Introduction: Planification of living donor nephrectomy requires exact knowledge of the renal vascular architecture because of the high prevalence of anatomical variants. After magnetic resonance angiography (MRA) challenged CT angiography for preoperative assessment over the last years, we revisit in this study the reliability of MRA as the sole preoperative assessment for living donor nephrectomy. Method: We compared the radiological findings of MRA performed as the sole radiological procedure in 44 living kidney donors with perioperative anatomy to verify its sensitivity and to validate its systematic use in the preoperative assessment for living donor nephrectomy. Results: 22 anatomical variants were found in 16 patients (16/44 = 36%). In 4 patients, a polar artery (3 superior, 1 inferior) was not seen by MRA and was detected during surgery (open nephrectomy). Supposing the anatomical variants it described on the opposite side of the nephrectomy are real, sensitivity of this technique in this series is 40/44 (91%) for arterial and 100% for venous imaging. Conclusion: MRA as the sole radiological preoperative assessment performed by a single radiologist with specific expertise and preoperatively reviewed with the harvesting surgeon has been validated as the sole radiological preoperative assessment for living donor nephrectomy at our institution.

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