Kidney transplantation is the best treatment option for patients with end-stage renal disease (ESRD). Because of the limited availability of deceased donor organs, only a minor percentage of the patients with ESRD receive the kidney transplants they need.
Living donor transplants help meet this need. Screening helps determine medical suitability for donation, of course, and many transplant centers use computed tomography (CT) as part of their donor assessment.
In a new study, researchers aim to measure the number incidentally detected lesions and other health problems found on screening CTs.
Incidental Detection of Lesions and Other Health Problems in Kidney Donor Candidates
This new research performed by Dr. Damien C. O'Neill and collaborators at Beaumont Hospital in Dublin, Ireland, shows that routine assessment using multidetector computed tomography (MDCT) detects a number of different incidentally detected lesions in many potential living kidney donors.
The researchers wanted to determine the prevalence of incidental findings on preoperative CT in a healthy cohort of these potential donors. The team looked at 375 potential living kidney donors who underwent CT scanning during the living-donor assessment process over a 5-year period, from January 2012 to 2017.
Participants ranged in age from 21 to 71.5 years, with a mean age of 44.33 years. The scientists reported their findings in Experimental and Clinical Transplantation.
Of the 375 participants, 51 percent proceeded to donation. Routine screening with CT revealed 228 incidental findings among 158 individuals. Of the 228 with incidental findings, 97 were in the cohort that proceeded to donation and 131 were in the cohort that did not.
“Our main finding is that a variety of incidentally detected lesions of moderate to high importance were detected in the liver, kidney, pancreas, lung, reproductive organs, and gastrointestinal systems in this healthy subject cohort,” say the authors of the study.
The most common findings were Bosniak 1 renal cysts, with 46 cysts found. Liver cysts were second most common, with 42 cysts measuring less than 1.5 cm found, followed by urinary calculi at 21 incidental findings. Gallstones were detected in seven participants, MDCT revealed one pathologically proven malignancy.
“Potential donors undergoing assessment with MDCT for living donor nephrectomy should be counseled on the medical implications of incidentally detected lesions during the assessment process,” the authors concluded.
An Important Piece of the Kidney Transplantation Puzzle
The findings from the study, entitled “Prevalence of Incidental Findings on Multidetector Computed Tomography in Potential Nephrectomy Donors: A Prospective Observational Study,” add to the body of information about the effects incidentalomas discovery may have on kidney transplant donors and recipients.
In an earlier 2018 study published in Clinical Transplantation, Dr. Arika L. Hoffman and colleagues at the University of Nebraska Medical Center in Omaha looked at the number of potential donors disqualified because of a newly diagnosed serious condition found during evaluation. In that retrospective study of 762 potential living kidney donor candidates, spanning over ten years, 65 (8.5 percent) were disqualified for an incidental finding.
The disqualified group included six patients diagnosed with malignancies, five of whom required surgery. Six more had transmittable diseases requiring follow-up and treatment, four had bilateral renal stones with significant stone burden, and two were diagnosed with IgA nephropathy. Four were diagnosed with significant heart disease.
Living donor transplants help ease the burden posed by limited availability of deceased donor organs; thorough and accurate evaluation of prospective renal donors is essential for minimizing perioperative outcomes. Screening with CT can reduce the risk for complications — and it can even help improve the health of prospective donors through incidental discovery of serious health issues.
