An Analysis of the Aortorenal Angiograms of Sixty-Six Prospective Renal Donors

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Abstract
THE UNIVERSITY of Colorado Medical Center, Denver, Colo., is engaged in an organ transplantation program in which 76 renal transplants have been accomplished. Details of the surgical technic, immunologic implications, and general progress of this program are available elsewhere (8). The evaluation of prospective human renal donors includes excretory urography and aortorenal angiography. The opportunity to study a group of "normal" subjects constitutes a unique roentgenologic experience. Material Prospective donors were screened for evidence of renal disease by history, physical examination, routine urinalysis, urine culture, blood urea nitrogen, and creatinine clearance determinations. If these tests were normal, excretory urography was performed. (At this stage one prospective renal donor was found to have a single kidney.) An aortorenal angiogram constituted the final step in donor evaluation. A review of the roentgenologic examinations including aortorenal angiography of 66 prospective renal donors constitutes the basis of this report. The angiograms obtained at the Denver Veterans Administration Hospital have not been included. Six heterotransplants utilizing baboon donors were performed. These account for the discrepancy between the number of aortorenal angiograms and the number of transplants. The candidates ranged in age from eighteen to sixty-three years with an even sex distribution (Table I). Angiographic Technic Percutaneous transfemoral aortic catheterization was performed according to the method described by Seldinger (7). At first an end-and-side-hole Teflon catheter was used, and the tip was placed at the level of the third lumbar vertebral body. Fifteen cubic centimeters of 90 per cent Hypaque was injected with a Taveras injector at maximum speed and pressure. The injection time was 0.8 second. Subsequently the end-hole of the catheter was occluded during the injection by a metal plug and the catheter tip was placed at the level of the top of the second lumbar vertebral body (9). At the same time, the contrast agent was changed to Renovist and 25 cc was injected over a period of 1.8 seconds. These modifications resulted in better filling of the major renal arteries, better delineation of the intraparenchymal branches, a more dense nephrographic phase and a lower incidence of opacification of overlying vessels. Only occasionally were the veins sufficiently opacified to permit identification. One complication was encountered in the series. A false aneurysm developed at the site of arterial puncture and required open repair of the artery. The distal pulses in the extremity remained normal. Findings Difference in Renal Size: The long axis of each kidney was measured on films of the nephrographic phase.

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