RT Journal
A1 Smith D, Chudgar A, Daly B, Cooper M
T1 EValuation of potential renal transplant recipients with computed tomography angiography
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD December 1
VO 147
IS 12
SP 1114
OP 1122
DO 10.1001/archsurg.2012.1466
UL http://dx.doi.org/10.1001/archsurg.2012.1466
AB Objectives 
                  To determine the safety, clinical yield, and cost of computed tomography angiography (CTA) use in the workup of potential renal transplant recipients.Design 
                  Single-site, retrospective review of medical, surgical, and radiologic records.Setting 
                  Large university tertiary care center.Patients 
                  Potential recipients of transplants from living donors.Interventions 
                  Computed tomography with and without 100 mL of iodixanol intravenous contrast enhancement as part of the preoperative workup.Main Outcome Measures 
                  Mean pre- and post-CTA estimated glomerular filtration rate and number of patients requiring emergent dialysis after CTA, number of patients who had their treatment changed by CTA findings, patient predictors of significant CTAs, and cost per significant CTA.Results 
                  From July 20, 2006, through December 10, 2010, a total of 179 transplant candidates underwent CTA. Forty-two patients were predialysis at the time of CTA. Mean (SD) serum creatinine levels in this group were unchanged after CTA (5.06 [2.13] mg/dL vs 5.00 [2.28] mg/dL [to convert to micromoles per liter, multiply by 88.4], P = .49), and no patients required subsequent emergent dialysis. Forty-one patients (22.9%) had their treatment changed by CTA findings. Multivariate logistic regression analysis revealed 3 patient history and physical criteria that predicted significant CTA findings: chronic infection (odds ratio, 10.91; 95% CI, 2.72-43.69; P < .001), patient weight less than 69 kg (3.11; 1.49-6.51; P < .001), and ventral torso surgical scarring (4.13; 1.57-10.84; P < .001). Diagnostic cost per significant CTA study was $2660, with an estimated reduced cost of $1480 per significant study with screening using 1 of the 3 predictors.Conclusion 
                  Diagnostic CTA is a safe and cost-effective procedure for both operative planning and screening for potentially prohibitive abdominal disease.