Magnetic Resonance Angiography for Preoperative Evaluation of Potential Kidney Donors 1 Amer Rajab, M.D., Ph.D.,* ,2 Hooman Khabiri, M.D.,† Ronald P. Pelletier, M.D.,* Mitchell L. Henry, M.D.,* Baris Akin, M.D.,* Elmahdi Elkhammas, M.D.,* Ginny L. Bumgardner, M.D., Ph.D.,* and Ronald M. Ferguson, M.D., Ph.D.* Division of Transplantation, *Department of General Surgery, and †Department of Radiology, Ohio State University College of Medicine, Columbus, Ohio Submitted for publication September 29, 2003 Background. Careful evaluation of the renovascular anatomy for living kidney donors is essential to opti- mize donor and recipient outcomes. Arteriography has been the standard for delineating the renovascu- lar anatomy. However, this procedure is invasive. Magnetic resonance angiography (MRA) is an attrac- tive, noninvasive alternative. The aim of this study was to evaluate the accuracy of MRA in potential liv- ing kidney donors. Methods. A retrospective comparison of the preoper- ative MRA results with the intraoperative anatomy was performed in 189 living kidney donors. Results. MRA interpretations correctly identified the vascular anatomy of the donor kidneys in 173 do- nors (91.5%). In the remaining 16 patients (8.5%), the MRA interpretation was inaccurate. In 10 patients, the MRA reported fewer arteries than the number encoun- tered during the donor operation, whereas in six pa- tients MRA reported more arteries than what found during operation. In seven patients, MRA supplied ad- ditional important anatomical information, including kidney size disparity, the presence of nephrolithiasis, the presence of a renal cyst, and renal artery stenosis. All kidneys were successfully transplanted. The mis- interpretation of the MRA did not adversely affect the recipient outcome. Conclusion. The noninvasive MRA evaluation of do- nor renovascular anatomy is an acceptable substitute for traditional angiography. © 2004 Elsevier Inc. All rights reserved. Key Words: angiogram; kidney; laparoscopic, live do- nors; MRA; transplantation. INTRODUCTION The modest increase in cadaveric kidney transplants performed annually over the last decade has not kept pace with the tremendous increase in patients with end-stage renal failure being placed on the cadaveric waiting list over the same period of time [1]. As a result, the transplant community has placed a greater emphasis on living donor kidney transplantation as one of several approaches aimed at reducing the num- ber of renal failure patients awaiting transplantation. Increasingly, transplant centers are offering the minimally invasive laparoscopic or hand-assisted lapa- roscopic (HAL) donor nephrectomy as an alternative to the standard open nephrectomy [2, 3]. It is hoped that these newer techniques will increase the number of donor candidates willing to undergo the surgical pro- cedure. Many centers continue to rely on an invasive, potentially complicated angiogram to evaluate donor renovascular anatomy. An alternative method of eval- uation with the same degree of accuracy, yet less inva- sive, may also increase the willingness of potential kidney donors to undergo the donor surgery. Computed tomographic (CT) angiography has been used success- fully by many centers for living donor evaluation [4–6]. CT angiography requires toxic contrast materials and uses radiation. Magnetic resonance angiography (MRA) is not invasive and does not use potentially toxic contrast materials or radiation. However, the accuracy of MRA for kidney donor has not been well established. At the Ohio State University, MRA was used for all living kidney donors. The present study was performed to evaluate the accuracy of MRA for evaluation of po- tential living kidney donor anatomy. 1 Presented at the American Transplant Congress, June 2003. 2 To whom correspondence and reprint requests should be ad- dressed at Room 359 Means Hall, 1654 Upham Drive, Columbus, OH. E-mail: Rajab-1@medctr.osu.edu. Journal of Surgical Research 120, 195–200 (2004) doi:10.1016/j.jss.2003.11.009 195 0022-4804/04 $30.00 © 2004 Elsevier Inc. All rights reserved.