The value of chest and abdominal CT-scans in deceased-organ donor screening: a prospective nation-wide cohort study

Abstract

Introduction

Standard CT-scanning in deceased organ donor screening may offer advantages over conventional chest X-ray and abdominal ultrasound.

Method A nation-wide prospective cohort study in The Netherlands was conducted, including all deceased organ donors between July 2022–April 2024. There were two groups: those who received standard chest and abdominal CT-scan (study-group, n=330) with a new standardised scan protocol and those screened according to the current protocol (chest radiograph and abdominal ultrasound, n=224, or chest- or abdominal CT-scan already performed in the clinal work-up, n=162, together the control-group, n=386). Outcomes included detection of suspicious lesions during screening or procurement, incidence of procurement-related-injuries, explantation-time and transplant outcome. Results During screening, suspicious lesions were identified in 19 donors (5.8%) in the study-group and in 2 donors (0.5%) in the control-group, p<0.01. This resulted in more biopsies, but the majority were benign. During procurement, suspicious unexpected lesions were identified in 2 donors (0.7%) in the study-group and in 7 donors (2.2%) in the control-group, p=0.13. Kidneys from the study-group had a lower rate of procurement-related injuries (16% versus control 23%, p<0.01). No significant difference was observed for livers and pancreases. Nephrectomy (36 minutes versus 39 minutes) and hepatectomy (31 minutes versus 33 minutes) times were significantly shorter in the study-group. No significant difference in kidney-function up to one-year post transplantation was seen. Conclusion In conclusion, CT-scanning improves deceased donor screening by reducing unexpected findings during procurement, lowering the risk of procurement-related kidney graft injuries and shortening explantation-times.