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Can the DJ stent be dispensed? A prospective randomised study in renal transplant recipients
indian journal of transplantation 9 (2015) 47–60
multivariate analysis of all parameters, CIMT correlated only with age (b = 0.238, p = 0.03) and eGFR (b = 0.248, p = 0.01). Conclusions: Higher burden of NTRFs and increased CIMT was noted in stable post-transplant patients. Factors influencing this high atherosclerotic profile need to be delineated. http://dx.doi.org/10.1016/j.ijt.2015.09.026 Abstract #: ISOT2015-71 An increased P-glycoprotein positive Th17 cell is associated with late renal allograft dysfunction Brijesh Yadav, Narayan Prasad, Vikas Agarwal Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India Background: Th17 is a proinflamatory subsets remained refractory under calcineurin inhibitor based immunosuppressive regimen. Although etiology is unknown. Recent studies have suggested, Th17 have pleotropic function, induce plasma cell antibody secretion, neutrophil recruitment, IL-17A induces pulmonary, lung fibrosis. Permeable glycoprotein (Pgp) is a trans-membrane glycoprotein efflux xenobiotics, cytokines, and immunosuppressive regimen from the cytoplasm and limits their bioavailability to cell. Aims: To determine the circulating frequency of Th17, Pgp + Th17, soluble IL-17A level and their correlation with renal graft functions parameters (24 hrs Proteinuria, Serum creatinine level, eGFR). Methodology: Twenty five patients with stable graft function (SGF) (> 10% rise in serum creatinine level from baseline which was stable in last six month, No evidence of active proteinuria). Twenty five patients were of active late renal allograft dysfunction (LAD), showing serum creatinine >1.5 mg/dl, nephrotic range proteinuria, were recruited in study. Blood sample was withdrawn for flow cytometry frequency determination and IL-17 level by ELISA assay. The mean values in different groups were compared with Man Whitney U test for continuous variables and Chi square test for categorical variables. Pearson correlation was applied for correlation analysis. Results: The %frequency of circulating CD4+Th cell was significantly high in LAD (34.97 5.10%) compare to SGF (31.71 3.49; P = 0.011). Th17 (CD4+IL 17A+) cell in LAD was (7.16 1.96) compare to SGF (4.12 1.57; P < 0.001). The serum IL17A level (pg/ml) in LAD was (87.56 18.77) compare to SGF (32.54 8.65; P < 0.001). The ratio of Th17/CD4+Th cell in LAD was (0.210 0.069), compare to that of SGF (0.130 0.051; P < 0.001). Similarly, the frequency of Pgp+CD4+Th cell in LAD was (17.02 6.96) compare to SGF (12.28 4.14; P = 0.005). Frequency of Pgp+Th17 (Pgp+IL-17A+ CD4+ triple positive) cell in LAD was (2.49 1.06) compare to SGF (0.982 0.66; P < 0.001), Serum creatinine was positively correlating with Th17 (r = 0.529, P < 0.001), Pgp+Th17 (r = 0.392, P = 0.005), 24 hrs proteinuria with Th17 (r = 0.614, P < 0.001) cell, Pgp +Th17 (r = 0.656, P < 0.001).(eGFR) was negatively correlating with Th17 cell (r = 0.545, P < 0.001), Pgp+Th17 cell (r = 0.382, P = 0.006). Conclusions: Higher Pgp expression on Th17 cell surface may be the cause of Th17 cell dysregulation and chronic allograft dysfunction. An inhibition of Pgp together with immunosuppressive medicine may be used to treat Th17 mediated allograft dysfunction. http://dx.doi.org/10.1016/j.ijt.2015.09.027 Abstract #: ISOT2015-40 Antibody mediated rejection of renal transplantation – Clinicopathological correlation
57
Bavikar Suhas, Oswal Ajay, Swarnalata Gowrishankar Kamalnayan Bajaj Hospital, Aurangabad, Apollo Hospital, Hyderabad, India Background: kidney transplant rejection is classified as cellular, humoral or mixed. Definitive diagnosis of antibodymediated rejection was made if some of the 3 observations were noted but not all were present: (1) Morphological evidence of tissue injury. (2) PTC C4d positivity – immunopathologic evidence for antibody action. (3) Serologic evidence for circulating donor specific antibody. Antibody mediated rejections with DSA positivity behaved differently to treatment. Aims: Treatment responders and nonresponders were analysed for clinical presentations, DSA titres, intervention, and histopathologicaly in ABMR in retrospective fashion in 138 cases over 3 year 2010–2013. Methodology: Antibody mediated (C4d positive and DSA by luminex positive, C4d positive – DSA negative, DSA+ and c4d –ve?) rejection vs T cell mediated rejection in 81 graft biopsies done over 3 year in 138 kidney transplant recipients – were compared for treatment outcomes in retrospective fashion indications for biopsy after kidney transplant were (1) persistent Proteinuria, Decrease in GFR on (nuclear scan); (2) rise in Creatinine after reaching Nadir, (3) oliguria after transplant, biopsy diagnosis were classified into C4d positive vs negative rejections. Effective treatment given was methylprednisolone 500 mg daily for 3 days started on suspicion of rejection, sending for graft biopsy with c4d staining in all before first dose of pulse steroids. C4d staining positive cases with positive DSA in 3 first 30 post-operative day period cases recd. rabbit thymoglobulin 3 mg/kg over 3 days and 5 mg/kg over 5 days in one case. All these patients recovered. Results: Outcome in early ABMR was good with steroids, RATG, TPE. Favourable histology feature was leukocytes in PTC and changes of ATN as against interstitial n vascular inflammation in late ABMR, and TGP, IFTA in chronic ABMR. DSA involved in early group were/PREEXISTING (NOT done before KT). In late and chronic ABMR-DSA were de novo observed in 50% cases before rejection. Grafts could not be salvaged in late acute ABMR, even with TPE, Steroid and RATG pulse. In chronic ABMR treatment did not make any difference with higher titres >10,000 MFI values. Titres with <6000 MFI cases benefited after TPE, steroid pulse and bortezomib as their albuminria and creeping creatinine stabilised. Conclusions: Lack of correlation between DSA,C4d. graft biopsy and response to treatment Response to treatment is a matter of timely intervention If all patients were tested for pretransplant LCM by CDC, flow and DSA by Luminex cross match, Early ABMR could have been predicted, prevented. http://dx.doi.org/10.1016/j.ijt.2015.09.028 Abstract #: ISOT2015-39 Can the DJ stent be dispensed? A prospective randomised study in renal transplant recipients L.N. Murthy, Charan Srinivas, Rahul Devraj, Vidyasagar Ramachandraih, Ramreddy Department of Urology & Renal Transplantation, Nizam's Institute of Medical Sciences Hyderabad, India Background: The use of prophylactic double-J ureteric stent during renal transplantation is debatable. There were studies in literature in favor and against to routine stenting during ureteroneocystostomy. The authors who favor stenting claim that the incidence of urological complications were reduced and thereby decreasing the post op morbidity. On the Contrary, some studies showed routine stenting is unnecessary as
58
indian journal of transplantation 9 (2015) 47–60
it adds to the cost and complications. We performed a prospective randomized controlled stent. Aims: To find out whether a DJ stent can be dispensed in live transplant surgery. Methodology: One hundred and seventy six consecutive patients waiting for live related renal transplantation were recruited in this study between November 2012 and July 2015 at our centre. Based on computerized randomization using Ran between function of Microsoft Excel, Indexed patients underwent transplant surgery with and without a DJ stent. Ureteroneocystostomy performed by modified Lich-Gregoir technique using 6-0 double arm PDS suture with (85 patients) and without a DJ stent (85 patients) based on computerized randomization One hundred and seventy patients were evaluated in the immediate post op and at the end of 4,12 and 24 weeks post operatively for urological complication. Urine culture, serum creatinine, ultrasound examination of the graft and Doppler studies were performed as per the protocol. DJ stent was removed at the end of 4 weeks. Six patients were excluded from the study as they did not fulfil the criteria. Results: A total of 170 patients,85 pts. without a stent and 85 pts. with a stent were evaluated for urological complications like urinary tract infection, urinary leak and ureteric obstruction postoperatively. There was no statistically significant difference noticed between the two groups. Conclusions: Prophylactic DJ stenting is not mandatory and the incidence of urinary tract infection was same in both groups. http://dx.doi.org/10.1016/j.ijt.2015.09.029 Abstract #: ISOT2015-30 Response of antiblood group antibodies to desensitization procedures & kidney transplantation Prashant Rajput, Bharat Shah, Zaheer Virani Institute of Renal Sciences, Global Hospital, Mumbai, India Background: ABO-incompatible (ABOi) kidney transplantation (KT) is an important option for overcoming the shortage of organ donors. In recent years, performing transplant after reducing anti-blood group antibody titers (ABGAT) by desensitization protocols has yielded results that are comparable to or better than ABO-compatible KT. Aims: To determine: (1) baseline ABGAT in our patients undergoing ABOi KT, (2) response of ABGAT to desensitization procedures and (3) behavior of ABGAT after transplantation. Methodology: Nineteen (13 male and 6 female) ABO-I patients (6-O, 8-A and 5-B blood groups) have been studied. The IgG and IgM ABGAT were determined using column agglutination technique (CAT). Desensitization was attempted if baseline IgG ABGAT >1:32. For desensitization, besides rituximab, plasmapheresis and/or Glycosorb column was used. Desensitization was considered successful if IgG ABGAT dropped to <1:32. ABGAT were monitored daily or alternate days for 1 week after transplant, twice a week in the second week and weekly for next 2 weeks. Results: The baseline IgG antibody titres ranged from 1:4 to >1:512 (median 1:64) while IgM antibody titres ranged from 1:2 to >1:512, (median 1:32). In one case with baseline titre <1:4 no desensitization was done. In 15 cases, plasmapharesis alone was attempted. In 3 of these cases (with baseline titre >1:512), the titres could not be reduced to <1:32 and transplant was not done. Based on this experience, we used Glycosorb with or without plasmapharesis in next 3 cases with titres >1:512. All of these 3 cases could be desensitized. Of the 16 patients who were transplanted, the titres remained <1: 64 (median 1:8) after transplant in 15. None of them required plasmapharesis or Glycosorb treatment after transplant. In one patient, IgG ABGAT rose to >1:128 in the first week after transplant. Biopsy
was done which was suggestive of acute antibody mediated rejection. This was treated with PP, Rituximab and Bortezomib. He rapidly improved and his titres remain 1:64 Conclusions: Our study shows that majority of our patients have low baseline ABGAT. In these cases with low ABGAT, Rituximab (2 doses of 200 mg weekly) and 2 to 3 sessions of plasmapharesis bring down titres to <1:32. For those with baseline titres >1:512, use of Glycosorb column may be required. http://dx.doi.org/10.1016/j.ijt.2015.09.030 Abstract #: ISOT2015-76 The learning curve of retroperitoneoscopic donor nephrectomy Bipin Chandra Pal, Pranjal R. Modi, Syed Jamal Rizvi Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Ahmedabad, India Background: Since its introduction in 1995 Laparoscopic donor nephrectomy has been established as the standard of surgery for the procurement of kidneys for kidney transplant. It improves the morbidity and shortens the convalescence period. Retroperitoneoscopic living donor nephrectomy further has the intraoperative advantage of direct access to the renal pedicles besides avoiding. Aims: To assess the learning curve of pure retroperitoneoscopic living donor nephrectomy (RLDN). Methodology: Between August 2012 and April 2015 102 voluntary kidney donors underwent RLDN by a single laparoscopic surgeon. These 102 donors were classified into 3 groups in the order in which they underwent the RLDN. Group A (1–34), Group B (35–68) and group C (69–102). The clinical perioperative data was obtained for each group. The data was entered in SPSS 20 for statistical analysis. One Way ANOVA and Kruskal– Wallis test have been used to calculate statistically significant value i.e. P-value. Chi Square test and Fisher Exact test have been used for categorical data. P-value <0.05 considered to be statistically significant difference. Results: The demographic variables of age, gender and BMI did not differ significantly between the three groups. RRDN was performed in 6 (21%), 9 (36%) and 6 (21%) cases of group A, B and C respectively. Double renal arteries were present in 3, 6 and 11 cases in group A, Band C respectively. Circumaortic vein was observed in two cases of group A and one case each of group Band C. Retro aortic vein was observed in two cases each of group B and C. Duplication of IVC was seen in one case of group B. The difference was statistically significant for operative time and the warm ischemia time. The mean operative time in group A, B& C was 295.59 42.81 min, 252.65 45.55 min and 216.18 42.71 min, respectively. Warm ischemia time showed a decreasing trend and was 231.76 96.22 for group A, 201.67 45.39 for group B and 187.71 68.00 for group C, respectively. Conclusions: Retroperitoneoscopic donor nephrectomy is a very important armamentarium for the transplant surgeon and has a learning curve of 40 cases. http://dx.doi.org/10.1016/j.ijt.2015.09.031 Abstract #: ISOT2015-7 Impact of transfer process on PaO2/FiO2 ratio in brain dead potential donors and effect of recruitment maneuver on its reversal: A controlled clinical trial Meysam Mojtabaee, Farahnaz Sadegh Beygi Lung Transplantation Research Center, Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
multivariate analysis of all parameters, CIMT correlated only with age (b = 0.238, p = 0.03) and eGFR (b = 0.248, p = 0.01). Conclusions: Higher burden of NTRFs and increased CIMT was noted in stable post-transplant patients. Factors influencing this high atherosclerotic profile need to be delineated. http://dx.doi.org/10.1016/j.ijt.2015.09.026 Abstract #: ISOT2015-71 An increased P-glycoprotein positive Th17 cell is associated with late renal allograft dysfunction Brijesh Yadav, Narayan Prasad, Vikas Agarwal Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India Background: Th17 is a proinflamatory subsets remained refractory under calcineurin inhibitor based immunosuppressive regimen. Although etiology is unknown. Recent studies have suggested, Th17 have pleotropic function, induce plasma cell antibody secretion, neutrophil recruitment, IL-17A induces pulmonary, lung fibrosis. Permeable glycoprotein (Pgp) is a trans-membrane glycoprotein efflux xenobiotics, cytokines, and immunosuppressive regimen from the cytoplasm and limits their bioavailability to cell. Aims: To determine the circulating frequency of Th17, Pgp + Th17, soluble IL-17A level and their correlation with renal graft functions parameters (24 hrs Proteinuria, Serum creatinine level, eGFR). Methodology: Twenty five patients with stable graft function (SGF) (> 10% rise in serum creatinine level from baseline which was stable in last six month, No evidence of active proteinuria). Twenty five patients were of active late renal allograft dysfunction (LAD), showing serum creatinine >1.5 mg/dl, nephrotic range proteinuria, were recruited in study. Blood sample was withdrawn for flow cytometry frequency determination and IL-17 level by ELISA assay. The mean values in different groups were compared with Man Whitney U test for continuous variables and Chi square test for categorical variables. Pearson correlation was applied for correlation analysis. Results: The %frequency of circulating CD4+Th cell was significantly high in LAD (34.97 5.10%) compare to SGF (31.71 3.49; P = 0.011). Th17 (CD4+IL 17A+) cell in LAD was (7.16 1.96) compare to SGF (4.12 1.57; P < 0.001). The serum IL17A level (pg/ml) in LAD was (87.56 18.77) compare to SGF (32.54 8.65; P < 0.001). The ratio of Th17/CD4+Th cell in LAD was (0.210 0.069), compare to that of SGF (0.130 0.051; P < 0.001). Similarly, the frequency of Pgp+CD4+Th cell in LAD was (17.02 6.96) compare to SGF (12.28 4.14; P = 0.005). Frequency of Pgp+Th17 (Pgp+IL-17A+ CD4+ triple positive) cell in LAD was (2.49 1.06) compare to SGF (0.982 0.66; P < 0.001), Serum creatinine was positively correlating with Th17 (r = 0.529, P < 0.001), Pgp+Th17 (r = 0.392, P = 0.005), 24 hrs proteinuria with Th17 (r = 0.614, P < 0.001) cell, Pgp +Th17 (r = 0.656, P < 0.001).(eGFR) was negatively correlating with Th17 cell (r = 0.545, P < 0.001), Pgp+Th17 cell (r = 0.382, P = 0.006). Conclusions: Higher Pgp expression on Th17 cell surface may be the cause of Th17 cell dysregulation and chronic allograft dysfunction. An inhibition of Pgp together with immunosuppressive medicine may be used to treat Th17 mediated allograft dysfunction. http://dx.doi.org/10.1016/j.ijt.2015.09.027 Abstract #: ISOT2015-40 Antibody mediated rejection of renal transplantation – Clinicopathological correlation
57
Bavikar Suhas, Oswal Ajay, Swarnalata Gowrishankar Kamalnayan Bajaj Hospital, Aurangabad, Apollo Hospital, Hyderabad, India Background: kidney transplant rejection is classified as cellular, humoral or mixed. Definitive diagnosis of antibodymediated rejection was made if some of the 3 observations were noted but not all were present: (1) Morphological evidence of tissue injury. (2) PTC C4d positivity – immunopathologic evidence for antibody action. (3) Serologic evidence for circulating donor specific antibody. Antibody mediated rejections with DSA positivity behaved differently to treatment. Aims: Treatment responders and nonresponders were analysed for clinical presentations, DSA titres, intervention, and histopathologicaly in ABMR in retrospective fashion in 138 cases over 3 year 2010–2013. Methodology: Antibody mediated (C4d positive and DSA by luminex positive, C4d positive – DSA negative, DSA+ and c4d –ve?) rejection vs T cell mediated rejection in 81 graft biopsies done over 3 year in 138 kidney transplant recipients – were compared for treatment outcomes in retrospective fashion indications for biopsy after kidney transplant were (1) persistent Proteinuria, Decrease in GFR on (nuclear scan); (2) rise in Creatinine after reaching Nadir, (3) oliguria after transplant, biopsy diagnosis were classified into C4d positive vs negative rejections. Effective treatment given was methylprednisolone 500 mg daily for 3 days started on suspicion of rejection, sending for graft biopsy with c4d staining in all before first dose of pulse steroids. C4d staining positive cases with positive DSA in 3 first 30 post-operative day period cases recd. rabbit thymoglobulin 3 mg/kg over 3 days and 5 mg/kg over 5 days in one case. All these patients recovered. Results: Outcome in early ABMR was good with steroids, RATG, TPE. Favourable histology feature was leukocytes in PTC and changes of ATN as against interstitial n vascular inflammation in late ABMR, and TGP, IFTA in chronic ABMR. DSA involved in early group were/PREEXISTING (NOT done before KT). In late and chronic ABMR-DSA were de novo observed in 50% cases before rejection. Grafts could not be salvaged in late acute ABMR, even with TPE, Steroid and RATG pulse. In chronic ABMR treatment did not make any difference with higher titres >10,000 MFI values. Titres with <6000 MFI cases benefited after TPE, steroid pulse and bortezomib as their albuminria and creeping creatinine stabilised. Conclusions: Lack of correlation between DSA,C4d. graft biopsy and response to treatment Response to treatment is a matter of timely intervention If all patients were tested for pretransplant LCM by CDC, flow and DSA by Luminex cross match, Early ABMR could have been predicted, prevented. http://dx.doi.org/10.1016/j.ijt.2015.09.028 Abstract #: ISOT2015-39 Can the DJ stent be dispensed? A prospective randomised study in renal transplant recipients L.N. Murthy, Charan Srinivas, Rahul Devraj, Vidyasagar Ramachandraih, Ramreddy Department of Urology & Renal Transplantation, Nizam's Institute of Medical Sciences Hyderabad, India Background: The use of prophylactic double-J ureteric stent during renal transplantation is debatable. There were studies in literature in favor and against to routine stenting during ureteroneocystostomy. The authors who favor stenting claim that the incidence of urological complications were reduced and thereby decreasing the post op morbidity. On the Contrary, some studies showed routine stenting is unnecessary as
58
indian journal of transplantation 9 (2015) 47–60
it adds to the cost and complications. We performed a prospective randomized controlled stent. Aims: To find out whether a DJ stent can be dispensed in live transplant surgery. Methodology: One hundred and seventy six consecutive patients waiting for live related renal transplantation were recruited in this study between November 2012 and July 2015 at our centre. Based on computerized randomization using Ran between function of Microsoft Excel, Indexed patients underwent transplant surgery with and without a DJ stent. Ureteroneocystostomy performed by modified Lich-Gregoir technique using 6-0 double arm PDS suture with (85 patients) and without a DJ stent (85 patients) based on computerized randomization One hundred and seventy patients were evaluated in the immediate post op and at the end of 4,12 and 24 weeks post operatively for urological complication. Urine culture, serum creatinine, ultrasound examination of the graft and Doppler studies were performed as per the protocol. DJ stent was removed at the end of 4 weeks. Six patients were excluded from the study as they did not fulfil the criteria. Results: A total of 170 patients,85 pts. without a stent and 85 pts. with a stent were evaluated for urological complications like urinary tract infection, urinary leak and ureteric obstruction postoperatively. There was no statistically significant difference noticed between the two groups. Conclusions: Prophylactic DJ stenting is not mandatory and the incidence of urinary tract infection was same in both groups. http://dx.doi.org/10.1016/j.ijt.2015.09.029 Abstract #: ISOT2015-30 Response of antiblood group antibodies to desensitization procedures & kidney transplantation Prashant Rajput, Bharat Shah, Zaheer Virani Institute of Renal Sciences, Global Hospital, Mumbai, India Background: ABO-incompatible (ABOi) kidney transplantation (KT) is an important option for overcoming the shortage of organ donors. In recent years, performing transplant after reducing anti-blood group antibody titers (ABGAT) by desensitization protocols has yielded results that are comparable to or better than ABO-compatible KT. Aims: To determine: (1) baseline ABGAT in our patients undergoing ABOi KT, (2) response of ABGAT to desensitization procedures and (3) behavior of ABGAT after transplantation. Methodology: Nineteen (13 male and 6 female) ABO-I patients (6-O, 8-A and 5-B blood groups) have been studied. The IgG and IgM ABGAT were determined using column agglutination technique (CAT). Desensitization was attempted if baseline IgG ABGAT >1:32. For desensitization, besides rituximab, plasmapheresis and/or Glycosorb column was used. Desensitization was considered successful if IgG ABGAT dropped to <1:32. ABGAT were monitored daily or alternate days for 1 week after transplant, twice a week in the second week and weekly for next 2 weeks. Results: The baseline IgG antibody titres ranged from 1:4 to >1:512 (median 1:64) while IgM antibody titres ranged from 1:2 to >1:512, (median 1:32). In one case with baseline titre <1:4 no desensitization was done. In 15 cases, plasmapharesis alone was attempted. In 3 of these cases (with baseline titre >1:512), the titres could not be reduced to <1:32 and transplant was not done. Based on this experience, we used Glycosorb with or without plasmapharesis in next 3 cases with titres >1:512. All of these 3 cases could be desensitized. Of the 16 patients who were transplanted, the titres remained <1: 64 (median 1:8) after transplant in 15. None of them required plasmapharesis or Glycosorb treatment after transplant. In one patient, IgG ABGAT rose to >1:128 in the first week after transplant. Biopsy
was done which was suggestive of acute antibody mediated rejection. This was treated with PP, Rituximab and Bortezomib. He rapidly improved and his titres remain 1:64 Conclusions: Our study shows that majority of our patients have low baseline ABGAT. In these cases with low ABGAT, Rituximab (2 doses of 200 mg weekly) and 2 to 3 sessions of plasmapharesis bring down titres to <1:32. For those with baseline titres >1:512, use of Glycosorb column may be required. http://dx.doi.org/10.1016/j.ijt.2015.09.030 Abstract #: ISOT2015-76 The learning curve of retroperitoneoscopic donor nephrectomy Bipin Chandra Pal, Pranjal R. Modi, Syed Jamal Rizvi Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Ahmedabad, India Background: Since its introduction in 1995 Laparoscopic donor nephrectomy has been established as the standard of surgery for the procurement of kidneys for kidney transplant. It improves the morbidity and shortens the convalescence period. Retroperitoneoscopic living donor nephrectomy further has the intraoperative advantage of direct access to the renal pedicles besides avoiding. Aims: To assess the learning curve of pure retroperitoneoscopic living donor nephrectomy (RLDN). Methodology: Between August 2012 and April 2015 102 voluntary kidney donors underwent RLDN by a single laparoscopic surgeon. These 102 donors were classified into 3 groups in the order in which they underwent the RLDN. Group A (1–34), Group B (35–68) and group C (69–102). The clinical perioperative data was obtained for each group. The data was entered in SPSS 20 for statistical analysis. One Way ANOVA and Kruskal– Wallis test have been used to calculate statistically significant value i.e. P-value. Chi Square test and Fisher Exact test have been used for categorical data. P-value <0.05 considered to be statistically significant difference. Results: The demographic variables of age, gender and BMI did not differ significantly between the three groups. RRDN was performed in 6 (21%), 9 (36%) and 6 (21%) cases of group A, B and C respectively. Double renal arteries were present in 3, 6 and 11 cases in group A, Band C respectively. Circumaortic vein was observed in two cases of group A and one case each of group Band C. Retro aortic vein was observed in two cases each of group B and C. Duplication of IVC was seen in one case of group B. The difference was statistically significant for operative time and the warm ischemia time. The mean operative time in group A, B& C was 295.59 42.81 min, 252.65 45.55 min and 216.18 42.71 min, respectively. Warm ischemia time showed a decreasing trend and was 231.76 96.22 for group A, 201.67 45.39 for group B and 187.71 68.00 for group C, respectively. Conclusions: Retroperitoneoscopic donor nephrectomy is a very important armamentarium for the transplant surgeon and has a learning curve of 40 cases. http://dx.doi.org/10.1016/j.ijt.2015.09.031 Abstract #: ISOT2015-7 Impact of transfer process on PaO2/FiO2 ratio in brain dead potential donors and effect of recruitment maneuver on its reversal: A controlled clinical trial Meysam Mojtabaee, Farahnaz Sadegh Beygi Lung Transplantation Research Center, Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran