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MP29-07 ROBOTIC KIDNEY TRANSPLANTATION WITH REGIONAL HYPOTHERMIA: RESULTS FROM A PROSPECTIVE TWO-ARM NON-RANDOMIZED CONTROLLED TRIAL (IDEAL PHASE 2B)
THE JOURNAL OF UROLOGYâ
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residents also expressed a greater interest in pursuing fellowship training in transplant (9.7%). These results demonstrate that comparatively urology residents have the greatest exposure to transplant throughout their residency, despite this only a limited number of urology trainees are interested in pursuing future careers in transplant. Consequently, a continued strong exposure to transplant during residency is essential to ensure that urology continues to be highly involved with renal transplantation across Canada. Source of Funding: None
MP29-06 LONG TERM TRANSPLANTATION OF BIOENGINEERED PORCINE KIDNEY CONSTRUCTS SEEDED WITH AUTOLOGOUS CELLS Joao Paulo Zambon*, In Kap Ko, Ick-Hee Kim, Charesa Smith, John Jackson, Anthony Atala, James Yoo, Winston Salem, NC INTRODUCTION AND OBJECTIVES: Kidney transplantation is the only definitive treatment for end stage renal disease (ESRD). However, the availability of transplantable kidneys is limited. Recent advances in the field of bioengineering whole kidney constructs have provided a promising solution to address the shortage. Previously, we have developed decellularization and recellularization methods that allowed efficient recellularizaiton including re-endothelia-lization of vasculatures and repopulation with renal cells using acellular porcine kidney scaffolds, followed by promising outcomes from short-term implantation. To make this technology amenable for clinical translation, this study aimed to evaluate vascular patency of bioengineered porcine kidney constructs seeded with autologous cell sources in a heterotopic implantation pig model. METHODS: To provide anti-thrombogenic capability, the decellularized kidney scaffold from native porcine kidneys was reendothelialized following conjugation of heparin and CD31 antibody. For renal function, the re-endothelialized kidney scaffold was seeded with the renal cells, followed by bioreactor culture before implantation. The engineered kidney construct was implanted at the iliac site of pigs. During implantation, blood perfusion through the kidney implant was examined by CT scan and at 1 week implantation, the harvested implant was processed for histological analysis. RESULTS: CT scan demonstrated evidences of partial blood perfusion within the implant. The histological and immunochemical analysis confirmed the vascular patency and viability of the seeded renal cells with maintenance of renal phenotype during the implantation. CONCLUSIONS: These results demonstrate that long-term implantation of engineered porcine kidney constructs is possible and this approach will lead to the development of an alternative treatment method for patients with ESRD. Source of Funding: State of North Carolina
MP29-07 ROBOTIC KIDNEY TRANSPLANTATION WITH REGIONAL HYPOTHERMIA: RESULTS FROM A PROSPECTIVE TWO-ARM NON-RANDOMIZED CONTROLLED TRIAL (IDEAL PHASE 2B) Akshay Sood*, Detroit, MI; Prasun Ghosh, Gurgaon, India; Wooju Jeong, Deepansh Dalela, Mahendra Bhandari, Detroit, MI; Rajesh Ahlawat, Gurgaon, India; Mani Menon, Detroit, MI INTRODUCTION AND OBJECTIVES: Minimally invasive approaches to kidney transplantation are up-coming. We recently developed and described a novel technique of robotic KT (RKT) using intra corporeal graft cooling. Here, we assess the comparative effectiveness of RKT and open KT (OKT) by evaluating peri- and postoperative outcomes. METHODS: From Jan-Dec 2013, a total of 247 patients with end stage renal disease underwent KT at a tertiary referral center of which 225 patients who met the selection criteria (live donor, first
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
transplant, single organ transplant and low-intermediate immunologic risk) were enrolled into this prospective two-arm non-randomized controlled trial (IDEAL Phase-2b). Primary outcome was post transplant graft function. Secondary outcomes included surgical and immunologic complications, and perioperative parameters. All patients had a minimum follow up of 6 months. RESULTS: Fifty and 175 patients underwent RKT and OKT, respectively. The baseline characteristics of the two groups were comparable. Mean serum creatinine at discharge was 1.2 and 1.3 mg/dl in RKT and OKT patients respectively (p¼0.71). Post-operative pain and analgesic requirements were significantly less in patients undergoing RKT (p¼0.01). None of the RKT patients developed any wound complications and none had delayed graft function. Eleven patients in the RKT group required a biopsy and 7 developed acute rejection. One RKT patient and 4 (2.2%) of OKT needed post-transplant dialysis. No lymphocele was detected on protocol non-contrast CT done at 3 months in the RKT group (0% vs. 23.8% in OKT; p¼0.05). One graft was lost in the OKT group. One patient death in RKT (1.5 months post transplant, cardiac failure) and 2 in OKT group were noted, respectively. CONCLUSIONS: RKT with regional hypothermia is safe and easily reproducible. Early outcomes are equivalent to OKT; with trends towards lower complications, quicker graft function recovery and shorter patient convalescence. Source of Funding: None
MP29-08 PERCUTANEOUS RENAL HILAR BLOCKADE TO PREDICT SUCCESS OF AUTO KIDNEY TRANSPLANTATION FOR LOIN PAIN HEMATURIA SYNDROME Jeffrey Campsen, Mitchell Bassett*, Ryan O’Hara, Heather Thiesset, Robin Kim, Rulon Hardman, Blake Hamilton, Salt Lake City, UT INTRODUCTION AND OBJECTIVES: Previous reports describe renal auto-transplantation (RAT) as a possible therapy for loin pain hematuria syndrome (LPHS) with reported successful pain relief ranging between 25-65%. We propose that in patients with classic symptoms of LPHS, a response to percutaneous renal hilar blockade (RHB) can help predict when a patient should be referred for RAT. METHODS: The procedure of renal hilar block is similar to that of a percutaneous celiac plexus block. Prior to performing the procedure, a pain assessment is performed using a 0-10 numeric pain rating scale. Percutaneous hilar block is performed with the patient in the prone position on the CT gantry. The skin is cleansed using chlorexidine scrub and anesthetized using lidocaine. Using CT guidance, a 21G chiba needle is advanced to the anterior renal hilum. Aspiration is performed to ensure a vessel has not been entered. A solution of 10ml 2.0% lidocaine and 10ml 0.25% Marcaine is injected slowly to infiltrate the hilum. A post-procedure pain assessment is then performed. If their pain score was reduced immediately after the RHB then they were referred for RAT. RESULTS: There were 10 RAT preformed at the University of Utah during a 3 year period. Six had LPHS and were enrolled in this study. All patients receiving RHB had relief of pain. Pre-procedure average score was 8/10 with post-procedure score being 0/10. All patients underwent a successful RAT and currently have a functioning graft 6-12 months post- procedure (Table). CONCLUSIONS: Successful RAT for LPHS relies on the appropriate diagnosis. In this study all patients had relief of pain after RHB and then were successfully transplanted. RHB should be considered as a tool to define LPHS patients appropriate for RAT. This appears to be a viable method for further study to help predict which patients should be referred for RAT after diagnosis of LPHS.
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residents also expressed a greater interest in pursuing fellowship training in transplant (9.7%). These results demonstrate that comparatively urology residents have the greatest exposure to transplant throughout their residency, despite this only a limited number of urology trainees are interested in pursuing future careers in transplant. Consequently, a continued strong exposure to transplant during residency is essential to ensure that urology continues to be highly involved with renal transplantation across Canada. Source of Funding: None
MP29-06 LONG TERM TRANSPLANTATION OF BIOENGINEERED PORCINE KIDNEY CONSTRUCTS SEEDED WITH AUTOLOGOUS CELLS Joao Paulo Zambon*, In Kap Ko, Ick-Hee Kim, Charesa Smith, John Jackson, Anthony Atala, James Yoo, Winston Salem, NC INTRODUCTION AND OBJECTIVES: Kidney transplantation is the only definitive treatment for end stage renal disease (ESRD). However, the availability of transplantable kidneys is limited. Recent advances in the field of bioengineering whole kidney constructs have provided a promising solution to address the shortage. Previously, we have developed decellularization and recellularization methods that allowed efficient recellularizaiton including re-endothelia-lization of vasculatures and repopulation with renal cells using acellular porcine kidney scaffolds, followed by promising outcomes from short-term implantation. To make this technology amenable for clinical translation, this study aimed to evaluate vascular patency of bioengineered porcine kidney constructs seeded with autologous cell sources in a heterotopic implantation pig model. METHODS: To provide anti-thrombogenic capability, the decellularized kidney scaffold from native porcine kidneys was reendothelialized following conjugation of heparin and CD31 antibody. For renal function, the re-endothelialized kidney scaffold was seeded with the renal cells, followed by bioreactor culture before implantation. The engineered kidney construct was implanted at the iliac site of pigs. During implantation, blood perfusion through the kidney implant was examined by CT scan and at 1 week implantation, the harvested implant was processed for histological analysis. RESULTS: CT scan demonstrated evidences of partial blood perfusion within the implant. The histological and immunochemical analysis confirmed the vascular patency and viability of the seeded renal cells with maintenance of renal phenotype during the implantation. CONCLUSIONS: These results demonstrate that long-term implantation of engineered porcine kidney constructs is possible and this approach will lead to the development of an alternative treatment method for patients with ESRD. Source of Funding: State of North Carolina
MP29-07 ROBOTIC KIDNEY TRANSPLANTATION WITH REGIONAL HYPOTHERMIA: RESULTS FROM A PROSPECTIVE TWO-ARM NON-RANDOMIZED CONTROLLED TRIAL (IDEAL PHASE 2B) Akshay Sood*, Detroit, MI; Prasun Ghosh, Gurgaon, India; Wooju Jeong, Deepansh Dalela, Mahendra Bhandari, Detroit, MI; Rajesh Ahlawat, Gurgaon, India; Mani Menon, Detroit, MI INTRODUCTION AND OBJECTIVES: Minimally invasive approaches to kidney transplantation are up-coming. We recently developed and described a novel technique of robotic KT (RKT) using intra corporeal graft cooling. Here, we assess the comparative effectiveness of RKT and open KT (OKT) by evaluating peri- and postoperative outcomes. METHODS: From Jan-Dec 2013, a total of 247 patients with end stage renal disease underwent KT at a tertiary referral center of which 225 patients who met the selection criteria (live donor, first
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
transplant, single organ transplant and low-intermediate immunologic risk) were enrolled into this prospective two-arm non-randomized controlled trial (IDEAL Phase-2b). Primary outcome was post transplant graft function. Secondary outcomes included surgical and immunologic complications, and perioperative parameters. All patients had a minimum follow up of 6 months. RESULTS: Fifty and 175 patients underwent RKT and OKT, respectively. The baseline characteristics of the two groups were comparable. Mean serum creatinine at discharge was 1.2 and 1.3 mg/dl in RKT and OKT patients respectively (p¼0.71). Post-operative pain and analgesic requirements were significantly less in patients undergoing RKT (p¼0.01). None of the RKT patients developed any wound complications and none had delayed graft function. Eleven patients in the RKT group required a biopsy and 7 developed acute rejection. One RKT patient and 4 (2.2%) of OKT needed post-transplant dialysis. No lymphocele was detected on protocol non-contrast CT done at 3 months in the RKT group (0% vs. 23.8% in OKT; p¼0.05). One graft was lost in the OKT group. One patient death in RKT (1.5 months post transplant, cardiac failure) and 2 in OKT group were noted, respectively. CONCLUSIONS: RKT with regional hypothermia is safe and easily reproducible. Early outcomes are equivalent to OKT; with trends towards lower complications, quicker graft function recovery and shorter patient convalescence. Source of Funding: None
MP29-08 PERCUTANEOUS RENAL HILAR BLOCKADE TO PREDICT SUCCESS OF AUTO KIDNEY TRANSPLANTATION FOR LOIN PAIN HEMATURIA SYNDROME Jeffrey Campsen, Mitchell Bassett*, Ryan O’Hara, Heather Thiesset, Robin Kim, Rulon Hardman, Blake Hamilton, Salt Lake City, UT INTRODUCTION AND OBJECTIVES: Previous reports describe renal auto-transplantation (RAT) as a possible therapy for loin pain hematuria syndrome (LPHS) with reported successful pain relief ranging between 25-65%. We propose that in patients with classic symptoms of LPHS, a response to percutaneous renal hilar blockade (RHB) can help predict when a patient should be referred for RAT. METHODS: The procedure of renal hilar block is similar to that of a percutaneous celiac plexus block. Prior to performing the procedure, a pain assessment is performed using a 0-10 numeric pain rating scale. Percutaneous hilar block is performed with the patient in the prone position on the CT gantry. The skin is cleansed using chlorexidine scrub and anesthetized using lidocaine. Using CT guidance, a 21G chiba needle is advanced to the anterior renal hilum. Aspiration is performed to ensure a vessel has not been entered. A solution of 10ml 2.0% lidocaine and 10ml 0.25% Marcaine is injected slowly to infiltrate the hilum. A post-procedure pain assessment is then performed. If their pain score was reduced immediately after the RHB then they were referred for RAT. RESULTS: There were 10 RAT preformed at the University of Utah during a 3 year period. Six had LPHS and were enrolled in this study. All patients receiving RHB had relief of pain. Pre-procedure average score was 8/10 with post-procedure score being 0/10. All patients underwent a successful RAT and currently have a functioning graft 6-12 months post- procedure (Table). CONCLUSIONS: Successful RAT for LPHS relies on the appropriate diagnosis. In this study all patients had relief of pain after RHB and then were successfully transplanted. RHB should be considered as a tool to define LPHS patients appropriate for RAT. This appears to be a viable method for further study to help predict which patients should be referred for RAT after diagnosis of LPHS.