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FEATURES AND OUTCOMES OF RENAL CELL CARCINOMA IN RENAL TRANSPLANT RECIPIENTS: A 20-YEAR SINGLE CENTER EXPERIENCE
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Wednesday, April 29, 2009
transplant waiting list. The inclusion of these extremely old receptors in the kidney transplant waiting list may increase the number of old donors and diminish the number of rejected kidneys from old donors. Source of Funding: None
2232 RENAL TRANSPLANTATION IN CHILDREN WITH PRIOR CONTINENT BLADDER RECONSTRUCTION: SIX YEAR EXPERIENCE OF A SINGLE INSTITUTION Jesus A Pires, Daniel A Pereira, Claudio Jose Ramos Almeida, Jose Osmar M Pestana, Tiago Elias Rosito, Eulalio Damazio, Valdemar Ortiz, Antonio Macedo, Jr*, São Paulo, Brazil INTRODUCTION AND OBJECTIVE: Bladder reconstruction (augmentation/substitution) is the treatment of choice for improving/ replacing bladder function when conservative attempts fail or are inadequate. This study aims to present our experience with renal transplantation in the pediatric population with bladder reconstruction in regards to graft function and survival. METHODS: From January 2001 to January 2007, 329 patients, under 18 years of age underwent a kidney transplantation at our Institution. We selected in this study patients who had also undergone vesical augmentation/substitution. RESULTS: Thirty-six patients underwent bladder reconstruction (23 male and 13 female) and received 38 grafts, 26 transplantations from deceased donors and 12 from living donors, with an average age of 11 (5 to 17 years of age). The etiology of vesical dysfunction was distributed as follows: 20 cases of posterior urethral valve, 12 cases of neurogenic bladder, 2 cases of vesicoureteral reflux and 2 cases with other lower urinary tract abnormalities. Most bladder augmentations were done with intestinal segments: 28 with ileum, 4 with sigmoid and ureter in only four cases. Average interval between bladder augmentation and renal transplantation was 31 months (2 to 108 months) only 1 patient had TX before augmentation. Graft survival at 1 year was 90%, with average creatinine levels at six months of 1.1 ± 0.3, at one year of 1.0 ±0.2 and at five years of 1.15 ±0.2. Main clinical complication was UTI in 83% of the cases. Three cases of acute rejection, three cases of renal graft loss (not related to bladder augmentation) and one death due to sepsis was observed. Complications related to neobladder were two cases of urinary retention, one case of stoma prolapse and one case of leakage through the stoma related and both patients were reoperated (5% revision rate) CONCLUSIONS: Renal transplantation is safe in pediatric patients who had undergone bladder augmentation. Graft survival and complication rates were comparable to patients that did not undergo vesical reconstruction. Therefore a careful evaluation of bladder function prior to renal tranplantation is recommended and bladder augmentation can be performed before renal transplantation. Source of Funding: None
2233 FEATURES AND OUTCOMES OF RENAL CELL CARCINOMA IN RENAL TRANSPLANT RECIPIENTS: A 20-YEAR SINGLE CENTER EXPERIENCE
RESULTS: RCC was diagnosed in 18 men and 6 women at a median age of 58.9 years. Twenty patients (83%) had unilateral disease and 4 (17%) presented with synchronous bilateral RCC. The median time between renal transplantation/start of dialysis and RCC occurrence was 5.6/10.4 years. Acquired cystic disease was found in 67% of the patients. The last 12 cases were managed by retroperitoneoscopic nephrectomy. No perioperative deaths and major perioperative complications occurred. Twenty-one tumors (75%) staged T1N0M0 and only 2 were metastasized at diagnosis. Ninety-six percent of the tumors showed Fuhrman grade 1 or 2. In terms of subtype, 43% were papillary and only 54% were clear cell. Forty percent of the tumors occurred in a multifocal fashion. After a median follow-up of 6.7 years, 8 patients had died (33%), but only 2 deaths were due to RCC. The 5- and 10-year survival probabilities were 91% and 91% for cancer-specific survival, and 72% and 51% for overall survival, respectively. CONCLUSIONS: The majority of RCCs in renal transplant recipients are low-stage low grade tumors. When managed by extirpative surgery, perioperative morbidity is low and survival outcomes are excellent. The outstanding clinical and pathological findings are bilateral occurrence, papillary subtype and multifocality. Source of Funding: None
2234 DETERMINATION OF A “SAFE” COLD ISCHEMIC TIME IN KIDNEY TRANSPLANTATION - A COMPARISON OF FIRST AND SECOND KIDNEY TRANSPLANTS FROM THE SAME DECEASED DONOR Markus Giessing*, Florian Fuller, Frank Friedersdorff, Lutz Liefeldt, Kurt Miller, Serdar Deger, Berlin, Germany INTRODUCTION AND OBJECTIVE: Cold ischemic time (CIT) may negatively influence graft function, increase the risk of acute rejection and have adverse effects on graft and patient survival. This holds true especially for expanded criteria donors. Nevertheless, some data has been published that kidney transplantations (KTX) performed at night have a worse outcome compared to daytime KTX. In order to identify the threshold of a “safe” CIT we performed a single-center analysis of both kidneys from the same deceased donor transplanted consecutively into two recipients. METHODS: Retrospective analysis of 80 kidneys from 40 donors transplanted consecutively into 80 recipients between January 1989 and December 2007. 10 donors/20 kidneys were allocated in the Eurotransplant Senior Program (ESP). RESULTS: Overall, no difference was found for number of rejections, DGF, functional data (creatinine, GFR) or graft survival despite a significant difference in cold ischemic time (CIT) of rank 8.3h vs. 14.3 h (p<0.01). Interstingly, subgroup analysis of kidneys transplanted in the Eurotransplant Senior Program (CIT: 7 vs. 12 hours; p<0.05) also showed no difference for all items studied. CONCLUSIONS: The non immunologic damage of a deceased donor kidney seems to be low as long as transport time does not exceed 12-14 hours. This is of utmost importance of donors above the age of 65 years. As a consequence, if a center receives both kidneys of the same donor all efforts must be made to not exceed 12 of CIT and both kidneys should be transplanted in parallel into the two recipients. Source of Funding: None
Tobias Klatte*, Christian Seitz, Matthias Waldert, Michela de Martino, Michael Marberger, Mesut Remzi, Vienna, Austria INTRODUCTION AND OBJECTIVE: Renal transplant patients carry an increased risk of developing solid malignancies including renal cell carcinoma (RCC) in their native end-stage kidneys. Features and clinical courses of these tumors are mainly unknown. Here, we present a large series derived from a single institution over a 20-year period. METHODS: We retrospectively studied 28 RCCs, which developed in the native kidneys of 24 renal transplant recipients. All tumors were managed surgically. Histological slides were reviewed by one urologic pathologist. Clinical and follow-up data were gathered for each patient. The endpoints of this study were overall and cancer-specific survival time, which were both calculated from the date of nephrectomy.
809
2235 EXPERIENCE WITH 750 CONSECUTIVE LAPAROSCOPIC DONOR NEPHRECTOMIES: A CALL FOR USING A STANDARDIZED CLASSIFICATION OF COMPLICATIONS Jonathan D Harper*, Alberto Breda, John T Leppert, Jeffrey L Veale, H. Albin Gritsch, Peter G Schulam, Los Angeles, CA INTRODUCTION AND OBJECTIVE: Laparoscopic living donor nephrectomy (LLDN) offers patients the benefits of decreased morbidity and improved cosmesis. LLDN is associated with equivalent graft outcomes and similar complication rates, when compared with open
Vol. 181, No. 4, Supplement, Wednesday, April 29, 2009
transplant waiting list. The inclusion of these extremely old receptors in the kidney transplant waiting list may increase the number of old donors and diminish the number of rejected kidneys from old donors. Source of Funding: None
2232 RENAL TRANSPLANTATION IN CHILDREN WITH PRIOR CONTINENT BLADDER RECONSTRUCTION: SIX YEAR EXPERIENCE OF A SINGLE INSTITUTION Jesus A Pires, Daniel A Pereira, Claudio Jose Ramos Almeida, Jose Osmar M Pestana, Tiago Elias Rosito, Eulalio Damazio, Valdemar Ortiz, Antonio Macedo, Jr*, São Paulo, Brazil INTRODUCTION AND OBJECTIVE: Bladder reconstruction (augmentation/substitution) is the treatment of choice for improving/ replacing bladder function when conservative attempts fail or are inadequate. This study aims to present our experience with renal transplantation in the pediatric population with bladder reconstruction in regards to graft function and survival. METHODS: From January 2001 to January 2007, 329 patients, under 18 years of age underwent a kidney transplantation at our Institution. We selected in this study patients who had also undergone vesical augmentation/substitution. RESULTS: Thirty-six patients underwent bladder reconstruction (23 male and 13 female) and received 38 grafts, 26 transplantations from deceased donors and 12 from living donors, with an average age of 11 (5 to 17 years of age). The etiology of vesical dysfunction was distributed as follows: 20 cases of posterior urethral valve, 12 cases of neurogenic bladder, 2 cases of vesicoureteral reflux and 2 cases with other lower urinary tract abnormalities. Most bladder augmentations were done with intestinal segments: 28 with ileum, 4 with sigmoid and ureter in only four cases. Average interval between bladder augmentation and renal transplantation was 31 months (2 to 108 months) only 1 patient had TX before augmentation. Graft survival at 1 year was 90%, with average creatinine levels at six months of 1.1 ± 0.3, at one year of 1.0 ±0.2 and at five years of 1.15 ±0.2. Main clinical complication was UTI in 83% of the cases. Three cases of acute rejection, three cases of renal graft loss (not related to bladder augmentation) and one death due to sepsis was observed. Complications related to neobladder were two cases of urinary retention, one case of stoma prolapse and one case of leakage through the stoma related and both patients were reoperated (5% revision rate) CONCLUSIONS: Renal transplantation is safe in pediatric patients who had undergone bladder augmentation. Graft survival and complication rates were comparable to patients that did not undergo vesical reconstruction. Therefore a careful evaluation of bladder function prior to renal tranplantation is recommended and bladder augmentation can be performed before renal transplantation. Source of Funding: None
2233 FEATURES AND OUTCOMES OF RENAL CELL CARCINOMA IN RENAL TRANSPLANT RECIPIENTS: A 20-YEAR SINGLE CENTER EXPERIENCE
RESULTS: RCC was diagnosed in 18 men and 6 women at a median age of 58.9 years. Twenty patients (83%) had unilateral disease and 4 (17%) presented with synchronous bilateral RCC. The median time between renal transplantation/start of dialysis and RCC occurrence was 5.6/10.4 years. Acquired cystic disease was found in 67% of the patients. The last 12 cases were managed by retroperitoneoscopic nephrectomy. No perioperative deaths and major perioperative complications occurred. Twenty-one tumors (75%) staged T1N0M0 and only 2 were metastasized at diagnosis. Ninety-six percent of the tumors showed Fuhrman grade 1 or 2. In terms of subtype, 43% were papillary and only 54% were clear cell. Forty percent of the tumors occurred in a multifocal fashion. After a median follow-up of 6.7 years, 8 patients had died (33%), but only 2 deaths were due to RCC. The 5- and 10-year survival probabilities were 91% and 91% for cancer-specific survival, and 72% and 51% for overall survival, respectively. CONCLUSIONS: The majority of RCCs in renal transplant recipients are low-stage low grade tumors. When managed by extirpative surgery, perioperative morbidity is low and survival outcomes are excellent. The outstanding clinical and pathological findings are bilateral occurrence, papillary subtype and multifocality. Source of Funding: None
2234 DETERMINATION OF A “SAFE” COLD ISCHEMIC TIME IN KIDNEY TRANSPLANTATION - A COMPARISON OF FIRST AND SECOND KIDNEY TRANSPLANTS FROM THE SAME DECEASED DONOR Markus Giessing*, Florian Fuller, Frank Friedersdorff, Lutz Liefeldt, Kurt Miller, Serdar Deger, Berlin, Germany INTRODUCTION AND OBJECTIVE: Cold ischemic time (CIT) may negatively influence graft function, increase the risk of acute rejection and have adverse effects on graft and patient survival. This holds true especially for expanded criteria donors. Nevertheless, some data has been published that kidney transplantations (KTX) performed at night have a worse outcome compared to daytime KTX. In order to identify the threshold of a “safe” CIT we performed a single-center analysis of both kidneys from the same deceased donor transplanted consecutively into two recipients. METHODS: Retrospective analysis of 80 kidneys from 40 donors transplanted consecutively into 80 recipients between January 1989 and December 2007. 10 donors/20 kidneys were allocated in the Eurotransplant Senior Program (ESP). RESULTS: Overall, no difference was found for number of rejections, DGF, functional data (creatinine, GFR) or graft survival despite a significant difference in cold ischemic time (CIT) of rank 8.3h vs. 14.3 h (p<0.01). Interstingly, subgroup analysis of kidneys transplanted in the Eurotransplant Senior Program (CIT: 7 vs. 12 hours; p<0.05) also showed no difference for all items studied. CONCLUSIONS: The non immunologic damage of a deceased donor kidney seems to be low as long as transport time does not exceed 12-14 hours. This is of utmost importance of donors above the age of 65 years. As a consequence, if a center receives both kidneys of the same donor all efforts must be made to not exceed 12 of CIT and both kidneys should be transplanted in parallel into the two recipients. Source of Funding: None
Tobias Klatte*, Christian Seitz, Matthias Waldert, Michela de Martino, Michael Marberger, Mesut Remzi, Vienna, Austria INTRODUCTION AND OBJECTIVE: Renal transplant patients carry an increased risk of developing solid malignancies including renal cell carcinoma (RCC) in their native end-stage kidneys. Features and clinical courses of these tumors are mainly unknown. Here, we present a large series derived from a single institution over a 20-year period. METHODS: We retrospectively studied 28 RCCs, which developed in the native kidneys of 24 renal transplant recipients. All tumors were managed surgically. Histological slides were reviewed by one urologic pathologist. Clinical and follow-up data were gathered for each patient. The endpoints of this study were overall and cancer-specific survival time, which were both calculated from the date of nephrectomy.
809
2235 EXPERIENCE WITH 750 CONSECUTIVE LAPAROSCOPIC DONOR NEPHRECTOMIES: A CALL FOR USING A STANDARDIZED CLASSIFICATION OF COMPLICATIONS Jonathan D Harper*, Alberto Breda, John T Leppert, Jeffrey L Veale, H. Albin Gritsch, Peter G Schulam, Los Angeles, CA INTRODUCTION AND OBJECTIVE: Laparoscopic living donor nephrectomy (LLDN) offers patients the benefits of decreased morbidity and improved cosmesis. LLDN is associated with equivalent graft outcomes and similar complication rates, when compared with open