2163 THE SOCIOECONOMIC STATUS OF LIVING UNRELATED RENAL TRANSPLANT DONORS IN THE US IS CONSISTENT WITH ALTRUISTIC MOTIVATION

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

2162 END-DIASTOLIC VELOCITY/RESISTIVE INDEX AT NEUROVASCULAR BUNDLE VESSELS MIGHT BE A POTENTIAL MARKER FOR PROSTATE CANCER DETECTION AND RESISTIVE INDEX INCREASED WITH HIGHER GLEASON SCORE Yuh-Shyan Tsai*, Tzong-Shin Tzai, Chien-Cheng Chang, Wen-Horng Yang, Tainan, Taiwan INTRODUCTION AND OBJECTIVES: Our previous study has demonstrated the increased peak systolic velocity (PSV) and end diastolic velocity (EDV), and decreased resistive index (RI) of vessels of bilateral neurovascular bundles (NVB) measured with power Doppler ultrasonography were significantly associated with prostate cancer. Therefore, the aim of the study is to explore their diagnostic performance as compared with prostate-specific antigen (PSA) and their correlation with Gleason score. METHODS: From Jan., 2007 to Oct., 2009, 300 men with clinically suspicious prostate cancer (mean age, 69 years) were prospectively evaluated by power Doppler ultrasonography. Clinically suspicious prostate cancer patients who had either rinsing PSA (⬎ 4.0 ng/ml) or abnormal digital rectal examination (DRE) were categorized into benign or malignant disease according to transrectal ultrasoundguided biopsy report. The biopsy strategy is bilateral randomly six to ten biopsy cores. The values of PSV, EDV, and RI of bilateral NVB vessels were assessed by one investigator. The diagnostic performance of these parameters and EDV/RI were compared with PSA using the receiver operator characteristic (ROC) assay. Also, these parameters were explored for their correlation with Gleason score using Pearson’s Correlation. RESULTS: Biopsy results from 300 patients with clinically suspicious prostate cancer demonstrated that there were 90 with bilateral malignancy, 52 with unilateral malignancy, and 158 with benign diseases. The diagnostic performances of these parameters were illustrated as one figure (Figure 1). The area under the ROC curve and 95 % confidence interval of EDV/RI is comparable with PSA. Both of EDV/RI and PSA were better than any individual flow parameter. As for malignant half of the prostate, RI significantly increased with Gleason score (Pearson¡¦s correlation, 0.03), rather than PSV, EDV, or EDV/RI. CONCLUSIONS: Comparable with PSA, EDV/RI at neurovascular bundle vessels might be a potential marker for prostate cancer detection. RI may provide some information about the histological grading of prostate cancer.

Source of Funding: None

THE JOURNAL OF UROLOGY姞

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Transplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery II Podium 63 Wednesday, June 2, 2010

3:30 PM-5:30 PM

2163 THE SOCIOECONOMIC STATUS OF LIVING UNRELATED RENAL TRANSPLANT DONORS IN THE US IS CONSISTENT WITH ALTRUISTIC MOTIVATION John L. Gore*, Seattle, WA; Gabriel M. Danovitch, Arleen Brown, Jennifer S. Singer, Los Angeles, CA INTRODUCTION AND OBJECTIVES: The National Organ Transplant Act of 1984 prohibited the buying and selling of human organs for transplantation. In other countries, despite similar laws, ecologic evidence of large socioeconomic discrepancies between unrelated donor-recipient pairs suggests the possibility of subversive payment for donated organs. We sought to evaluate the presumption that living unrelated renal transplants (LURTS) in the US are performed for altruistic motives by examining differences in socioeconomic status (SES) in donor-recipient pairs. METHODS: We accessed the United Network for Organ Sharing research files to identify adult living donor renal transplant recipients transplanted between 1997-2007. We used a validated composite index (SESI) of the SES characteristics of the ZIP code of residence for each donor and recipient, derived from 2000 US Census Files. An index of 0 represented a patient living in a ZIP code with the median national SES. An index below 0 represented lower SES, and indices above 0 represented higher SES. We compared the SESI of living related and LURT pairs and examined factors associated with a large SESI difference (⬎ 3.0) with logistic regression. RESULTS: 51,057 subjects underwent live donor renal transplantation between 1997-2007, of whom 26,978 (53%) lived in higher SES ZIP codes than their donors (p⫽0.19 compared with related pairs). Although LURT donor-recipient pairs had a higher mean SES index difference (-0.18⫾3.61 vs 0.04⫾3.86, respectively), LURT pairs lived in higher SES ZIP codes than their related counterparts (SESI 0.33⫾3.61 and 0.51⫾3.74 for LURT donors and recipients; SESI -0.07⫾3.88 and -0.11⫾3.85 for related donors and recipients). Being in a LURT pair was associated with higher odds of having a large donor-recipient SESI difference among white recipients (OR 1.50, 95%CI 1.34-1.68, compared with OR 0.99, 95%CI 0.73-1.32 for African Americans, and OR 1.19, 95%CI 0.80-1.75 for Hispanics) and those recipients with at least some college education (OR 0.95, 95%CI 0.41-2.19 for those with less than a high schooled education, OR 1.20, 95%CI 0.98-1.43 for high school-educated recipients, OR 1.54, 95%CI 1.28-1.86 for those with some college, and OR 1.50, 95%CI 1.28-1.75 for those with at least a college degree). CONCLUSIONS: We did not identify large discrepancies between the SES of LURT donors and their recipients, suggesting that subversive payment does not confound US LURT. The finding that among certain recipient categories, SES differences tended to be larger requires further evaluation. Source of Funding: None