Sarsengaliyev Timur, Chuvakova Elmira, Tsoy Boris, Zhangalova Aisulu, Gaipov Abduzhappar
From the Department of Radiology, JSC National Research Medical Center, Astana, Kazakhstan.
Exp Clin Transplant. 2015 Nov;13 Suppl 3:88-90. doi: 10.6002/ect.tdtd2015.P48.
Computed tomography is required for selection of living donors for kidney transplant. We assessed the diagnostic relevance and effectiveness of multiphase contrast-enhanced computed tomography angiography for evaluating patients before and after transplant.
Thirty-two potentially living kidney donors (15 men and 17 women) underwent multiphase computed tomography angiography for evaluation before kidney transplant and 2 posttransplant recipients under went this test owing to abnormal vascularization. Computed tomography angio graphy was used to determine parenchymal blood-flow conditions and vascular architecture of the kidney grafts. All of the 34 patients underwent prestudy Doppler ultrasonography.
Additional renal arteries were found in 11 patients (32.3%). From them, a single additional renal artery, situated from the aorta to the lower segment of the kidney, was observed in 8 (72.7%) patients; dual additional renal arteries with equivalent caliber trunks were observed in 3 (27.3%) patients. An additional renal artery occurred more often in women in 6 (54.5%) donors. Concomitant renal pathology was detected in 3 (9.3%) of 32 donors: simple cysts in 2 donors and hydro nephrosis transformation in 1 donor. These 3 cases represented an accidental discovery and were therefore excluded from the list of donors. In addition, all donors underwent excretory-phase computed tomography, and their renal function and urinary collecting system results were evaluated. Two recipients with graft dysfunction presented with decreased venous return and delayed arterial filling of the renal arteries that manifested as delayed contrast in the kidney graft medulla. Renal parenchymal ischemic zones were consistent with microvasculature thrombosis, the most common cause of vascular complications in these recipients.
Multiphase computed tomography angiography is a necessary tool for assessing the structure and condition of vascular architecture in kidney donors and recipients. Individuals with ambiguous Doppler results, this test should be required; it is also warranted when renal graft vascular complications are suspected.
计算机断层扫描是肾移植活体供体选择所必需的。我们评估了多期对比增强计算机断层扫描血管造影在评估移植前后患者方面的诊断相关性和有效性。
32名潜在的活体肾供体（15名男性和17名女性）在肾移植前接受了多期计算机断层扫描血管造影评估，2名移植后受者因血管化异常接受了此项检查。计算机断层扫描血管造影用于确定肾移植实质血流情况和血管结构。所有34名患者均在研究前接受了多普勒超声检查。
11名患者（32.3%）发现有额外肾动脉。其中，8名（72.7%）患者观察到一条从主动脉至肾下段的单一额外肾动脉；3名（27.3%）患者观察到两条管径相当的额外肾动脉。额外肾动脉在6名（54.5%）女性供体中更为常见。32名供体中有3名（9.3%）检测出合并肾脏病变：2名供体为单纯囊肿，1名供体为肾盂积水转变。这3例为意外发现，因此被排除在供体名单之外。此外，所有供体均接受了排泄期计算机断层扫描，并对其肾功能和泌尿系统结果进行了评估。2名移植功能障碍受者表现为肾静脉回流减少和肾动脉动脉充盈延迟，表现为肾移植髓质造影剂延迟。肾实质缺血区与微血管血栓形成一致，这是这些受者血管并发症的最常见原因。
多期计算机断层扫描血管造影是评估肾供体和受者血管结构及其状况的必要工具。对于多普勒结果不明确的个体，应进行此项检查；怀疑肾移植血管并发症时也有必要进行此项检查。
