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MP30-07 BLADDER AUGMENTATION IN KIDNEY TRANSPLANT PATIENTS: COMPARISON BETWEEN TYPES OF LOWER URINARY RECONSTRUCTION.
THE JOURNAL OF UROLOGYâ
e392
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
MP30-07
MP30-08
BLADDER AUGMENTATION IN KIDNEY TRANSPLANT PATIENTS: COMPARISON BETWEEN TYPES OF LOWER URINARY RECONSTRUCTION.
DOES MARIJUANA INTAKE AFFECT OUTCOMES IN LIVING RENAL DONORS AND THEIR RECIPIENTS?
Kleiton Yamaçake*, Affonso Piovesan, Renato Falci, Gustavo Messi, Ioannis Antonopoulos, Elias David-Neto, Hideki Kanashiro, Rafael Locali, Gustavo Ebaid, William Nahas, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: The aim of this study was to assess the results of kidney transplant(KT) in patients with bladder augmentation (BA) and compare results between enterocistoplasty and ureterocistoplasty. METHODS: Betwenn 1988 and 2015, 64 patients with BA underwent KT ( 3 after KT), due to significant lower urinary tract dysfunction. Ten second and 1 third KT were performed, comprising 75 KT in 64 patients The bowel segments used in the augmentation included ileum in 45(70.3%) patients, ileocecal in 3(4.7%) patients and sigmoid in 4(6.3%) patients. The ureter was used in 12 (18.8%) patients. Redo BA was performed in 4 patients after ureterocistoplasty (1 redo ureterocistoplasty, 3 redo ileocistoplasty); 2 redo BA were performed before the first KT. Mean age at first KT in Group 1(enterocistoplasty, n¼48) and Group 2(ureterocistoplasty, n¼12) was 24.28 and 15.06 years, respectively. Mean age at BA in Group 1 and 2 was 19.06 and 11.87 years, respectively. Redo KT was performed in 6 (11.3%) and 6 (50%) patients in Group 1 and 2, respectively. KT from deceased donor in Group 1 and 2 was 39.6% and 44.4%, respectively. KT from living donor in Group 1 and 2 was 60.4% and 55.6%, respectively. RESULTS: Mean follow-up after first BA was 188,8118,9 (17522) months and 140,571,5 (16-224) months in Group 1 and 2, respectively. In group 1, overall patient survival after 10 years was 78.78% and actuarial graft survival at 1,3,5,7 and 10 years was 94.3%,92.2%,83.1%,70.1 and 63.1%, respectively. In group 2, overall patient survival after 10 years was 90.9% and actuarial graft survival at 1,3,5,7 and 10 years was 88.5%,76.7%,76.7%,68.2 and 34.1%, respectively. Forty (83.3%) and 8(66.7%) patients in Group 1 and 2 were in clean intermittent catheterism (CIC), respectively. Symptomatic or febrile urinary tract infection occurred at least 1 episode in 81.3% and 83.3% in group 1 and 2, respectively. CONCLUSIONS: Both enterocistoplasty and ureterocistoplasty are safe and effective methods of restoring lower urinary tract function in patients with end stage renal disease and a small, noncompliant bladder. CIC is safe in both groups. Graft survival rates are similar until 9 years, with a tendency of poor results after 10 years in ureterocistoplasty patients.
David Ruckle, Mohamed Keheila*, Benjamin West, Braden Mattison, Jerry Thomas, Samuel Abourbih, Michael De Vera, Arputharaj Kore, Pedro Baron, D. Duane Baldwin, LOMA LINDA, CA INTRODUCTION AND OBJECTIVES: There is a current shortage of kidneys available for transplantation. Based on United Network for Organ Sharing recommendations that exclude substance abusers from donation, many transplant institutions refuse live kidney donors who have a history of marijuana use; however, there is no evidence pertaining specifically to the donor or recipient outcomes. This is the first study to investigate the effect of marijuana use by live kidney donors upon outcomes in both donors and recipients. METHODS: A retrospective chart review for living kidney donors and their recipients between January 2000 and May 2016 was performed, stratifying patients based upon prior donor marijuana usage. Demographics and intra-operative variables were reported and compared for all groups. Outcomes compared included absolute and percent creatinine change and percent glomerular filtration rate (GFR) change in both donors and recipients, stratified by duration of marijuana usage. Baseline values for recipients were calculated based on their 1 week post-op creatinine values. Statistical analysis was performed using the t-test for numerical variables and the chi-square test for categorical variables with p<0.05 considered significant. RESULTS: Of total of 294 renal donor charts reviewed in this study,31 were marijuana using donors and 263 were non-marijuana using donors. There was no difference in donor preoperative, perioperative, or postoperative outcomes based upon marijuana use (p>0.05 for all comparisons). However, there was a trend toward better preservation of donor GFR at 1 month for marijuana using donors vs. nonmarijuana using donors (-33.3% vs. -38.6%; p¼0.07) respectively. Marijuana kidney recipients and non-marijuana kidney recipients were similar in creatinine change and percent creatinine change at all time periods. At 1 month, marijuana kidney recipients showed a lower percent change in GFR compared to non-marijuana kidney recipients (+0.9% vs. +20.4%; p¼0.035) respectively. However, for all other time points (6 months, 1 year, and 5 years), there was no difference in percent GFR change between marijuana kidney recipients and nonmarijuana kidney recipients (p>0.05 for all comparisons). CONCLUSIONS: There was no difference in renal function between marijuana using donors and non-marijuana using donors and no long-term differences in renal function between non marijuana kidney recipients and marijuana kidney recipients. Considering individuals with a history of marijuana use for live kidney donation could increase the donor pool and yield acceptable outcomes. Source of Funding: None
MP30-09 TREATMENT MODALITY FOR SMALL RENAL MASSES MAY AFFECT TIME TO ELIGIBILITY FOR RENAL TRANSPLANT CANDIDATES Alp Tuna Beksac*, David Paulucci, John Sfakianos, Susan Lerner, Jorge Pereira, Ketan Badani, New York, NY
Source of Funding: none
INTRODUCTION AND OBJECTIVES: There is no standardized approach to the treatment of small renal masses (SRM) in renal transplant candidates. Time on dialysis is associated with worse graft survival and overall mortality. Therefore, we conducted a study to evaluate whether treatment modality of SRM impacts time to eligibility for renal transplantation. METHODS: We queried transplant centers in the United States via an online survey. The survey was designed to analyze practice patterns to treat SRM and specifically focused on treatment modality and wait time required to become eligible for renal transplantation. Surveys were sent to 212 transplant centers in the US.
e392
Vol. 197, No. 4S, Supplement, Saturday, May 13, 2017
MP30-07
MP30-08
BLADDER AUGMENTATION IN KIDNEY TRANSPLANT PATIENTS: COMPARISON BETWEEN TYPES OF LOWER URINARY RECONSTRUCTION.
DOES MARIJUANA INTAKE AFFECT OUTCOMES IN LIVING RENAL DONORS AND THEIR RECIPIENTS?
Kleiton Yamaçake*, Affonso Piovesan, Renato Falci, Gustavo Messi, Ioannis Antonopoulos, Elias David-Neto, Hideki Kanashiro, Rafael Locali, Gustavo Ebaid, William Nahas, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: The aim of this study was to assess the results of kidney transplant(KT) in patients with bladder augmentation (BA) and compare results between enterocistoplasty and ureterocistoplasty. METHODS: Betwenn 1988 and 2015, 64 patients with BA underwent KT ( 3 after KT), due to significant lower urinary tract dysfunction. Ten second and 1 third KT were performed, comprising 75 KT in 64 patients The bowel segments used in the augmentation included ileum in 45(70.3%) patients, ileocecal in 3(4.7%) patients and sigmoid in 4(6.3%) patients. The ureter was used in 12 (18.8%) patients. Redo BA was performed in 4 patients after ureterocistoplasty (1 redo ureterocistoplasty, 3 redo ileocistoplasty); 2 redo BA were performed before the first KT. Mean age at first KT in Group 1(enterocistoplasty, n¼48) and Group 2(ureterocistoplasty, n¼12) was 24.28 and 15.06 years, respectively. Mean age at BA in Group 1 and 2 was 19.06 and 11.87 years, respectively. Redo KT was performed in 6 (11.3%) and 6 (50%) patients in Group 1 and 2, respectively. KT from deceased donor in Group 1 and 2 was 39.6% and 44.4%, respectively. KT from living donor in Group 1 and 2 was 60.4% and 55.6%, respectively. RESULTS: Mean follow-up after first BA was 188,8118,9 (17522) months and 140,571,5 (16-224) months in Group 1 and 2, respectively. In group 1, overall patient survival after 10 years was 78.78% and actuarial graft survival at 1,3,5,7 and 10 years was 94.3%,92.2%,83.1%,70.1 and 63.1%, respectively. In group 2, overall patient survival after 10 years was 90.9% and actuarial graft survival at 1,3,5,7 and 10 years was 88.5%,76.7%,76.7%,68.2 and 34.1%, respectively. Forty (83.3%) and 8(66.7%) patients in Group 1 and 2 were in clean intermittent catheterism (CIC), respectively. Symptomatic or febrile urinary tract infection occurred at least 1 episode in 81.3% and 83.3% in group 1 and 2, respectively. CONCLUSIONS: Both enterocistoplasty and ureterocistoplasty are safe and effective methods of restoring lower urinary tract function in patients with end stage renal disease and a small, noncompliant bladder. CIC is safe in both groups. Graft survival rates are similar until 9 years, with a tendency of poor results after 10 years in ureterocistoplasty patients.
David Ruckle, Mohamed Keheila*, Benjamin West, Braden Mattison, Jerry Thomas, Samuel Abourbih, Michael De Vera, Arputharaj Kore, Pedro Baron, D. Duane Baldwin, LOMA LINDA, CA INTRODUCTION AND OBJECTIVES: There is a current shortage of kidneys available for transplantation. Based on United Network for Organ Sharing recommendations that exclude substance abusers from donation, many transplant institutions refuse live kidney donors who have a history of marijuana use; however, there is no evidence pertaining specifically to the donor or recipient outcomes. This is the first study to investigate the effect of marijuana use by live kidney donors upon outcomes in both donors and recipients. METHODS: A retrospective chart review for living kidney donors and their recipients between January 2000 and May 2016 was performed, stratifying patients based upon prior donor marijuana usage. Demographics and intra-operative variables were reported and compared for all groups. Outcomes compared included absolute and percent creatinine change and percent glomerular filtration rate (GFR) change in both donors and recipients, stratified by duration of marijuana usage. Baseline values for recipients were calculated based on their 1 week post-op creatinine values. Statistical analysis was performed using the t-test for numerical variables and the chi-square test for categorical variables with p<0.05 considered significant. RESULTS: Of total of 294 renal donor charts reviewed in this study,31 were marijuana using donors and 263 were non-marijuana using donors. There was no difference in donor preoperative, perioperative, or postoperative outcomes based upon marijuana use (p>0.05 for all comparisons). However, there was a trend toward better preservation of donor GFR at 1 month for marijuana using donors vs. nonmarijuana using donors (-33.3% vs. -38.6%; p¼0.07) respectively. Marijuana kidney recipients and non-marijuana kidney recipients were similar in creatinine change and percent creatinine change at all time periods. At 1 month, marijuana kidney recipients showed a lower percent change in GFR compared to non-marijuana kidney recipients (+0.9% vs. +20.4%; p¼0.035) respectively. However, for all other time points (6 months, 1 year, and 5 years), there was no difference in percent GFR change between marijuana kidney recipients and nonmarijuana kidney recipients (p>0.05 for all comparisons). CONCLUSIONS: There was no difference in renal function between marijuana using donors and non-marijuana using donors and no long-term differences in renal function between non marijuana kidney recipients and marijuana kidney recipients. Considering individuals with a history of marijuana use for live kidney donation could increase the donor pool and yield acceptable outcomes. Source of Funding: None
MP30-09 TREATMENT MODALITY FOR SMALL RENAL MASSES MAY AFFECT TIME TO ELIGIBILITY FOR RENAL TRANSPLANT CANDIDATES Alp Tuna Beksac*, David Paulucci, John Sfakianos, Susan Lerner, Jorge Pereira, Ketan Badani, New York, NY
Source of Funding: none
INTRODUCTION AND OBJECTIVES: There is no standardized approach to the treatment of small renal masses (SRM) in renal transplant candidates. Time on dialysis is associated with worse graft survival and overall mortality. Therefore, we conducted a study to evaluate whether treatment modality of SRM impacts time to eligibility for renal transplantation. METHODS: We queried transplant centers in the United States via an online survey. The survey was designed to analyze practice patterns to treat SRM and specifically focused on treatment modality and wait time required to become eligible for renal transplantation. Surveys were sent to 212 transplant centers in the US.