792The incidence of de novo post-transplantation diabetes mellitus is threefold higher in Indo-Asian renal allograft recipients compared with matched Caucasian controls

790

789 PREOPERATIVE EVALUATION OF LIVING RENAL TRANSPLANT DONORS USING M A G N E T I C RESONANCE ANGIOGRAPHY: COMPARISON W I T H CONVENTIONAL ANGIOGRAPHY

MAGNETIC RESONANCE I M A G I N G OF LIVING RELATED KIDNEY D O N O R - AN ANALYSIS OF 111 CONSECUTIVE CASES Hodgson D. ~, Ahmad S. ~, Ranldn S. 2, Jan W.2, Koffman G. 3, Taylor j.3, Khan S. 1

Yoo E.S.1, Seo J.H.2, Lee J.W.2, Jung H.C.3, Kiln D.Y.4, Kwon T.G.~ 1Kytmgpook University Hospital, Urology, Daegu, South Korea, 2Gumi Cha Hospital, Urology, Daegu, South Korea, 3yeungnamUniversity,Urology, Daegu, South Korea, 4Daegu Catholic University, Urology, Daegu, South Korea INTRODUCTION & OBJECTIVES: This study evaluated the accuracy of magnetic resonance angiography(MRA) in a preoperative evaluation of living renal transplant donors (LRTDs) for visualizing the renal vascular anatomy with an emphasis on identifying the number of renal arteries and the presence of small branches and venous anomalies. MATERIAL & METHODS: From Aug. 2002 to Jul. 2004, a total of 45 potential living kidney donors were examined with contrast-enhancedMRA after conventional angiography (CRA). All candidates then underwent a hand assisted laparoscopic donor nephrectomy. The MRA were evaluated for the number of renal arteries, the presence of early arterial branching and vasculnr pathologies by two independent readers. The results were compared with those of MRA and intraoperative findings.

RESULTS: There was an overall agreementbetween CRA and MRA findings on the number of renal arteries (100%) and veins (98%). The overall accuracies for predicting the number of renal arteries compared to intraoperative findings were 96% for CRA and 96% for MRA, respectively. The CRA and MRA missed 1 accessory renal artery respectively. Despite the misdiagnosed cases, there was no significant intraoperative morbidity. The MRA revealed another lesion of a renal parenchyme, the urinary collecting system and other viscera. There were no significant complications in the process of both techniques. Of the 45 patients, CRA identified 29 patients with normal single arterial and venous anatomy, and concordance was fotmd at surgery in 27 of these patients. Vascular anomalies were depicted on CRA in 16 patients, with complete concordance at surgery in 14 patients. Thirty patients showed normal vasculature on MRA and concordance was found at surgery in 27 of these patients. Vascularanomalies were depicted on MRA in 15 patients, with complete concordance at surgery in 13 patients. The accuracies of CRA and MRA for revealing arterial anomalies were 95.6% and 93.3%, respectively. For the venous anomalies, CRA and MRA had accuracy of 93.3 % and 95.6%, respectively. No importantparenchymalor utereric anomalieswere identified at surgery or on MR imaging. CONCLUSIONS: A MRA appears to be as accurate as a CRA for visualizing the renal vascular anatomy in the preoperative assessmentof potential LRTDs.A MRA has the potential to be a good alternative to a CRA for assessingpotential LRTDs.

1Guy's Hospital, Urology, London, United Kingdom, 2Guy°s Hospital, Radiology, London, United Kingdom, SGuy's Hospital, Transplant, London, United Kingdom INTRODUCTION & OBJECTIVES: Prior to donor nephrectomy, information on the vascularture influences the choice of kidney. We have previously reported on the use of the non-invasive imaging modalities: single slice spiral CT angiography; and Gadolinium-enhanced MR Angiography, and the latter became our investigation of choice. We have now compared the information gained from 111 consecutive scans with the true anatomy, relating this to the complexity of surgery required at transplantation. MATERIAL & M E T H O D S : A retrospective case note study was performed on all patients between December 1999 and March 2004 who underwent MRI angiography prior to live renal donation. The MRI findings were compared with the anatomy seen at the time of surgery. Parameters studied were the number and origin of renal arteries and veins. RESULTS: 111 donors were scanned. There were 50 males and 61 females with an age range of 23-74. In the absence of any anatomic contraindication, the left kidney was chosen for donation in 82 (73.9%) cases. Arteries: 93 kidneys (83.8%) had one artery, and 18 kidneys (16.2%) had a single accessory artery, ten of which were considered of sufficient size to anastomose. Of the total of 129 arteries MRI visualised 120 (93.1%). Of the 9 accessory arteries not identified preoperatively, four were considered insignificant and were sacrificed, and four were anastomosed. One artery was inadvertently damaged at the time of donor nephrectomy. Veins: 98 (88.2%)patients had one renal vein. Of the 13 extra renal veins only 1 was anastomosed (not seen pre-operatively). Of the 12 vessels that were sacrificed, three were identified by MRI. CONCLUSIONS: MRI missed 9 out of 129 arteries, but only five were considered significant. MR angiography has the advantage over CT of virtually no side effects. However, in light of the failure to visualise all arteries transplanted, we have started to use multi-slice (16 channel) to see if its improved spatial resolution alters our results.

791 THE PURE LAPAROSCOPIC TRANSPERITONEAL APPROACH FOR LIVING DONOR KIDNEY EXPLANATATION - T H E CHARITI~ BERLIN EXPERIENCE W I T H M O R E T H A N 100 CASES

792 THE INCIDENCE OF DE NOVO POST-TRANSPLANTATION DIABETES M E L L I T U S IS T H R E E F O L D H I G H E R 1N INDO-ASIAN R E N A L ALLOGRAFT RECIPIENTS COMPARED WITH MATCHED CAUCASIAN CONTROLS

Giessing M., Deger S., Roigas J., Turk I., Schoenberger B., Loening S. Dooldeniya M. i, Dupunt p.z, Basra R. 2, He

X. 3,

Johnston A. 3, Warrens A. 2

Charit6 Hospital, Department of Urology, Berlin, Germany INTRODUCTION & OBJECTIVES: Laparoscopic living donor nephrectomy (LLDN), which was first performed 10 years ago, bears multiple advantages for the donor, like reduced blood loss, reduced pain, a shorter hospital stay and a better cosmesis. While it is practiced in many centres in the US, LLDN in Europe is performed in only a few centres yet. Technical development includes a hand-assisted approach, which is favoured by some urologists due to the tactile feedback. The department of Urology of the Charit6 Berlin has the strongest LLDD-program in Germany and one of the largest in Europe. We have started with a pure laparoscopic transperitoneal LLDNprogram in 1999 and performed more than 100 donor kidney retrievals with this minimal invasive approach. M A T E R I A L & METHODS: To elucidate the impact of this new surgical technique,

we analyzed the outcome for donors, graft and recipient in our LLDN-program. Also, the technical changes in laparoscopic organ procurement, like right kidney retrieval with preservation of full vein length and pure laparoscopic vs. hand-assisted approach will be discussed. RESULTS: Between February 1999 and October 2004 106 LLDN were performed in our institution. 89 left and 17 right kidneys were retrieved from 44 male and 62 female donors (median age 50.1 years] for 66 male and 40 female recipients [medium age 38.9 years]. 34 of the donor/recipient pairs were genetically unrelated, mean HLA mismatches were 3.26. Median warm ischemic time [WIT] was 137 seconds. Initial graft function was good with DGF in only 4 patients. After a median follow-up of 29.9 months graft survival is 94.4%, recipient survival 98%. Three ureteral complications occurred. Intraoeprative donor complications were due to insufficient closure of the vessels and necessitated conversion in 3 cases. Of the donors some reported problems with organ donation (hernia, affection of job, etc.), but most of them were happy with kidney donation, as we also found out in an additional study of donors Quality of Life. CONCLUSIONS: LLDN is a safe method with good functional results for donor and recipient. Criticism of LLDN referring to a supposed prolongued WIT is not justified. Due to the minimal trauma this method may increase the number of donors stepping forward. With laparoscopic techniques being performed more often in oncologic and reconstructive urologic surgery, LLDN-programs may increase in Europe in the future.

European Urology Supplements 4 (2005) No. 3, pp. 200

IHammersmith Hospitals NHS Trust, Urology, London, United Kingdom, 2Imperial College, Hammersmith, Immunology, London, United Kingdom, 3Barts and the London, Clinical Pharmacology, London, United Kingdom INTRODUCTION & OBJECTIVES: Indo-Asians have a higher incidence of diabetes mellitus (DM) and diabetic nephropathy when compared with other ethnic groups. De novo DM occurring post-transplantatiun (PTDM) has not been well studied in this population. We sought to define the incidence of PTDM in this ethnic group. MATERIAL & METHODS: We did this by a retrospective review of patients transplanted at Hammersmith Hospital from 1994 to 1998 (N=147). We also sought corroborative information from UK registry data. We used the LOTESS database of ciclosporin-treated renal allograft recipients spanning the period 1995 to 1998 (N=6,574). From this dataset we identified adult Caucasian (N=4262) and Indo-Asian (N=254) allograft recipients and reviewed their outcome following transplantation. RESULTS: Baseline clinical data and complete follow-up information were available for 139 patients. Of these 39 were Indo-Asian (defined as UK residents born in India, Pakistan or Bangladesh or whose parents had emigrated from that region) and 97 Caucasian. Median follow-up was 7.8 years. Baseline clinical characteristics, (including pre-existing DM) were similar for the two groups. When we looked at the LOTESS data for corroboration, at 5 years posttransplantation, there was a threefold increase in PTDM in the Indo-Asian group relative to Caucasian coholt controls (3.0% vs. 9.2%; p<0.05 Chi Squaretest). Patient and graft survival were similar in the two groups. At 5 years post-transplantation, the incidence of PTDM, was more than threefold higher in Indo-Asian allograft recipients than in Caucasian controls (1.62% vs. 5.51%; p<0.0001 Chi square test). Interestingly, cardiovascular complications at 5 years were not significantly increased (9.92% vs. 10.63%; p=0.72 Chi square test) nor was there a difference in patient or graft survival. CONCLUSIONS: Indo-Asian patients are at increased risk of developing PTDM. Immunosuppressive protocols with lesser diabetogenic potential (e.g. steroid-free regimes) may be of particular benefit in this ethnic group.