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

Parth M. Patel; Parth Y. Patel; Farouk Abu Alhana; Eyad Jaara; Zayd G. Safadi; Connor D. Parsell; Graham Mitro; Michael Rees; Jorge Ortiz

doi:10.18203/2349-2902.isj20194039

Authors

Parth M. Patel College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA
Parth Y. Patel College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA
Farouk Abu Alhana College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA
Eyad Jaara College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA
Zayd G. Safadi College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA
Connor D. Parsell College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA
Graham Mitro College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA
Michael Rees Departments of Urology and Pathology, College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA
Jorge Ortiz Department of Surgery, College of Medicine and Health Sciences, University of Toledo, Toledo, Ohio, USA

DOI:

https://doi.org/10.18203/2349-2902.isj20194039

Keywords:

Diagnostic techniques and imaging, Computed tomography, Kidney transplantation, Living donor, Waitlist management, Registry analysis

Abstract

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.

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References

Fishbane S, Hazzan AD, Halinski C, Mathew AT. Challenges and opportunities in late-stage chronic kidney disease. Clin Kidney J. 2015;8(1):54-60.

Eggers PW. Has the incidence of end-stage renal disease in the USA and other countries stabilized? Curr Opin Nephrol Hypertens. 2011;20(3):241-5.

Knoll GA. Is kidney transplant for everyone? The example of the older dialysis patient. Clin J Am Soc Nephrol. 2009;4(12):2040-4.

2014 Annual Data Report. United States Renal Data System. Available at: https://www.usrds.org/2014/ view/Default.aspx. Accessed on 30 April 2017.

Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, et al. Kidney Transplantation as Primary Therapy for End-Stage Renal Disease: A National Kidney Foundation/Kidney Disease Outcomes Quality Initiative Conference. Clin J Am Soc Nephrol. 2008;3(2):471-80.

Ferguson TW, Tangri N, Rigatto C, Komenda P. Cost-effective treatment modalities for reducing morbidity associated with chronic kidney disease. Expert Rev Pharmacoecon Outcomes Res. 2015;15(2):243-52.

Stahl CC, Wima K, Hanseman DJ, Hoehn RS1, Ertel A1, Midura EF, et al. Organ quality metrics are a poor predictor of costs and resource utilization in deceased donor kidney transplantation. Surgery. 2015;158(6):1635-41.

Gill JS, Tonelli M, Johnson N, Kiberd B, Landsberg D, Pereira BJ. The impact of waiting time and comorbid conditions on the survival benefit of kidney transplantation. Kidney Int. 2005;68(5):2345–51.

Harmath, CB, Wood CG III, Berggruen SM, Tantisattamo E. Renal pretransplantation work-up, donor, recipient, surgical techniques. Radiologic Clin N Am. 2016;54(2):217-34.

Soto JR, Zhou C, Hu D, Arazoza AC, Dunn E, Sladek P, et al. Skip and save:utility of pelvic x-rays in the initial evaluation of blunt trauma patients. Am J Surg. 2015;210(6):1076-9.

Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89(9):46-61.

Hendee WR, Becker GJ, Borgstede JP, Bosma J, Casarella WJ, Erickson BA, et al. Addressing overutilization in medical imaging. Radiology. 2010;257(1):240-5.

National Health Expenditure Projection 2015-2025. Centers for Medicare & Medicaid Services. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/proj2015.pdf. Accessed on 2 May 2017.

Levin DC, Parker L, Palit CD, Rao VM. After nearly a decade of rapid growth, use and complexity of imaging declined, 2008–14. Health Affairs. 2017;36(4):663-70.

Mitchell JM, LaGalia RR. Controlling the escalating use of advanced imaging: The role of radiology benefit management programs. Medical Care Res Rev. 2009;66(3):339-51.

Brenner DJ, Hall EJ. Current Concepts: Computed tomography – An increasing source of radiation exposure. N Engl J Med. 2007;357:2277-84.

ICRP, 1991. 1990 Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. Ann ICRP. 1990;21 (1-3).

NRC Regulations (10 CFR) Part 20: standards for protection against risks: subpart C, occupational dose limits. US Nuclear Regulatory Commission. December 2, 2015. Available at: https://www.nrc.gov/reading-rm/doc-collections/ cfr/part020/part020-1201.html. Accessed on 5 May 2017.

Bindman-Smith R, Miglioretti DL, Johnson E, Lee C, Feigelson HS, Flynn M, et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA. 2012;307(22):2400-9.

Lin EC. Radiation risk from medical imaging. Mayo Clin Proc. 2010;85(12):1142-6.

Kasiske BL, Cangro CB, Hariharan S, et al. The evaluation of the renal transplant candidates:clinical practice guidelines. Am J Transplant. 2001;1(S2):3-95.

Sag AA, Covic A, London G, et al. Clinical imaging of vascular disease in chronic kidney disease. Int Urol Nephrol. 2016;48(6):827-37.

Aitken E, Ramjug S, Buist L, Kingsmore D. The prognostic significance of iliac vessel calcification in renal transplantation. Transplant Proc. 2012;44:2925-31.

Davis B, Marin D, Hurwitz LM, Ronald J, Ellis MJ, Ravindra KV, et al. Application of a novel CT-based iliac artery calcification scoring system for predicting renal transplant outcomes. Am J Roentgenol. 2016;206:436-41.

Kahn J, Ram LM, Eberhard K, Groselj-Strele A, Obermayer-Pietsch B, Müller H. Calcification score evaluation in patients listed for renal transplantation. Clin Transplant. 2017;31(3).

Berrington GA, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169:2071-7.