operative evaluation of a generally healthy donor population. However, MRA provides suboptimal accuracy in detecting small accessory arteries.

Multivalvular heart failure improvement after successful kidney transplantation.

Chronic renal disease is responsible for various cardiac complications. After renal transplantation many of these complications improve. However the extent to which cardiac failure is reversible post transplant is not known. We report two cases of end stage renal disease (ESRD) and severe heart failure characterized by left ventricular ejection fraction (LVEF) less than 20%. Three months after kidney transplantation, the LVEF rose to more than 50%. Successful renal transplantation can significantly improve cardiac function compromised as a result of ESRD.