ALGORITHM FOR SELECTING THE FUNCTIONALLY DOMINANT KIDNEY FOR LIVING-RELATED TRANSPLANTATION BASED ON ANGIONEPHROSCINTIGRAPHY

Objective: To develop an effective algorithm for selecting the side of donor nephrectomy for living-related kidney transplantation based on angionephroscintigraphy.

Methods: Radionuclide renal scintigraphy was performed in 340 donors aged 21-60 years (mean age: 38.4 ± 9.8 years) to diagnose urinary system pathology and assess the total and differential excretory function of the kidneys. The parameters were evaluated in comparison with normal values and for each kidney in comparison with the contralateral kidney.

Results: Dynamic angionephroscintigraphy (DANGS) using nephrotropic radiopharmaceuticals labeled with technetium-99m, either tubulotropic (MAG3) or glomerulotropic (DTPA), makes it possible to assess effective renal plasma flow (ERPF) or glomerular filtration rate (GFR), as well as the perfusion and urodynamics of each kidney separately. An algorithm was proposed that allows the functionally dominant kidney to be identified based on a комплекс of DANGS parameters, including in cases where the differences in ERPF values are not statistically significant. If a statistically significant difference in the functional parameters of the paired kidneys is detected at any stage of the algorithm, a conclusion is made regarding the functionally dominant kidney.

Conclusion: Using the developed algorithm, the functionally dominant kidney was identified in almost all cases, making it possible to objectify the selection of the kidney for donor nephrectomy and preserve the donor’s renal function to the maximum extent.