*Purpose: Pretransplant graft volume and function has been demonstrated to be an important factor in subsequent allograft outcomes. Most transplant centers underwent renal split function test to assess functional asymmetry with technetium dimercaptosuccinic acid (^99mTc-DMSA) renography and or computed tomography (CT). We evaluated which of the two methods better reflected posttransplant renal function.

*Methods: We analyzed 159 living donors who underwent pretransplant kidney evaluation with both ^99mTc-DMSA renography and CT, and their matching recipients. We measured glomerular filtration rate (GFR) in donor with ⁵¹Chromium (Cr) plasma clearance and in recipients using the chronic kidney disease epidemiology collaboration formula (CKD-EPI) equation at 1, 6, and 12 months after transplantation. Kidney volumes were calculated using semi-automatic, three-dimensional (3D) CT volumetry methods. Absolute transplanted graft GFR was calculated by donor GFR (ml/min) x the proportion of donated kidney to total kidney (transplanted kidney volume/total kidney volume in CT, and transplanted kidney isotope uptake/total uptake in renography).

*Results: The mean absolute transplanted graft GFR were 53.3±10.6 ml/min by renography and 53.5±10.7 ml/min by CT (p=0.872). Posttransplant graft functions were 84.5±18.6, 72.3±14.1, and 74.9±16.7 ml/min/1.73m² at 1, 6, and 12 months after transplantation, respectively. Pearson correlation coefficients between absolute transplanted graft GFR and posttransplant GFR were 0.289, 0.362, and 0.256 in renography (all p<0.001), and 0.318, 0.378, and 0.269 (all p<0.001) in CT at 1, 6, and 12 months, respectively. Multiple linear regression analysis adjusted by age and gender demonstrated that a 1 ml/min increase in absolute transplanted graft GFR calculated by 3D CT volume was associated with 0.56±0.13 ml/min/1.73m² increase in posttransplant GFR, and one year increase in recipient age was associated with a 0.46±0.12 ml/min/1.73m² reduction of GFR.

*Conclusions: 3D CT volumetry method is more useful to predict renal graft outcome than isotope renography before transplantation.

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