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MP32-19 INCIDENCE AND TREATMENT OF MALIGNANT TUMORS OF THE GENITOURINARY TRACT IN RENAL TRANSPLANT RECIPIENTS
THE JOURNAL OF UROLOGYâ
e434
operation or history of acute rejection postoperatively. Preoperative MAG3 clearance of the remaining and transplanted kidneys were almost equal, 15734 ml/min and 15635 ml/min respectively. The measuring method of MAG3 clearance used RUNQ (Renal Uptake New Quantitative method) mood. Analyzed factors were dialysis period, height, body weight, graft weight, body mass index, and surface of the body area. RESULTS: Preoperative MAG3 clearance of remaining kidney and transplanted kidney negatively correlated with donor age (P0.001), and we can confirm the regular decline of the kidney function with the aging in MAG3 clearance. Postoperative MAG3 clearance of remaining kidney and transplanted kidney significantly increased compared with that of pre-transplantation, 24251 ml/min and 23657 ml/min respectively (P0.001), though there is no difference in the ERPF increase rate between donor and recipient, 58.540 % and 55.638 % respectively (P¼0.649). There are significant factors correlated with increasing rate of graft compensatory hypertrophy in MAG3 clearance, which are the height ratio between donor and recipient (P¼0.003), the weight of graft (P¼0.01), and preoperative ERPF of transplanted kidney (P¼0.002). On the other hand, body weight, WIT, and dialysis period were not significant. CONCLUSIONS: In conclusion, the compensatory hypertrophy ratio (increasing rate of the ERPF) in a transplanted kidney correlates with the graft weight and preoperative ERPF of the transplanted kidney. It is also prescribed by the physique difference between donor and recipient. There was no difference in the ERPF increase rate between donor and recipient. Source of Funding: none
MP32-17 CLINICAL SIGNIFICANCE OF ISOLATED V1 ARTERITIS IN RENAL TRANSPLANTATION David Mikhail*, Derek Kleinsteuber, James Wei, Manal Gabril, Alp Sener, Madeleine Moussa, Patrick Luke, London, Canada INTRODUCTION AND OBJECTIVES: The presence of intimal arteritis (v) in kidney transplant biopsies establishes Grade II-III AVR (Acute Vascular Rejection) according to the Banff Classification. The clinical significance of ‘isolated v’ lesions (v1) in this group, characterized by arteritis alone vs lesions of arteritis with tubulointerstitial inflammation (i-t-v) is unknown. METHODS: In patients undergoing kidney transplantation between 2005-2013, ‘for cause’ transplant biopsies were retrospectively reviewed at our center utilizing Banff Classification. Those with Grade IIa AVR were separated into groups with isolated v1 arteritis and i-t-v. Clinical outcomes including renal function prior to and after treatment, patient graft and overall survival and post-treatment biopsy results were assessed. Statistical analysis was performed using t-test, chi-square test and z-test where appropriate. RESULTS: In our review, 613 biopsies in 280 patients were performed. Of these, 110 biopsies demonstrated Grade IIa rejection in 83 patients. Fifty-one (61%) were isolated v1, while 29 (35%) were i-t-v. There were no significant differences in recipient age (46 vs 40, p¼NS), donor age (42 vs 40, p¼NS), PRA pre-transplant, donor status with regards to living, expanded criteria or donor brain death status between groups. Mean time from transplant to biopsy proven arteritis was not statistically significant (8mo vs 13mo, p¼NS). Patients in the v1 group were more likely to have associated C4d+ (32% vs. 17%). All patients with v1 received pulsed steroids (methylprednisolone 250 mg daily x 3) only, whereas 76% i-t-v patients received thymoglobulin or IVIG in adjunct to steroids. Within the first year post-transplant, 50% of total death or graft failure events occurred in the i-t-v group, while none occurred in the v1 group. Mean time from biopsy to death or graft failure was 22 months in v1 group vs. 8 months in the i-t-v group (p¼NS). At a median follow-up time of 41 months from transplant, death censored graft survival was 92% (v1) compared to 79% (i-t-v) (p¼0.04) and overall survival was 98% vs 79% (p<0.004).
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
CONCLUSIONS: Despite having the same Banff Classification of IIa AVR, graft survival in patients with isolated v1 rejection is markedly superior compared to those with tubulointerstitial inflammation. Modification of the Banff Classification Grading scheme should be considered if these findings are corroborated in a larger multi-center study. Source of Funding: none
MP32-18 RENAL TRANSPLANTATION WITH DONORS OLDER THAN 70 YEARS Paulo Dinis*, Lorenzo Marconi, Pedro Nunes, Arnaldo Figueiredo, nio Roseiro, Belmiro Parada, Pedro Moreira, Carlos Bastos, Anto Vítor Dias, Franscisco Rolo, Alfredo Mota, Coimbra, Portugal INTRODUCTION AND OBJECTIVES: The growing need for organs for kidney transplantation and its increasing shortage have been encouraging the use of renal grafts from donors increasingly elderly. There are few studies on transplant outcomes with donors older than 70 years. The objective of this work is to analyze our series, comparing the results of renal transplantation using grafts from donors older and younger than 70 years. METHODS: Retrospective study that included 2738 consecutive renal transplant from deceased donor performed in our unit between June 1980 and June 2015. We analyzed and compared the results of renal grafts from donors aged over 70 years (group 1 ¼ 70, n ¼ 115) to those of the grafts from donors older than 70 years (group 2 <70, n ¼ 2605). RESULTS: Univariate analysis of pre-renal transplant data showed significant differences (p <0.05) between groups ¼ 70 and > 70 for the following variables: recipient age (44 13 vs 61 6 years), donor age (40 16 vs 73 2 years) and donor serum creatinine (1.1 0.4 vs 0.88 0.3). As to the results of transplantation, it was found that the average serum creatinine was significantly lower for the <70 group at 1, 3, 6, 12 and 24 months after transplantation (p <0.05) but not at 36 months and later. There was no significant difference in terms of delayed graft function (18.1% vs 22%). The cumulative graft survival at 1, 3 and 4 years was 91%, 85% and 83% for <70 group versus 87%, 78% and 71% for the ¼ 70% group (p 0.036). Considering only the subgroup of recipients under the age of 60, we found no significant difference in graft survival between the groups. The same is true if we consider only donors older than 60 years. Using Cox regression to analyze graft survival, we found that donor age did not constitute an independent risk factor for graft loss. CONCLUSIONS: The group of patients who received renal grafts from donors under the age of 70 years achieved better results in terms of graft survival. However, kidneys from older donors appear to represent an excellent alternative. Source of Funding: None.
MP32-19 INCIDENCE AND TREATMENT OF MALIGNANT TUMORS OF THE GENITOURINARY TRACT IN RENAL TRANSPLANT RECIPIENTS Juan Manuel Ochoa Lopez*, Bernardo Gabilondo Pliego, Jaime O Herrera Caceres, Francisco Rodriguez Covarrubias, Ricardo Alonso Castillejos Molina, Mexico City, Mexico INTRODUCTION AND OBJECTIVES: A well-known late complication of kidney transplantation is the development of malignant neoplasms. Renal transplant recipients (RTR) have a risk three to five times higher than the general population of developing cancer. The development of malignancies markedly decreases the survival rate of affected patients, Therefore the aim of this study is to provide data of the
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
incidence and management of common urological malignancies in RTR. METHODS: We conducted a retrospective analysis of a prospective database from august 1967 to august 2015. A descriptive analysis of the sample was performed. RESULTS: Among 1256 consecutive RTR a total of 88 patients developed malignant neoplasms (7%), of who 19 (21.59%) had genitourinary tumors. There were 21 genitourinary tumors in the 19 patients, incidence of 1.51%. The distribution and treatment of neoplasm are shown in table 1. The mean age at diagnosis was 3515 (range, 17 to 70). Median follow up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 8472 (R, 12-276). For immunosuppression Cyclosporine A (CyS) was given in 14/19 (73.68%) patients, Azathioprine (AZA) 14/19 (73.68%), Mycophenolate (MMF) 8/ 19 (42.10%), Tacrolimus (TAC) 6/19 (31.57%), and Prednisone (PDN) 19/19 (100%). In 9 patients (47.36%) the calcineurin inhibitor was exchange for rapamicyn after cancer diagnosis. Prior history of tobacco use in 42.10%. The mean follow up after diagnosis was 11876 (R 10221). Recurrence free survival rate of 100%, none had tumor recurrence during the follow up. Overall survival of 89.5%, there were two non-related cancer deaths during the follow up. CONCLUSIONS: In our study the incidence of neoplasm in RTR was lower than in other series, with good functional and oncologic results after treatment. This suggests that measures to reduce the risk of these malignancies and a strict follow up are mandatory to an early detection and treatment of these malignancies.
THE JOURNAL OF UROLOGYâ
by ultrasound (US) at 6 and 12 months, then every year. The donor surgery was laparoscopic except two patients were open. RESULTS: Patients with renal mass (a_image): The average recipient age was 48.4 years (range from 21 to 79). The average size of the mass was 8.1 mm 3.6. Histological characteristics were Renal Cell Carcinoma RCC in four patients including Clear Cell type (n¼2, Furhman grade I/II), Papillary (n¼1, grade I), Multilocular cystic RCC (n¼1, grade I) and the last one was Angiomyolipoma. All patients had follow up US up to 2 years that showed no tumor. One patient suffered from Tcell rejection (non-compliance) and lost the graft at three years. Mean creatinine at three years was (1.4 mg/dL 0.3). Patients with RAA (b_image): The average recipient age was 28.7 years (Range from 3 to 45). Mean creatinine at one year was (1 mg/dL 0.4). Length of hospital stay was (6.25 days 2.6). Duplex US of the allograft artery at one year showed patent vessels. The average warm and cold ischemia time were (50.5 min 20) and (86.5 min 18.5) respectively. CONCLUSIONS: Using kidneys with renal and vascular pathology for transplantation is safe and efficient. It plays an important role in expanding the donor pool. Close follow up of both group patients is necessary. Also, removing those kidneys appears beneficial to the donors who have RAA and RCC.
Source of Funding: none
MP32-20 KIDNEY TRANSPLANTATION FROM LIVING DONORS WITH RENAL AND VASCULAR PATHOLOGY Mahmoud Alameddine*, Zhobin Moghadamyeghaneh, Mohammed Osman, Luay Alshara, Mahmoud Morsi, Vincent Chia, Gaetano Ciancio, Miami, FL INTRODUCTION AND OBJECTIVES: With the present disparity between organ availability and recipient demands, living donor kidneys with renal and vascular pathology were used to increase the donor pool. We review our experience in using kidneys with renal and vascular pathology. METHODS: Nine patients were identified from 2009 to 2015. Five of them, had kidneys with cystic masses which were resected completely with negative margin. The other four had renal artery aneurysms (RAA) reconstruction of their grafts. The repair included excision of the RAA with ostial closure and in one of them ovarian vein patch was used. Peri-operative outcomes were reviewed. All donors were asymptomatic prior to surgery. Donor and recipients were followed
e435
Source of Funding: none
e434
operation or history of acute rejection postoperatively. Preoperative MAG3 clearance of the remaining and transplanted kidneys were almost equal, 15734 ml/min and 15635 ml/min respectively. The measuring method of MAG3 clearance used RUNQ (Renal Uptake New Quantitative method) mood. Analyzed factors were dialysis period, height, body weight, graft weight, body mass index, and surface of the body area. RESULTS: Preoperative MAG3 clearance of remaining kidney and transplanted kidney negatively correlated with donor age (P0.001), and we can confirm the regular decline of the kidney function with the aging in MAG3 clearance. Postoperative MAG3 clearance of remaining kidney and transplanted kidney significantly increased compared with that of pre-transplantation, 24251 ml/min and 23657 ml/min respectively (P0.001), though there is no difference in the ERPF increase rate between donor and recipient, 58.540 % and 55.638 % respectively (P¼0.649). There are significant factors correlated with increasing rate of graft compensatory hypertrophy in MAG3 clearance, which are the height ratio between donor and recipient (P¼0.003), the weight of graft (P¼0.01), and preoperative ERPF of transplanted kidney (P¼0.002). On the other hand, body weight, WIT, and dialysis period were not significant. CONCLUSIONS: In conclusion, the compensatory hypertrophy ratio (increasing rate of the ERPF) in a transplanted kidney correlates with the graft weight and preoperative ERPF of the transplanted kidney. It is also prescribed by the physique difference between donor and recipient. There was no difference in the ERPF increase rate between donor and recipient. Source of Funding: none
MP32-17 CLINICAL SIGNIFICANCE OF ISOLATED V1 ARTERITIS IN RENAL TRANSPLANTATION David Mikhail*, Derek Kleinsteuber, James Wei, Manal Gabril, Alp Sener, Madeleine Moussa, Patrick Luke, London, Canada INTRODUCTION AND OBJECTIVES: The presence of intimal arteritis (v) in kidney transplant biopsies establishes Grade II-III AVR (Acute Vascular Rejection) according to the Banff Classification. The clinical significance of ‘isolated v’ lesions (v1) in this group, characterized by arteritis alone vs lesions of arteritis with tubulointerstitial inflammation (i-t-v) is unknown. METHODS: In patients undergoing kidney transplantation between 2005-2013, ‘for cause’ transplant biopsies were retrospectively reviewed at our center utilizing Banff Classification. Those with Grade IIa AVR were separated into groups with isolated v1 arteritis and i-t-v. Clinical outcomes including renal function prior to and after treatment, patient graft and overall survival and post-treatment biopsy results were assessed. Statistical analysis was performed using t-test, chi-square test and z-test where appropriate. RESULTS: In our review, 613 biopsies in 280 patients were performed. Of these, 110 biopsies demonstrated Grade IIa rejection in 83 patients. Fifty-one (61%) were isolated v1, while 29 (35%) were i-t-v. There were no significant differences in recipient age (46 vs 40, p¼NS), donor age (42 vs 40, p¼NS), PRA pre-transplant, donor status with regards to living, expanded criteria or donor brain death status between groups. Mean time from transplant to biopsy proven arteritis was not statistically significant (8mo vs 13mo, p¼NS). Patients in the v1 group were more likely to have associated C4d+ (32% vs. 17%). All patients with v1 received pulsed steroids (methylprednisolone 250 mg daily x 3) only, whereas 76% i-t-v patients received thymoglobulin or IVIG in adjunct to steroids. Within the first year post-transplant, 50% of total death or graft failure events occurred in the i-t-v group, while none occurred in the v1 group. Mean time from biopsy to death or graft failure was 22 months in v1 group vs. 8 months in the i-t-v group (p¼NS). At a median follow-up time of 41 months from transplant, death censored graft survival was 92% (v1) compared to 79% (i-t-v) (p¼0.04) and overall survival was 98% vs 79% (p<0.004).
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
CONCLUSIONS: Despite having the same Banff Classification of IIa AVR, graft survival in patients with isolated v1 rejection is markedly superior compared to those with tubulointerstitial inflammation. Modification of the Banff Classification Grading scheme should be considered if these findings are corroborated in a larger multi-center study. Source of Funding: none
MP32-18 RENAL TRANSPLANTATION WITH DONORS OLDER THAN 70 YEARS Paulo Dinis*, Lorenzo Marconi, Pedro Nunes, Arnaldo Figueiredo, nio Roseiro, Belmiro Parada, Pedro Moreira, Carlos Bastos, Anto Vítor Dias, Franscisco Rolo, Alfredo Mota, Coimbra, Portugal INTRODUCTION AND OBJECTIVES: The growing need for organs for kidney transplantation and its increasing shortage have been encouraging the use of renal grafts from donors increasingly elderly. There are few studies on transplant outcomes with donors older than 70 years. The objective of this work is to analyze our series, comparing the results of renal transplantation using grafts from donors older and younger than 70 years. METHODS: Retrospective study that included 2738 consecutive renal transplant from deceased donor performed in our unit between June 1980 and June 2015. We analyzed and compared the results of renal grafts from donors aged over 70 years (group 1 ¼ 70, n ¼ 115) to those of the grafts from donors older than 70 years (group 2 <70, n ¼ 2605). RESULTS: Univariate analysis of pre-renal transplant data showed significant differences (p <0.05) between groups ¼ 70 and > 70 for the following variables: recipient age (44 13 vs 61 6 years), donor age (40 16 vs 73 2 years) and donor serum creatinine (1.1 0.4 vs 0.88 0.3). As to the results of transplantation, it was found that the average serum creatinine was significantly lower for the <70 group at 1, 3, 6, 12 and 24 months after transplantation (p <0.05) but not at 36 months and later. There was no significant difference in terms of delayed graft function (18.1% vs 22%). The cumulative graft survival at 1, 3 and 4 years was 91%, 85% and 83% for <70 group versus 87%, 78% and 71% for the ¼ 70% group (p 0.036). Considering only the subgroup of recipients under the age of 60, we found no significant difference in graft survival between the groups. The same is true if we consider only donors older than 60 years. Using Cox regression to analyze graft survival, we found that donor age did not constitute an independent risk factor for graft loss. CONCLUSIONS: The group of patients who received renal grafts from donors under the age of 70 years achieved better results in terms of graft survival. However, kidneys from older donors appear to represent an excellent alternative. Source of Funding: None.
MP32-19 INCIDENCE AND TREATMENT OF MALIGNANT TUMORS OF THE GENITOURINARY TRACT IN RENAL TRANSPLANT RECIPIENTS Juan Manuel Ochoa Lopez*, Bernardo Gabilondo Pliego, Jaime O Herrera Caceres, Francisco Rodriguez Covarrubias, Ricardo Alonso Castillejos Molina, Mexico City, Mexico INTRODUCTION AND OBJECTIVES: A well-known late complication of kidney transplantation is the development of malignant neoplasms. Renal transplant recipients (RTR) have a risk three to five times higher than the general population of developing cancer. The development of malignancies markedly decreases the survival rate of affected patients, Therefore the aim of this study is to provide data of the
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
incidence and management of common urological malignancies in RTR. METHODS: We conducted a retrospective analysis of a prospective database from august 1967 to august 2015. A descriptive analysis of the sample was performed. RESULTS: Among 1256 consecutive RTR a total of 88 patients developed malignant neoplasms (7%), of who 19 (21.59%) had genitourinary tumors. There were 21 genitourinary tumors in the 19 patients, incidence of 1.51%. The distribution and treatment of neoplasm are shown in table 1. The mean age at diagnosis was 3515 (range, 17 to 70). Median follow up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 8472 (R, 12-276). For immunosuppression Cyclosporine A (CyS) was given in 14/19 (73.68%) patients, Azathioprine (AZA) 14/19 (73.68%), Mycophenolate (MMF) 8/ 19 (42.10%), Tacrolimus (TAC) 6/19 (31.57%), and Prednisone (PDN) 19/19 (100%). In 9 patients (47.36%) the calcineurin inhibitor was exchange for rapamicyn after cancer diagnosis. Prior history of tobacco use in 42.10%. The mean follow up after diagnosis was 11876 (R 10221). Recurrence free survival rate of 100%, none had tumor recurrence during the follow up. Overall survival of 89.5%, there were two non-related cancer deaths during the follow up. CONCLUSIONS: In our study the incidence of neoplasm in RTR was lower than in other series, with good functional and oncologic results after treatment. This suggests that measures to reduce the risk of these malignancies and a strict follow up are mandatory to an early detection and treatment of these malignancies.
THE JOURNAL OF UROLOGYâ
by ultrasound (US) at 6 and 12 months, then every year. The donor surgery was laparoscopic except two patients were open. RESULTS: Patients with renal mass (a_image): The average recipient age was 48.4 years (range from 21 to 79). The average size of the mass was 8.1 mm 3.6. Histological characteristics were Renal Cell Carcinoma RCC in four patients including Clear Cell type (n¼2, Furhman grade I/II), Papillary (n¼1, grade I), Multilocular cystic RCC (n¼1, grade I) and the last one was Angiomyolipoma. All patients had follow up US up to 2 years that showed no tumor. One patient suffered from Tcell rejection (non-compliance) and lost the graft at three years. Mean creatinine at three years was (1.4 mg/dL 0.3). Patients with RAA (b_image): The average recipient age was 28.7 years (Range from 3 to 45). Mean creatinine at one year was (1 mg/dL 0.4). Length of hospital stay was (6.25 days 2.6). Duplex US of the allograft artery at one year showed patent vessels. The average warm and cold ischemia time were (50.5 min 20) and (86.5 min 18.5) respectively. CONCLUSIONS: Using kidneys with renal and vascular pathology for transplantation is safe and efficient. It plays an important role in expanding the donor pool. Close follow up of both group patients is necessary. Also, removing those kidneys appears beneficial to the donors who have RAA and RCC.
Source of Funding: none
MP32-20 KIDNEY TRANSPLANTATION FROM LIVING DONORS WITH RENAL AND VASCULAR PATHOLOGY Mahmoud Alameddine*, Zhobin Moghadamyeghaneh, Mohammed Osman, Luay Alshara, Mahmoud Morsi, Vincent Chia, Gaetano Ciancio, Miami, FL INTRODUCTION AND OBJECTIVES: With the present disparity between organ availability and recipient demands, living donor kidneys with renal and vascular pathology were used to increase the donor pool. We review our experience in using kidneys with renal and vascular pathology. METHODS: Nine patients were identified from 2009 to 2015. Five of them, had kidneys with cystic masses which were resected completely with negative margin. The other four had renal artery aneurysms (RAA) reconstruction of their grafts. The repair included excision of the RAA with ostial closure and in one of them ovarian vein patch was used. Peri-operative outcomes were reviewed. All donors were asymptomatic prior to surgery. Donor and recipients were followed
e435
Source of Funding: none