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2310 KIDNEY DONOR RADIATION EXPOSURE PRIOR TO TRANSPLANTATION
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
THE JOURNAL OF UROLOGY姞
e947
mandates growth in volume confined by the current allocation scheme, larger waiting lists draw more organs for the individual center. We hypothesize that highly competitive regions will approve and wait-list more end-stage kidney disease (ESRD) candidates for transplant despite consistent incidence and prevalence of ESRD nationwide. METHODS: The most recent data was obtained from all transplant centers. Data reviewed included listing data, market saturation, market share, organs transplanted, and ESRD prevalence. HerfindahlHirschman Index (HHI) was used to measure the size of firms in relation to the industry to determine amount of competition. RESULTS: Each state was classified into one of three groups, defined as: HHI⬍1000 ⫽ competitive, HHI 1000-1800 ⫽ moderate competition, and HHI⬎1800 as highly concentrated. The percentage of all ESRD patients listed in competitive, moderate, and highly concentrated regions was found to be 19.73%, 17.02%, and 13.75% respectively. The ESRD listing difference between competitive versus highlyconcentrated is significant (p⬍0.05). CONCLUSIONS: When there is strong competition without a dominant center, the entire state will list more patients for transplant in an attempt to drive up their own market share. Despite a government mandate to ensure equitable access, our analysis suggests a discrepancy in access for medical care in ESRD patient which may be driven by financial factors of competition. Source of Funding: None Source of Funding: None
2311 2310 KIDNEY DONOR RADIATION EXPOSURE PRIOR TO TRANSPLANTATION David Culpepper*, Caroline Wallner, Gene Huang, Steven Engebretsen, Gaudencio Olgin, Don Arnold II, Jason Smith, D. Duane Baldwin, Loma Linda, CA INTRODUCTION AND OBJECTIVES: During the evaluation of potential kidney donors, every effort is made to protect these patients from experiencing unnecessary harm. Thus it is important for donor surgeons to understand the potential risks and radiation dosages associated with donor imaging studies. The purpose of this study is to characterize living donor radiation exposure. METHODS: A retrospective review of 363 donor nephrectomy patients evaluated over a 12-year period was performed. By protocol, each donor received a chest x-ray, nuclear renal scan, and 3-phase CT of the abdomen. Female patients greater than 40 years of age received screening mammograms. Patients with a smoking history underwent CT of the chest. Estimated effective dose (EED) was calculated for CT by multiplying the dose-length product (DLP) by standard conversion factors. EED for nuclear renal scans, mammograms, and chest x-rays were calculated using published values. Image modality with total EED and EED averages with yearly time points were correlated using Pearson’s correlation. RESULTS: Of the 363 donors, complete radiation parameters including DLP were available in 154 patients. Mean total effective dose was 29.4 mSv (SD 13.4), with 83.7% of exposure resulting from 3-phase CT of the abdomen (Table 1). A subset of donors evaluated (42.7%) received ⱖ 30 mSv, while 4.8% received ⱖ 50 mSv. Average radiation exposure decreased by 30.4% in the latest 6 years of the study period (correlation ⫽ -0.90) with changes in imaging protocol. CONCLUSIONS: Renal donors are exposed to significant levels of ionizing radiation with a mean that approaches the maximum occupational radiation exposure for nuclear workers of 30 mSv. Knowledge of the radiation exposure received by donors may allow transplant centers to more accurately counsel donors regarding risk and tailor imaging protocols to maximize patient safety.
RECIPIENT GRAFT FAILURE OR DEATH IMPACT ON LIVING KIDNEY DONOR QUALITY OF LIFE BASED UPON THE LIVING ORGAN DONOR NETWORK DATABASE Justin Watson*, Norfolk, VA; Martha Behnke, Richmond, VA; Michael Fabrizio, Virginia Beach, VA; Thomas McCune, Norfolk, VA INTRODUCTION AND OBJECTIVES: There is a paucity of prospective long term data on living kidney donor long term quality of life (QOL) outcomes. The Living Organ Donor Network (LODN) database follows donors longitudinally and when cross-referenced with United Network for Organ Sharing (UNOS) data, can be used to assess the effect of recipient graft failure and death on donor QOL. METHODS: The SF-36 was sent to donors 6 months after donation and yearly thereafter. Recipient outcomes were determined from the UNOS database. Included were all donors who donated before 12/31/10 and returned at least 2 QOL surveys. Of 2,204 donors consented, 311 were associated with a functioning graft and living recipient, 54 were associated with a non-functioning graft, 34 were associated with recipient death. The results were analyzed by Student’s t-test. RESULTS: Initial QOL scores were not different between donors whose recipients are alive with graft function, and those whose recipients later died (88.9 vs 89.6, p ⫽ 0.8). For donors whose recipient died, QOL in the year subsequent to recipient death was an average of 6 points lower than the initial QOL (89.6 vs 83.6, p ⫽ 0.04). 24 donors returned surveys an average of 2.9 years after their recipient’s death. Final QOL score averaged 4.1 points higher than right after recipient death (87.7). This improvement did not reach significance (p ⫽ 0.11), but is also not significantly lower than the original QOL. For 51 donors, the recipient’s graft failed more than 6 months after transplant. Their initial QOL was lower than the donors whose recipients are still alive with graft function (88.9 vs. 84.8, p⫽0.02) and donors whose recipients died ⬎6 months post-donation (89.4 vs 84.8, p ⫽ 0.07). Eight recipients had graft failure within 6 months of transplant, and the QOL responses for their donors was 77.9 (n.s.). Forty donors returned surveys in the year subsequent to their recipient’s graft failure and their QOL scores were unchanged (86.4 vs 84.4, p ⫽ 0.54). 19 of these donors returned future surveys and their final QOL scores were slightly, but not significantly, lower than at time of recipient graft failure (84.4 vs 81.7, p ⫽ 0.53). CONCLUSIONS: Donor QOL was negatively impacted by the death of their recipient, with an average 6-point drop in the year
THE JOURNAL OF UROLOGY姞
e947
mandates growth in volume confined by the current allocation scheme, larger waiting lists draw more organs for the individual center. We hypothesize that highly competitive regions will approve and wait-list more end-stage kidney disease (ESRD) candidates for transplant despite consistent incidence and prevalence of ESRD nationwide. METHODS: The most recent data was obtained from all transplant centers. Data reviewed included listing data, market saturation, market share, organs transplanted, and ESRD prevalence. HerfindahlHirschman Index (HHI) was used to measure the size of firms in relation to the industry to determine amount of competition. RESULTS: Each state was classified into one of three groups, defined as: HHI⬍1000 ⫽ competitive, HHI 1000-1800 ⫽ moderate competition, and HHI⬎1800 as highly concentrated. The percentage of all ESRD patients listed in competitive, moderate, and highly concentrated regions was found to be 19.73%, 17.02%, and 13.75% respectively. The ESRD listing difference between competitive versus highlyconcentrated is significant (p⬍0.05). CONCLUSIONS: When there is strong competition without a dominant center, the entire state will list more patients for transplant in an attempt to drive up their own market share. Despite a government mandate to ensure equitable access, our analysis suggests a discrepancy in access for medical care in ESRD patient which may be driven by financial factors of competition. Source of Funding: None Source of Funding: None
2311 2310 KIDNEY DONOR RADIATION EXPOSURE PRIOR TO TRANSPLANTATION David Culpepper*, Caroline Wallner, Gene Huang, Steven Engebretsen, Gaudencio Olgin, Don Arnold II, Jason Smith, D. Duane Baldwin, Loma Linda, CA INTRODUCTION AND OBJECTIVES: During the evaluation of potential kidney donors, every effort is made to protect these patients from experiencing unnecessary harm. Thus it is important for donor surgeons to understand the potential risks and radiation dosages associated with donor imaging studies. The purpose of this study is to characterize living donor radiation exposure. METHODS: A retrospective review of 363 donor nephrectomy patients evaluated over a 12-year period was performed. By protocol, each donor received a chest x-ray, nuclear renal scan, and 3-phase CT of the abdomen. Female patients greater than 40 years of age received screening mammograms. Patients with a smoking history underwent CT of the chest. Estimated effective dose (EED) was calculated for CT by multiplying the dose-length product (DLP) by standard conversion factors. EED for nuclear renal scans, mammograms, and chest x-rays were calculated using published values. Image modality with total EED and EED averages with yearly time points were correlated using Pearson’s correlation. RESULTS: Of the 363 donors, complete radiation parameters including DLP were available in 154 patients. Mean total effective dose was 29.4 mSv (SD 13.4), with 83.7% of exposure resulting from 3-phase CT of the abdomen (Table 1). A subset of donors evaluated (42.7%) received ⱖ 30 mSv, while 4.8% received ⱖ 50 mSv. Average radiation exposure decreased by 30.4% in the latest 6 years of the study period (correlation ⫽ -0.90) with changes in imaging protocol. CONCLUSIONS: Renal donors are exposed to significant levels of ionizing radiation with a mean that approaches the maximum occupational radiation exposure for nuclear workers of 30 mSv. Knowledge of the radiation exposure received by donors may allow transplant centers to more accurately counsel donors regarding risk and tailor imaging protocols to maximize patient safety.
RECIPIENT GRAFT FAILURE OR DEATH IMPACT ON LIVING KIDNEY DONOR QUALITY OF LIFE BASED UPON THE LIVING ORGAN DONOR NETWORK DATABASE Justin Watson*, Norfolk, VA; Martha Behnke, Richmond, VA; Michael Fabrizio, Virginia Beach, VA; Thomas McCune, Norfolk, VA INTRODUCTION AND OBJECTIVES: There is a paucity of prospective long term data on living kidney donor long term quality of life (QOL) outcomes. The Living Organ Donor Network (LODN) database follows donors longitudinally and when cross-referenced with United Network for Organ Sharing (UNOS) data, can be used to assess the effect of recipient graft failure and death on donor QOL. METHODS: The SF-36 was sent to donors 6 months after donation and yearly thereafter. Recipient outcomes were determined from the UNOS database. Included were all donors who donated before 12/31/10 and returned at least 2 QOL surveys. Of 2,204 donors consented, 311 were associated with a functioning graft and living recipient, 54 were associated with a non-functioning graft, 34 were associated with recipient death. The results were analyzed by Student’s t-test. RESULTS: Initial QOL scores were not different between donors whose recipients are alive with graft function, and those whose recipients later died (88.9 vs 89.6, p ⫽ 0.8). For donors whose recipient died, QOL in the year subsequent to recipient death was an average of 6 points lower than the initial QOL (89.6 vs 83.6, p ⫽ 0.04). 24 donors returned surveys an average of 2.9 years after their recipient’s death. Final QOL score averaged 4.1 points higher than right after recipient death (87.7). This improvement did not reach significance (p ⫽ 0.11), but is also not significantly lower than the original QOL. For 51 donors, the recipient’s graft failed more than 6 months after transplant. Their initial QOL was lower than the donors whose recipients are still alive with graft function (88.9 vs. 84.8, p⫽0.02) and donors whose recipients died ⬎6 months post-donation (89.4 vs 84.8, p ⫽ 0.07). Eight recipients had graft failure within 6 months of transplant, and the QOL responses for their donors was 77.9 (n.s.). Forty donors returned surveys in the year subsequent to their recipient’s graft failure and their QOL scores were unchanged (86.4 vs 84.4, p ⫽ 0.54). 19 of these donors returned future surveys and their final QOL scores were slightly, but not significantly, lower than at time of recipient graft failure (84.4 vs 81.7, p ⫽ 0.53). CONCLUSIONS: Donor QOL was negatively impacted by the death of their recipient, with an average 6-point drop in the year