Publication:

The use of screening computed tomography prior to renal transplantation should be limited to high-risk patients with advanced age, coronary artery disease and diabetes mellitus

Background Computed tomography (CT) scans’ predictive value is not well established for screening prior to renal transplantation. The purpose of this study is to measure the extent to which CT findings during transplant evaluation alter candidacy.

Methods Data for 639 renal transplant candidates who underwent CT screening were obtained. Of these, 454 patients had sufficient data and met criterium of having undergone screening CT within six months of official renal transplant evaluation. Transplant status before and after CT imaging was assessed.

Results Those who had screening CTs prior to renal transplantation who were older (p=0.01), had coronary artery disease (p=0.006), or had diabetes mellitus (p=0.042) had significant waitlist status changes. Candidates whose CT findings included vascular calcification or pulmonary nodules were more likely to be permanently excluded from the waitlist (p<0.05). Thirty-two, or 7.0%, had a permanent waitlist status change due to pathologic CT findings that precluded transplantation.

Conclusions Focusing on older patients with coronay artery disease, atherosclerosis, or diabetes would reduce the number of CTs obtained during workup. Candidates with systemic vascular calcification or pulmonary nodules found on subsequent imaging are at the greatest risk for permanent exclusion from renal transplantation.