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2169 LAPAROENDOSCOPIC SINGLE SITE (LESS) VERSUS CONVENTIONAL LAPAROSCOPIC DONOR NEPHRECTOMY: PROSPECTIVE COMPARISON OF PERIOPERATIVE AND EARLY GRAFT OUTCOMES
e844
THE JOURNAL OF UROLOGY姞
Odds Ratio
Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010
95% CI
p-value
Recipient Diagnosis IgA Nephropathy
1.61
0.68, 3.83
0.28
Glomerulonephritis
1.06
0.96, 1.18
0.26
Diabetes
0.85
0.45, 1.60
0.62
Hypertension
0.79
0.27, 2.31
0.67
Polycystic Kidneys
0.71
0.29, 1.72
0.45
Glomerulosclerosis
0.38
0.09, 1.63
0.19
African American
1.40
0.98, 2.01
0.07
Hispanic
1.40
0.71, 2.76
0.34
Caucasian
1.19
0.66, 2.15
0.56
American Indian
0.22
0.03, 1.61
0.14
Recipient Male Gender
2.03
1.05, 3.91
0.035
African American Recipient
1.59
1.08, 2.34
0.020
Donor Age (per year)
1.03
1.00, 1.05
0.021
Recipient Ethnicity
Multinomial Model
1
Logarithmic transformation Table 2. Cox models of time to rejection within 1 year of transplantation Hazard Ratio 95% CI p-value Simple Model DGF/SGF vs IGF
3.62
2.16, 6.09
⬍0.0001
HLA MM ⬎31
2.97
1.34, 6.55
0.007
Pretransplant Dialysis
1.93
1.05, 3.54
0.03
Recipient Caucasian Race
1.88
1.01, 3.51
0.048
HLA Mistmatch
1.40
1.18, 1.66
⬍0.0001
Related D-R Pair
0.37
0.22, 0.61
⬍0.0001
Recipient Age
1.00
0.99, 1.02
0.63
1.00
0.62, 1.64
0.99
Recipient Age ⬎50
1
Serum Creatinine at Tx2
0.85
0.47, 1.52
0.58
Serum Creatinine at 1mo
1.12
0.94, 1.33
0.21
Recipient Male Gender1
0.69
0.43, 1.12
0.14
Recipient Diabetes
1.06
0.60, 1.86
0.84
Recipient Prior Transplant
1.29
0.64, 2.60
0.48
⬎1 Renal Artery
1.05
0.60, 1.85
0.86
Donor Age (per year)
1.01
0.99, 1.04
0.17
Donor Age ⬎50
1.36
0.82, 2.30
0.23
Donor BMI (kg/m2)2
1.00
0.25, 4.00
0.99
Donor Male Gender1
1.01
0.62, 1.66
0.97
Donor Right Kidney
0.83
0.38, 1.81
0.63
African American
0.93
0.68, 1.29
0.68
American Indian
0.24
0.33, 1.70
0.15
Hispanic
0.70
0.32, 1.53
0.37
Other
0.37
0.05, 2.63
0.32
DGF/SGF vs IGF
3.43
2.04, 5.77
⬍0.0001
Pretransplant Dialysis
1.94
1.05, 3.58
0.034
Related D-R Pair
0.40
0.24, 0.66
⬍0.0001
Caucasian Recipient
1.82
0.97, 3.42
0.064
Recipient Ethnicity
Multinomial Model
1
Variable violates proportional hazards assumption 2 Logarithmic transformation
Source of Funding: None
2169 LAPAROENDOSCOPIC SINGLE SITE (LESS) VERSUS CONVENTIONAL LAPAROSCOPIC DONOR NEPHRECTOMY: PROSPECTIVE COMPARISON OF PERIOPERATIVE AND EARLY GRAFT OUTCOMES Gerald Wang*, Elena Gimenez, James Wysock, Casey Ng, David Leeser, Sandip Kapur, Joseph Del Pizzo, New York, NY INTRODUCTION AND OBJECTIVES: Laparoendoscopic single site (LESS) surgery is a recent advance in minimally invasive
surgery that may have particular relevance to living donor nephrectomy (DN). While the benefits of laparoscopic DN (LDN) are well established and may have reduced some barriers to graft donation, kidney donors remain in short supply. Therefore, LESS-DN represents an important development with the potential to further reduce barriers to kidney donation. Here, we present a matched comparison of LESS-DN versus conventional LDN using a new single-port access system. METHODS: From August to October 2009, we performed 20 consecutive cases of LESS-DN using the new GelPoint™ system (Applied Medical, Rancho Santa Margarita, CA). A transumbilical approach was used through a 4-5 cm incision and no extra-umbilical incisions or punctures were made. Data was collected prospectively and compared to a matched cohort of 20 LDN performed by the same surgeons (JJD, DBL). RESULTS: LESS-DN was performed successfully in all 20 patients and each allograft demonstrated immediate function. There was no difference between the cohorts with regard to age, gender, BMI, anatomic complexity and surgical date. There was one conversion from LESS to conventional hand-assisted LDN for inability to maintain pneumoperitoneum. Operative time was longer in the LESS cohort (92 vs 78 min, p⫽0.8) and mean blood loss was lower in the LESS group (111 vs 122 mL, p⫽0.7) but neither was statistically significant. Warm ischemia time was longer in the LESS cohort (4 vs 3 min, p⫽0.3). There was a trend towards decreased visual analogue pain score in the LESS group but this was not statistically significant (1.4 vs 3.4, p⫽0.1). Length of stay was similar between the 2 groups (LESS 1.5 vs 1.8 days, p⫽0.2). There was one postoperative complication in the LESS cohort (wound infection). There was no difference in graft function between the 2 groups. Mean time to recipient creatinine ⬍ 3.0 mg/dL was 31 hrs for LESS-DN and 33 hrs for LDN (p⫽0.9). At time of discharge, recipient creatinine was 1.40 mg/dL for LESS-DN and 1.35 mg/dL for LDN (p⫽0.9). CONCLUSIONS: LESS-DN was performed successfully in 20 patients without additional extra-umbilical port sites and with one conversion to hand-assisted LDN. While the benefits of LESS-DN may be limited to decreased postoperative pain and improved cosmesis, this approach using the new GelPoint™ system demonstrates equivalent graft function and may nevertheless prove beneficial to further reduce barriers to kidney donation. Source of Funding: None
2170 NATIVE NEPHRECTOMY IN ADULT POLYCYSTIC KIDNEY DISEASE: PATIENTS TREATED WITH A STAGED APPROACH, WITH ONE KIDNEY REMOVED AT TRANSPLANTATION, HAVE BETTER OUTCOMES THAN THOSE UNDERGOING BILATERAL LAPAROSCOPIC NEPHRECTOMIES. Steven M Lucas*, Tobechukwu C Mofunanya, William C Goggins, Chandru P Sundaram, Indianapolis, IN INTRODUCTION AND OBJECTIVES: We compare the outcomes of bilateral nephrectomies in a single operation versus staged nephrectomies, one during transplant and the other via laparoscopic unilateral nephrectomy at another setting. METHODS: Patients with PKD requiring transplant and native bilateral nephrectomies performed 2003-2009 at Indiana University were reviewed. Indications for native nephrectomies included pain, symptoms from large kidneys, and infection. Operative time, blood loss, complications, open conversion, and transplant status were compared between bilateral and staged groups. Ipsilateral nephrectomy during transplant involves extending the Gibson incision upward by 3-4 cm. RESULTS: 38 patients were followed, with 15 unilateral nephrectomies during transplant, 19 transplants without concurrent nephrectomy, and 4 awaiting transplant. 17 patients had a unilateral laparoscopic native nephrectomy, while 21 had bilateral nephrectomies. Median follow-ups for unilateral and bilateral nephrectomies were 12.5 vs 37.3 mo (p ⫽ 0.01). There were no differences in the transplant versus transplant with unilateral nephrectomy groups in median age
THE JOURNAL OF UROLOGY姞
Odds Ratio
Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010
95% CI
p-value
Recipient Diagnosis IgA Nephropathy
1.61
0.68, 3.83
0.28
Glomerulonephritis
1.06
0.96, 1.18
0.26
Diabetes
0.85
0.45, 1.60
0.62
Hypertension
0.79
0.27, 2.31
0.67
Polycystic Kidneys
0.71
0.29, 1.72
0.45
Glomerulosclerosis
0.38
0.09, 1.63
0.19
African American
1.40
0.98, 2.01
0.07
Hispanic
1.40
0.71, 2.76
0.34
Caucasian
1.19
0.66, 2.15
0.56
American Indian
0.22
0.03, 1.61
0.14
Recipient Male Gender
2.03
1.05, 3.91
0.035
African American Recipient
1.59
1.08, 2.34
0.020
Donor Age (per year)
1.03
1.00, 1.05
0.021
Recipient Ethnicity
Multinomial Model
1
Logarithmic transformation Table 2. Cox models of time to rejection within 1 year of transplantation Hazard Ratio 95% CI p-value Simple Model DGF/SGF vs IGF
3.62
2.16, 6.09
⬍0.0001
HLA MM ⬎31
2.97
1.34, 6.55
0.007
Pretransplant Dialysis
1.93
1.05, 3.54
0.03
Recipient Caucasian Race
1.88
1.01, 3.51
0.048
HLA Mistmatch
1.40
1.18, 1.66
⬍0.0001
Related D-R Pair
0.37
0.22, 0.61
⬍0.0001
Recipient Age
1.00
0.99, 1.02
0.63
1.00
0.62, 1.64
0.99
Recipient Age ⬎50
1
Serum Creatinine at Tx2
0.85
0.47, 1.52
0.58
Serum Creatinine at 1mo
1.12
0.94, 1.33
0.21
Recipient Male Gender1
0.69
0.43, 1.12
0.14
Recipient Diabetes
1.06
0.60, 1.86
0.84
Recipient Prior Transplant
1.29
0.64, 2.60
0.48
⬎1 Renal Artery
1.05
0.60, 1.85
0.86
Donor Age (per year)
1.01
0.99, 1.04
0.17
Donor Age ⬎50
1.36
0.82, 2.30
0.23
Donor BMI (kg/m2)2
1.00
0.25, 4.00
0.99
Donor Male Gender1
1.01
0.62, 1.66
0.97
Donor Right Kidney
0.83
0.38, 1.81
0.63
African American
0.93
0.68, 1.29
0.68
American Indian
0.24
0.33, 1.70
0.15
Hispanic
0.70
0.32, 1.53
0.37
Other
0.37
0.05, 2.63
0.32
DGF/SGF vs IGF
3.43
2.04, 5.77
⬍0.0001
Pretransplant Dialysis
1.94
1.05, 3.58
0.034
Related D-R Pair
0.40
0.24, 0.66
⬍0.0001
Caucasian Recipient
1.82
0.97, 3.42
0.064
Recipient Ethnicity
Multinomial Model
1
Variable violates proportional hazards assumption 2 Logarithmic transformation
Source of Funding: None
2169 LAPAROENDOSCOPIC SINGLE SITE (LESS) VERSUS CONVENTIONAL LAPAROSCOPIC DONOR NEPHRECTOMY: PROSPECTIVE COMPARISON OF PERIOPERATIVE AND EARLY GRAFT OUTCOMES Gerald Wang*, Elena Gimenez, James Wysock, Casey Ng, David Leeser, Sandip Kapur, Joseph Del Pizzo, New York, NY INTRODUCTION AND OBJECTIVES: Laparoendoscopic single site (LESS) surgery is a recent advance in minimally invasive
surgery that may have particular relevance to living donor nephrectomy (DN). While the benefits of laparoscopic DN (LDN) are well established and may have reduced some barriers to graft donation, kidney donors remain in short supply. Therefore, LESS-DN represents an important development with the potential to further reduce barriers to kidney donation. Here, we present a matched comparison of LESS-DN versus conventional LDN using a new single-port access system. METHODS: From August to October 2009, we performed 20 consecutive cases of LESS-DN using the new GelPoint™ system (Applied Medical, Rancho Santa Margarita, CA). A transumbilical approach was used through a 4-5 cm incision and no extra-umbilical incisions or punctures were made. Data was collected prospectively and compared to a matched cohort of 20 LDN performed by the same surgeons (JJD, DBL). RESULTS: LESS-DN was performed successfully in all 20 patients and each allograft demonstrated immediate function. There was no difference between the cohorts with regard to age, gender, BMI, anatomic complexity and surgical date. There was one conversion from LESS to conventional hand-assisted LDN for inability to maintain pneumoperitoneum. Operative time was longer in the LESS cohort (92 vs 78 min, p⫽0.8) and mean blood loss was lower in the LESS group (111 vs 122 mL, p⫽0.7) but neither was statistically significant. Warm ischemia time was longer in the LESS cohort (4 vs 3 min, p⫽0.3). There was a trend towards decreased visual analogue pain score in the LESS group but this was not statistically significant (1.4 vs 3.4, p⫽0.1). Length of stay was similar between the 2 groups (LESS 1.5 vs 1.8 days, p⫽0.2). There was one postoperative complication in the LESS cohort (wound infection). There was no difference in graft function between the 2 groups. Mean time to recipient creatinine ⬍ 3.0 mg/dL was 31 hrs for LESS-DN and 33 hrs for LDN (p⫽0.9). At time of discharge, recipient creatinine was 1.40 mg/dL for LESS-DN and 1.35 mg/dL for LDN (p⫽0.9). CONCLUSIONS: LESS-DN was performed successfully in 20 patients without additional extra-umbilical port sites and with one conversion to hand-assisted LDN. While the benefits of LESS-DN may be limited to decreased postoperative pain and improved cosmesis, this approach using the new GelPoint™ system demonstrates equivalent graft function and may nevertheless prove beneficial to further reduce barriers to kidney donation. Source of Funding: None
2170 NATIVE NEPHRECTOMY IN ADULT POLYCYSTIC KIDNEY DISEASE: PATIENTS TREATED WITH A STAGED APPROACH, WITH ONE KIDNEY REMOVED AT TRANSPLANTATION, HAVE BETTER OUTCOMES THAN THOSE UNDERGOING BILATERAL LAPAROSCOPIC NEPHRECTOMIES. Steven M Lucas*, Tobechukwu C Mofunanya, William C Goggins, Chandru P Sundaram, Indianapolis, IN INTRODUCTION AND OBJECTIVES: We compare the outcomes of bilateral nephrectomies in a single operation versus staged nephrectomies, one during transplant and the other via laparoscopic unilateral nephrectomy at another setting. METHODS: Patients with PKD requiring transplant and native bilateral nephrectomies performed 2003-2009 at Indiana University were reviewed. Indications for native nephrectomies included pain, symptoms from large kidneys, and infection. Operative time, blood loss, complications, open conversion, and transplant status were compared between bilateral and staged groups. Ipsilateral nephrectomy during transplant involves extending the Gibson incision upward by 3-4 cm. RESULTS: 38 patients were followed, with 15 unilateral nephrectomies during transplant, 19 transplants without concurrent nephrectomy, and 4 awaiting transplant. 17 patients had a unilateral laparoscopic native nephrectomy, while 21 had bilateral nephrectomies. Median follow-ups for unilateral and bilateral nephrectomies were 12.5 vs 37.3 mo (p ⫽ 0.01). There were no differences in the transplant versus transplant with unilateral nephrectomy groups in median age