CANLI BÖBREK DONÖR VARYASYONLARININ ÇOK KESİTLİ BİLGİSAYARLI TOMOGRAFİ İLE PREOPERATİF DEĞERLENDİRİLMESİ VE SONUÇLARIN İNTRAOPERATİF BULGULAR İLE KARŞILAŞTIRILMASI

Yıl 2023, , 234 - 240, 05.04.2023

İbrahim Halil Sever , Tural Mammadov İlhami Barlas , Bahattin Özkul , Bedriye Koyuncu Sökmen , Fatma Yılmaz Zuhal Atan Uçar Ayşe Sinangil Emin Barış Akin

https://doi.org/10.18229/kocatepetip.1069333

Öz

AMAÇ: Bu çalışmayla, çok kesitli bilgisayarlı tomografi (ÇKBT) kullanarak canlı böbrek donörlerinde renal vasküler ve toplayıcı sistem varyasyonlarını değerlendirmek ve verileri retroperitonoskopik donör nefrektomisinde saptanan bulgular ile karşılaştırmak amaçlanmıştır.
GEREÇ VE YÖNTEM: Çalışmaya, Ocak 2015 ile Ekim 2021 arasında merkezimizde retroperitonoskopik donör nefrektomisi olan ve operasyon öncesi uygun protokol ile gerçekleştirilmiş ÇKBT görüntülemesi mevcut olan 652 donör dahil edildi. Böbreklerdeki arteryel, venöz ve toplayıcı sistem varyasyonları ÇKBT incelemesiyle değerlendirilip not edilerek sonuçlar operasyon bulguları ile karşılaştırıldı.
BULGULAR: Donörlerin %72,7’sine (474 kişi) sol nefrektomi, kalan 178 donöre (%27,3) ise sağ nefrektomi yapıldı. Nakledilen 652 böbreğin 99’unda (%15,1) çift arter, 11’inde (%1,6) üç arter ve 1’inde (%<1) dört arter mevcut iken; 14 (%2,1) böbrekte erken arteryel segmentasyon saptandı. Laparoskopik bulgulara göre 26 (%4) donör böbrekte çift renal ven, 3 (%0,4) böbrekte üç adet renal ven mevcut iken; 8 donörde yapısal venöz varyasyon ve 6 donörde toplayıcı sistem varyasyonu görüldü. Aksesuar arter varlığını saptamada, ÇKBT’nin duyarlılık, özgüllük, pozitif-negatif öngörü değeri ve doğruluk oranları sırasıyla %97,3; %98,5; %93,1; %99,4 ve %98,3 olarak bulundu. Arter sayılarını saptamadaki doğruluğu ise %98 olarak hesaplandı. Venlerdeki sayısal varyasyonu saptamada ÇKBT’nin duyarlılık, özgüllük, pozitif-negatif öngörü değeri ve doğruluk oranları sırasıyla %100; %99,8; %96,5; %100 ve %99,8 olarak bulundu. Ven sayılarını saptamadaki doğruluğu ise %99,8 olarak hesaplandı. Arteryel erken segmentasyon, geç venöz konfluens ve toplayıcı sistem varyasyonlarını tespit etmede ise %100 başarı sağlandı.
SONUÇ: Doğru teknik ile gerçekleştirilen ÇKBT, canlı donör böbrek nakli için donör adaylarında renal vasküler ve toplayıcı sistem varyasyonlarının değerlendirilmesi için oldukça doğru bir yöntemdir.

Anahtar Kelimeler

Canlı donör, ÇKBT, Arter, Ven, Toplayıcı sistem, Varyasyon

Destekleyen Kurum

yok

Proje Numarası

yok

PREOPERATIVE EVALUATION OF LIVING DONOR KIDNEY VARIATIONS WITH MULTIDETECTOR COMPUTED TOMOGRAPHY AND COMPARISON OF RESULTS WITH INTRAOPERATIVE FINDINGS

Öz

OBJECTIVE: The aim of this study was to evaluate the renal vascular and collecting system variations in living kidney donors using multidetector computed tomography (MDCT) and to compare the data with the findings detected during retroperitoneoscopic donor nephrectomy.
MATERIAL AND METHODS: Between January 2015 and October 2021, 652 living donors who underwent retroperitoneoscopic donor nephrectomy at our center and had preoperative MDCT imaging were included in the study. Arterial, venous, and collecting system variations in the kidneys were detected in MDCT, and the results were compared with the intraoperative findings.
RESULTS: Left nephrectomy was performed in 72.7% (474 individuals) of the donors, and right nephrectomy was performed on the remaining 178 donors (27.3%). While 99 (15.1%) of the 652 transplanted kidneys had double arteries, 11 (1.6%) had three arteries, and 1 (<1%) had four arteries; early arterial segmentation was detected in 14 (2.1%) kidneys. According to laparoscopic findings, there were double renal veins in 26 (4%) donor kidneys and three renal veins in 3 (0.4%) kidneys. Also structural venous variation was seen in 8 donors and collector system variation was seen in 6 donors. The sensitivity, specificity, positive-negative predictive value and accuracy of MDCT in detecting the presence of accessory arteries were; 97.3%, 98.5%, 93.1%, 99.4% and 98.3%, respectively. Its accuracy in detecting arterial counts was calculated as 98%. The sensitivity, specificity, positive-negative predictive value and accuracy rates of MDCT in detecting numerical variation in veins were; 100%, 99.8%, 96.5%, 100% and 99.8%, respectively. The accuracy in detecting the count of veins was calculated as 99.8%. 100% success was achieved in detecting arterial early segmentation, late venous confluence and collecting system variations.
CONCLUSIONS: MDCT performed with the right technique is a very accurate method for the evaluation of renal vascular and collecting system variations in living-donor candidates for kidney transplantation.

Anahtar Kelimeler

Living donor, MDCT, Artery, Vein, Collector system, Variation

Proje Numarası

yok

Kaynakça

• 1. Alsulaiman T, Mark S, Armstrong S, et al. D. Assessment of Potential Live Kidney Donors and Computed Tomographic Renal Angiograms at Christchurch Hospital. Adv Urol. 2016;2016:4924320.
• 2. Ratner LE, Montgomery RA, Kavoussi LR. Laparoscopic live donor nephrectomy: the four year Johns Hopkins University experience. Nephrol Dial Transplant. 1999;14:2090–93.
• 3. Flechner SM, Sandler CM, Houston GK, Van Buren CT, Lorber MI and Kahan BD. 100 living-related kidney donor evaluations using digital subtraction angiography. Transplantation. 1985;40(6):675–8.
• 4. Spring DB, Salvatierra O Jr, Palubinskas AJ, et al. Results and significance of angiography in potential kidney donors. Radiology. 1979;133(1):45–7.
• 5. Asghari B, Babaei M, Pakroshan B, Vaziriniya A and Babamahmoodi A. Role of Multidetector Computed Tomography for Evaluation of Living Kidney Donors. Nephrourol Mon. 2013;5:70–73.
• 6. Raman SS, Pojchamarnwiputh S, Muangsomboon K, Schulam PG, Gritsch HA and Lu DS. Utility of 16-MDCT angiography for comprehensive preoperative vascular evaluation of laparoscopic renal donors. AJR Am J Roentgenol. 2006;186:1630–38.
• 7. Kumar S, Neyaz Z and Gupta A. The Utility of 64 Channel Multidetector CT Angiography for Evaluating the Renal Vascular Anatomy and Possible Variations: A Pictorial Essay. Korean J Radiol. 2010;11:346–54.
• 8. Sebastià C, Peri L, Salvador R, et al. Multidetector CT of Living Renal Donors: Lessons Learned from Surgeons. Radiographics. 2010;30:1875-90.
• 9. Walker TG, Geller SC, Delmonico FL, Waltman AC, Athanasoulis CA. Donor renal angiography: its influence on the decision to use the right or left kidney. AJR Am J Roentgenol. 1988;151(6):1149–51.
• 10. Derauf B, Goldberg ME. Angiographic assessment of potential renal transplant donors. Radiol Clin North Am. 1987;25(2):261–5.
• 11. Nezami N, Naghavi-Behzad M, Piri R, et al. Preoperative Multi-Detector Computed Tomography in Kidney Donors; Quantitative Data Report from Operation Rooms. Iran J Radiol. 2018;15(4):e59025.
• 12. Jha RC, Korangy SJ, Ascher SM, et al. MR angiography and preoperative evaluation for laparoscopic donor nephrectomy. AJR Am J Roentgenol. 2002;178(6):1489–95.
• 13. Kim T, Murakami T, Takahashi S, et al. Evaluation of renal arteries in living renal donors: comparison between MDCT angiography and gadolinium-enhanced 3D MR angiography. Radiat Med. 2006;24(9):617–24.
• 14. Schlunt LB, Harper JD, Broome DR, et al. Multidetector computerized tomography angiography to predict lumbar venous anatomy before donor nephrectomy. J Urol. 2006;176(6):2576–81.
• 15. Sarier M, Callioglu M, Yuksel Y, et al. Evaluation of the Renal Arteries of 2,144 Living Kidney Donors Using Computed Tomography Angiography and Comparison with Intraoperative Findings. Urol Int. 2020;104:637- 40.
• 16. Chabchoub K, Mhiri MN, Bahloul A, et al. Does kidney transplantation with multiple arteries affect graft survival? Transplant Proc. 2011; 43:3423–25.
• 17. Paragi PR, Klaassen Z, Fletcher HS, et al. Vascular constraints in laparoscopic renal allograft: Comparative analysis of multiple and single renal arteries in 976 laparoscopic donor nephrectomies. World J Surg. 2011;35:2159–66.
• 18. Kok NF, Dols LF, Hunink MG, et al. Complex vascular anatomy in live kidney donation: imaging and consequences for clinical outcome. Transplantation. 2008; 85(12): 1760–5.
• 19. Hazirolan T, Oz M, Turkbey B, Karaosmanoglu AD, Oguz BS and Canyigit M. CT angiography of the renal arteries and veins: Normal anatomy and variants. Diagn Interv Radiol. 2011;17:67–73.
• 20. Asgari MA, Dadkhah F, Ghadian AR, Razzaghi MR, Noorbala MH and Amini E. Evaluation of the vascular anatomy in potential living kidney donors with gadolinium-enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings. Clin Transplant. 2011; 25(3): 481–5.
• 21. Chai JW, Lee W, Yin YH, et al. CT angiography for living kidney donors: Accuracy, cause of misinterpretation and prevalence of variation. Korean J Radiol. 2008;9:333-39.
• 22. Turkvatan A, Akinci S, Yildiz S, Olcer T and Cumhur T. MDCT for preoperative evaluation of vascular anatomy in living renal donors. Surg Radiol Anat. 2009;31:227–235.
• 23. Cira K, Demirtas H, Durmaz MS and Ceken K. Evaluation of renal arteries of 286 living donors by multidetector computed tomography angiography: A single-center study. Exp Clin Transplant. 2015;13(6): 581–7.
• 24. Tarzamni MK, Nezami N, Zomorrodi A, et al. Renal Collecting System Anatomy in Living Kidney Donors by Computed Tomographic Urography: Protocol Accuracy Compared to Intravenous Pyelographic and Surgical Findings. J Clin Imaging Sci. 2016;6:1.