2068 ARTIFICIAL URETERS IN RENAL TRANSPLANTATION: A RETROSPECTIVE CASE SERIES

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THE JOURNAL OF UROLOGY姞

logical derangement following IRI. MPO was at low levels in the ischemic kidneys from CGI group 6 hours after reperfusion when compared to the ischemic kidneys from control group. CONCLUSIONS: Treatment with Cathepsin G inhibitor improves kidney function and tissue damage in a murine-kidney ischemic/ reperfusion injury model. Source of Funding: None

2068 ARTIFICIAL URETERS IN RENAL TRANSPLANTATION: A RETROSPECTIVE CASE SERIES Raed A Azhar, Saad Aldousari*, Mazen Hassanain, Murad Aljiffry, Sero Andonian, Steven Paraskevas, Maurice Anidjar, Montreal, Canada INTRODUCTION AND OBJECTIVES: Ureteral stricture is the most common urologic complication after renal transplantation and is seldom cured by endoscopic management alone. When endourologic management fails, open ureteral reconstruction remains the standard treatment. The complexity of some of these procedures added to the additional risk of graft loss made it necessary to provide other means of bypass procedures. Subcutaneous pyelovesical bypass graft, otherwise known as the artificial ureter (AU), was used as an alternative method to treat ureteral strictures in selected patients as a last resort to prevent renal graft loss. The aim of the present study was to evaluate the intermediate-term outcome of AU. METHODS: A retrospective review of 8 patients (6 men and 2 woman; median age 49 years) who received AU was performed. Four patients had failed endourologic and open management of ureteral strictures, and in the other 4 we elected to proceed with AU primarily due to the complexity of their lesions. RESULTS: After a median follow-up of 19 months, 7 out of 8 renal grafts have good late function without evidence of encrustation or obstruction of their AUs. AU was dislodged in 2 patients; this was easily revised in the immediate post-operative period. One patient developed recurrent urinary tract infections which were managed with long-term antibiotic prophylaxis. Finally, one patient had graft loss secondary to persistent infection of the AU. CONCLUSIONS: AU offers a last resort option in the management of ureteral strictures after renal transplantation refractory to conventional therapy, which would otherwise necessitate permanent nephrostomy drainage or nephrectomy. In this intermediate-term analysis, there was stable graft function without evidence of obstruction. Long-term follow-up of these patients is planned to better evaluate the ability of AU in salvaging renal graft function in these high risk patients. Source of Funding: None

2069 IMMUKNOW ASSAY POORLY PREDICTS REJECTION OR OPPORTUNISTIC INFECTION IN RENAL TRANSPLANT RECIPIENTS Ahmer Farooq*, Streamwood, IL; Anthony Polcari, Cory Hugen, Geraldine Zingraf, Anita Pakrasi, Dadi Ding, Susan Hou, Maywood, IL; David Holt, Chicago, IL; John Milner, Maywood, IL INTRODUCTION AND OBJECTIVES: Calcineurin levels are currently used to monitor immunosuppression in renal transplant recipients. A major limitation is that these levels reflect the serum drug concentration but do not provide a direct measure of the drug’s effect on the immune system. The Immuknow immune cell function (ICF) assay was developed to measure overall immune response, and has generated optimism with regard to its ability to predict acute cellular rejection (ACR) and infection episodes. Previous reports correlated ICF levels with these events and established reference ranges of low (⬍225 ng/ml), moderate (226-525 ng/ml), and high (⬎525 ng/ml) immune response. In general, low values are associated with a risk of infection,

Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010

and high values should predict rejection. In this study we evaluate the ability of ICF levels to predict ACR and opportunistic infections in a large cohort of renal transplant recipients. METHODS: 215 renal transplant recipients were followed prospectively in an ICF database. ICF levels were collected following transplant and with a change in status, such as suspicion for infection or rejection. Episodes of ACR and infection were recorded and correlated with the assay. RESULTS: From 7/2007 to 10/2009, 413 ICF assay levels were recorded in 215 patients. 12 patients developed ACR and 26 developed opportunistic infections caused by BK in 16 and CMV in 10. Patients who developed ACR had similar mean ICF levels compared to those who did not (350 vs. 290 ng/ml, p⫽0.20). Only 17% of patients who developed ACR had ICF levels in the high range, which would predict rejection. Among patients who developed infection, the mean ICF level was similar to that of healthy recipients (253 vs. 290 ng/ml, p⫽0.30). A total of 66 patients with low range assay levels did not have opportunistic infections. ICF levels did not lead to immunosuppression modification in any patient. CONCLUSIONS: ICF levels poorly predicted the clinical course of our patients, with a large overlap in the values for a normal course, ACR, and opportunistic infection. We question the clinical utility of this expensive test. Further evaluation of this assay is mandatory before it is used routinely. Source of Funding: None

2070 LIVING DONOR RENAL TRANSPLANTATION OVERCOMES RACIAL DISPARITIES IN AFRICAN AMERICAN RECIPIENTS Ismail Saad*, Cairo, Egypt; Charles Modlin, Ho Yee Tiong, Joan Alster, Barbra Mastroinni, Kathy Savas, Stuart Flechner, Cleveland, OH INTRODUCTION AND OBJECTIVES: End stage renal disease (ESRD) has a higher incidence and prevalence in African-Americans (AA), who represent a disproportionate percentage of the dialysis population in the USA. AA accounted for 31% of wait list additions, but only 22 % of renal transplant recipients (RTR) in 2007. We compared graft and patient survival in AA and non-AA patients who received a living donor (LD) or a deceased donor (DD) transplant at our center. METHODS: Between 1995 and 2004, 772 patients underwent a primary kidney-only or kidney/pancreas transplant at our center. Patients were grouped into non-AA (including Whites and Hispanics) (N⫽604) and AA (N⫽168). Recipient, donor, transplant, and immunologic parameters were compared. Graft and patient survival, with regard to donor type (LD vs. DD), were estimated using the Kaplan-Meier method. RESULTS: Mean follow-up was 7.1⫾2.5 years. Percentage of DD transplants was higher in AA than non-AA (70% vs. 53%) (p⬍0.0001). In DD-RTR, AA compared to non-AA had significantly greater waiting list days (972⫾575 vs. 637⫾466, p⬍0.0001), and greater mean HLA mismatches (4.1⫾1.4 vs. 2.7 ⫾2.1, p⬍0.0001). These recipient discrepancies disappeared in LD- RTR. For DD- RTR, delayed graft function was significantly higher in AA than non-AA (48% vs. 26%, p⬍0.0001). In DD- RTR, mean post-transplant creatinine (mg/dl) at 1 and 3 years was significantly higher (p⫽0.004) in AA (2.3 and 2.8) than non-AA (1.6 and 2.0). However, there was no significant difference in 1 and 3 year mean creatinine among AA LD-RTR, (1.9 and 2.1) and non-AA (1.6 and 1.8). Patient survival was similar in AA and non-AA recipients for either LD or DD transplants. Graft survival was significantly worse (p⫽0.003) in AA undergoing DD transplants but similar for LD transplants. CONCLUSIONS: Although AAs experience worse graft survival following DD kidney transplants, outcomes are virtually the same as non-AAs following LD transplants. More research is needed to gain understanding of the factors involved in this racial disparity for outcome