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 however is associated with adverse reactions to the contrast material, as well as exposure to radiation. At our institution, prospective donors are evaluated with ultrasonography (US) and digital subtraction angiography (DSA) or magnetic resonance angiography (MRA), but NP is not employed. Methods. We reviewed the charts of our most recent 100 living donor and recipient pairs to determine whether complications related to donor renal structural 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 abnormalities (predominantly simple cysts) diagnosed on preoperative US. No renal or collecting system abnormalities were identified at the rime of donor nephrectomy. Furthermore, no recipient complications at any time after transplant 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 abnormality being identified;PA nt the time of transplant or in the post-transplanted period. Conclusions The risk of missing a significant donor-related structural abnormality using US and DSA or MRA during the preoperative evaluation is very low. NP is unnecessary for the preoperative evaluation of prospective living renal donors when routine US is used.