Abdominopelvic Preoperative Imaging in Adult Candidates for Kidney Transplant: A Systematic Review of Its Impact on Surgical Decision-making.

CONTEXT: Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease, but technical success depends on thorough preoperative evaluation. Imaging may detect vascular calcifications, anatomic abnormalities, or incidental findings that influence surgical planning. However, recommendations remain heterogeneous, and the optimal imaging strategy is unclear.

OBJECTIVE

To assess the role of preoperative abdominopelvic imaging in adult candidates for KT and its impact on surgical decision-making and outcomes.

EVIDENCE ACQUISITION: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines, PubMed/MEDLINE and Embase were searched (January 2000-August 2025) for studies reporting preoperative imaging in candidates for KT. Included modalities were Doppler ultrasound (DUS), contrast-enhanced ultrasound, noncontrast computed tomography (NCCT), computed tomography angiography, magnetic resonance imaging, and plain abdominal x-ray. Outcomes included detection of surgically relevant abnormalities, changes in surgical planning, and exclusion from transplantation.

EVIDENCE SYNTHESIS: Thirteen studies (eight prospective, five retrospective; 20-470 patients) were included. Imaging findings modified surgical strategy in up to 24% of cases and led to exclusion from KT in 2.0-29%. Vascular calcifications were identified in 14-20% with DUS and up to 90% with NCCT. Age, diabetes, and dialysis duration were common criteria for imaging. Data heterogeneity and limited sample sizes restricted firm conclusions.

CONCLUSIONS

Preoperative imaging can support surgical planning in KT, although the current evidence base remains limited. Although prospective studies are needed and are likely challenging to perform, a structured expert consensus could serve as a useful interim step to encourage more consistent imaging practices and help inform future multicentric research.