*Purpose: Noncontrast pelvic CT imaging can detect severe iliac artery calcifications (SAC) with technical contraindication to transplantation, avoiding morbidity from unnecessary surgical exploration.

*Methods: We devised a screening program for asymptomatic patients with any of the following: hemodialysis &gt10 years (HD10), diabetes mellitus &gt 20 years(DM20), coronary artery disease with percutaneous interventions or coronary bypass (CAD), carotid arterial disease, diabetics with below/above knee amputations, heart-kidney transplantation candidates.

*Results: 38 of 454 patients had SAC (8.4%) with technical contraindication for transplant (TCT); CT determined transplant choice of laterality (TL) in 63(13.9%). There were no TCT in: all patients below age 40 (n=34), all patients with HD10 (n=27), carotid arterial disease (n=5), amputation in diabetics (n=7), candidates for heart-kidney transplantation (n=10). DM20 (n=348) was associated with 7.5% TCT and 12.9% TL. Of 110 patients with CAD, 14.5% had TCT and in 15.4% CT determined TL. DM20 was not an aggravating factor in patients with CAD: CAD patients with DM20 had lower TCT than non DM or DM &lt 20 years (9.5% vs. 17.6%), with TL of 14.3% vs 16.1%. In multivariate analysis, CAD was associated with odds ratio of 2.35 (1.02-5.4) for TCT (p=0.049), while DM20 was not an independent variable (OR 1.12, p=0.808). Restricting screening to patients over the age of 40, with DM20, and/or CAD (n=386), 9.8% had TCT and in 14.2% CT determined TL, for 24% scans determining TCT or TL.

*Conclusions: Screening for severe arterial calcifications of the iliac arterial system can be used for selected kidney transplantation candidates over age of 40, with coronary disease with related percutaneous or surgical interventions and/or DM &gt 20 years. The burden of cost and radiation should be weighed against the risk of morbidity from unnecessary surgery.

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