2194 DOES THE COST OF CONTINUOUS PULSATILE PERFUSION PRECLUDE ITS BENEFIT? THE UNMHSC EXPERIENCE WITH CONTINUOUS PULSATILE PERFUSION VERSUS STATIC COLD STORAGE OF DECEASED DONOR KIDNEYS

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THE JOURNAL OF UROLOGY姞

Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011

CONCLUSIONS: While pumped kidneys had longer CIT, DGF & LOS were not significantly increased; graft & patient survival were equivalent. Cost of stay with CPP was also not statistically different than SCS. Continuous pulsatile perfusions allows the utilization of higher medical risk donors with increased donor age & CIT without increasing cost or compromising clinical outcomes. Donor Characteristics Continuous pulsatile Standard Cold perfusion Storage (n⫽29) (n⫽71) 32.3⫹/⫺ 13.9 44.4 ⫹/⫺ 13.4

Age

p value p⫽0.0001

# females (%)

29 (40.9%)

11 (37.9%)

HTN

11 (15.5%)

7 (24.1%)

p⫽0.79 p⫽0.31

CVA

14 (19.7%)

12 (41.4%)

p⫽0.03

Cold Ischemia Time

16.1 ⫹/⫺ 6.8

24.2 ⫹/⫺ 9.0

p⬎0.0001

Cold Ischemia Time⬎⫽24 hours

12 (16.9%)

17 (58.6%)

p⬍0.0001

Renal Transplant Outcome with Pulsatile Perfusion versus Static Cold Storage Continuous Pulsatile Perfusion Static Cold # ⫽ 29 p value Storage #⫽71 Delayed Graft Function 14 (19.7%) 10 (34.5%) p⫽0.12

Source of Funding: None

2194 DOES THE COST OF CONTINUOUS PULSATILE PERFUSION PRECLUDE ITS BENEFIT? THE UNMHSC EXPERIENCE WITH CONTINUOUS PULSATILE PERFUSION VERSUS STATIC COLD STORAGE OF DECEASED DONOR KIDNEYS Hannah Kerr*, Michael Davis, D. Mark Menotti, Albert Liu, Susan Paine, Antonia Harford, Albuquerque, NM INTRODUCTION AND OBJECTIVES: Continuous pulsatile perfusion (CPP) enables the use of higher risk kidneys that would otherwise have to be discarded. We evaluated whether CPP impacted kidney allograft outcome, including patient and graft survival, renal function, delayed graft function, and hospital stay compared to static cold storage (SCS) deceased donor kidneys. We evaluated the additional cost involved with CPP of deceased donor kidneys and whether there is a cost benefit for this technology compared to SCS at our institution. METHODS: We retrospectively reviewed transplant outcomes at our center from 2008 to the present. Donor characteristics included cold ischemia time(CIT), CVA, gender, whether the kidney was CPP or SCS. Recipient characteristics included age, gender, and race/ ethnicity. Overall cost of hospital stay including charges of the transplant recipient from admission to discharge as well as donor acquisition charges were evaluated for both types of preservation. Outcomes included delayed graft function (DGF), length of hospital stay, allograft & patient survival, allograft function at 1, 3, & 12 months. Wilcox & student’s t-test were utilized to test for statistical differences using the SAS statistical program. RESULTS: From 2008 to the present, 71 transplants were performed with SCS & 29 with CPP. Donor characteristics are shown in Table 1. 28% of the CPP kidneys were expanded donors (EXP), none of the SCS were EXP. 26 of the 71 SCS transplants came from female donors (36.6%) compared to 8 of the 29 CPP kidneys (27.6%). There were more CVAs and longer CIT in the CPP donor group. Mean age of SCS recipients was 46.4 ⫹/⫺ 15.0 years ( range 8 –73.3); mean age of CPP recipients was 54.2 ⫹/⫺ 15.2 years ( range 14.1–78.2). The race/ ethnicity of the recipients in both groups was similar & reflected the preponderance of Native American & Hispanics in our community. Transplant outcomes and costs are shown in Table 2. The outcomes for 71 SCS and 29 CPP kidneys are shown. Cost data was available for 59 SCS and 29 CPP kidneys. While the all CPP transplants incurred an additional $5000 donor charge, total hospital charges were not statistically different.

8.7 ⫹/⫺ 4.0

10.7 ⫹/⫺ 6.5

p⫽0.15

1 Month Serum Creatinine (Mean⫽/⫺ SD)

1.24 ⫹/⫺ 0.39

1.38 ⫹/⫺ 0.36

p⫽0.10

3 Month Serum Creatinine (Mean⫽/⫺ SD)

1.18 ⫹/⫺ 0.36

1.37 ⫹/⫺ 0.37

p⫽0.03

6 Month Serum Creatinine (Mean⫽/⫺ SD)

1.18 ⫹/⫺ 0.40

1.42 ⫹/⫺ 0.56

p⫽0.05

12 Month Serum Creatinine (Mean⫽/⫺ SD)

1.16 ⫹/⫺ 0.35

1.40 ⫹/⫺ 0.52

p⫽0.11

94.4%

96.6%

p⫽0.65

1 Year Patient Survival

97%

100%

p⫽0.36

Cost of Hospital Stay(Median⫽/⫺ SD)

$ 237,108

$ 225,816

p⫽0.155

Length of Stay (Mean⫽/⫺ SD)

1 Year Graft Survival

Source of Funding: None

2195 EVALUATION OF POTENTIAL LIVE RENAL DONORS: CAUSES FOR DENIAL, DEFERRAL AND PLANNED PROCEDURE TYPE: A SINGLE CENTRE EXPERIENCE Nathan Perlis*, Maureen Connelly, John Honey, Kenneth Pace, Robert Stewart, Toronto, Canada INTRODUCTION AND OBJECTIVES: Renal transplantation is the preferred therapy to extend life expectancy and quality of life for patients with end-stage renal disease (ESRD). There are many barriers within the process of live kidney donation that may prevent the timely progression from organ requirement to transplantation. One of these barriers for donors is the anxiety surrounding the medical evaluation. We propose that if the medical evaluation process and expected outcomes were more transparent to patients they may be more willing to participate, and proceed more quickly through the workup. As inclusion criteria for potential kidney donors continue to broaden, we were also interested to compare our acceptance rates to previously published data. METHODS: We reviewed the minutes from our multi-disciplinary CT Angiography (CTA) rounds from 2002 to 2008 to assess how the CTA results and other medical and psychological findings were used to decide on the candidacy of potential donors. The reasons for exclusion, delay, or acceptance for kidney donation, and the proposed technique (right or left, laparoscopic or open, with or without vascular reconstruction) were recorded from the transcribed CTA-round minutes. RESULTS: Of 467 pts reviewed in CTA rounds, 48 (10.3%) were excluded as donors and 419 (89.7%) were accepted. Of those