MP79-02 LAPAROSCOPIC NEPHRECTOMY WITH AUTOTRANSPLANTATION: SAFETY, EFFICACY AND LONG-TERM DURABILITY

THE JOURNAL OF UROLOGYâ

Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015

MP79-02 LAPAROSCOPIC NEPHRECTOMY WITH AUTOTRANSPLANTATION: SAFETY, EFFICACY AND LONG-TERM DURABILITY Geraldine Tran*, Krishna Ramaswamy, Thomas Chi, Maxwell Meng, Anobel Odisho, Chris Freise, Marshall Stoller, San Francisco, CA INTRODUCTION AND OBJECTIVES: Laparoscopic nephrectomy with autotransplantation (LNA) is a viable option in extreme cases where renal preservation is required or ureteral reconstruction is impossible. Alternatives to LNA include bowel interposition procedures. LNA does not violate other organ systems, thereby eliminating potential complications with mucus plugs (nidi for calculi and infection), strictures and metabolic derangements. The purpose of this study is to report our long-term experience with LNA. METHODS: A retrospective review of data from all patients who underwent LNA from 2000 - 2014 was undertaken. Complete data was available for 52/59 patients. Indications for LNA included refractory ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1), and renovascular hypertension (1). Follow-up imaging included ultrasonography, nuclear renography and computerized tomography. Complications (early: <30 days and late: >30 days) were defined as Clavien-Dindo grade III or higher. RESULTS: 52 patients (30/52 women [57.6%]) underwent LNA at a median age of 48 years (range 12-76). At a median follow-up of 73.5 months, 47/52 patients (90.3%) had successful long-term function of the autotransplanted renal unit; of which 3/4 (75%) were solitary kidneys. Five patients (9.7%) experienced failure of their renal unit at a median of 20.6 months. Three of these five patients required nephrectomy secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months), and chronic pain (48 months) after LNA. Four patients had early and 8 patients had late complications. Four patients in the tumor group had disease progression, managed with chemotherapy, cryoablation, or radiation therapy; all are alive. CONCLUSIONS: LNA is an excellent long-term surgical option (>90% success with >6 year median follow-up) for complex ureteral pathology and severe renal malady that necessitates valiant measures to preserve renal parenchyma. It affords treatment without violating the gastrointestinal tract. Our multi-disciplinary team has been critical for our long-term success. Tumor progression is possible after ex vivo tumor excision, especially in patients requiring heroic measures to avoid or delay dialysis; therefore, careful patient selection and vigilant followup are mandatory. This report supports the safety, efficacy and longterm durability of LNA in experienced hands. Source of Funding: None

MP79-03 WAG THE DOG?: PSA SCREENING IN KIDNEY TRANSPLANT CANDIDATES Daniel Canter*, Wynnewood, PA; Gerardo Vitiello, Blayne Sayed, Ken Ogan, Nicole Turgeon, Atlanta, GA INTRODUCTION AND OBJECTIVES: Screening recommendations for prostate cancer (PC) in the general population are controversial due to the low sensitivity of prostate-specific antigen (PSA) as a marker for PC as well as the indolent nature of PC. The current study aims to determine whether the use of PSA screening in men being evaluated for renal transplantation either delays the time to listing or time to kidney transplantation as well as whether the diagnosis of PC effects the rate of transplantation and graft/patient survival. METHODS: A single center retrospective analysis of 3737 patients undergoing kidney transplant evaluation from January 1, 2001 to January 1, 2011 was performed. Men were categorized according to the following American Urological Association (AUA) PSA screening guideline recommendations: Group 1: <55 y.o., Group 2: 55-69 y.o. and Group 3: >69 y.o. Univariate analysis and Cox Proportional Hazards (CPH) identified the independent effect of PSA screening on transplant

e1011

times. Kaplan Meier survival curves examined the effects of PSA screening and PC on overall patient and graft survivals. RESULTS: In total, 1135 patients received kidney transplants (30.4%). PSA screening was performed in 53.9% of Group 1, 81.1% of Group 2, and 83.8% of Group 3. In group 2, the time to transplant was significantly longer in patients having a PSA >4 versus those having a PSA <4 (1355 vs. 853 days; p<0.001). Men with a screening PSA > 4 who never developed prostate cancer were less likely to receive transplants than those patients with a positive screen who develop prostate cancer (18.5 versus 40%, p¼0.0025). PC was confirmed in 27% of patients with a PSA >4, and only 24.3% of patients with a PSA >4 received transplants. PSA screening did not impact overall patient survival or graft survivals, though a diagnosis of prostate cancer significantly reduced overall patient survival (HR 2.19 [1.04-4.59]; p¼0.0038). CONCLUSIONS: A PSA screening level >4 may lower the likelihood of receiving a kidney transplant, however, our data indicate that PSA screening has no effect on overall patient survival. Proper patient selection for PSA screening is essential as delayed transplant times in patients with end-stage renal disease (ESRD) leads to reduced quality of life as well as increase patients’ risk of medical and cardiovascular complications while awaiting transplantation. The routine use of PSA screening in renal transplant candidates should reflect a consideration of these risks compared to the biologic phenotype of PC. At the very least, PC screening in the renal transplant population should be more in line with recent recommendations for the general population. Source of Funding: None

MP79-04 NATIONAL TRENDS AND RACIAL DISPARITIES IN LIVING KIDNEY DONATION: ANALYSIS OF THE UNITED NETWORK OF ORGAN SHARING 1998-2011 Akshay Sood*, Firas Abdollah, Dane Klett, Wooju Jeong, James Peabody, Detroit, MI; Quoc-Dien Trinh, Boston, MA; Mani Menon, Jesse Sammon, Detroit, MI INTRODUCTION AND OBJECTIVES: Kidney transplantation (KT) is the treatment of choice for patients with end stage renal disease (ESRD). Racial disparities exist regarding KT, living-donor KT and living kidney donation. Utilizing a nationwide organ sharing registry, we sought to evaluate whether there has been attenuation in disparities over time. METHODS: The United Network of Organ Sharing (UNOS; 1998-2011) database was queried to extract patients undergoing KT, living-donor KT and living kidney donation. The incidences were normalized to ESRD incidence (obtained from freely available United States Renal Data System [USRDS] data) to derive the incidence of KT, living-donor KT and living kidney donation per 1000 ESRD patients. The trends were evaluated using the estimated annual change percent methodology (EAPC). RESULTS: A total of 184,303 (living-donor¼68,381) patients underwent KT over the study years. The overall rate of KT remained low with only 13.5% of the ESRD patients receiving a kidney; however, an encouraging reduction in racial disparity was noted over the study period (Fig. 1a). The rate of KT in Blacks increased over the study at an annual rate of 2.05% from 111 KT per 1000 ESRD in 1998 cases to 141 KT per 1000 ESRD cases in 2011 (p<0.001). The rate of living-donor KT in Blacks however did not change over the study period (EAPC -0.63%; p¼0.519) and this was probably driven by poor living kidney donation rate in Blacks (EAPC -0.59%; p¼0.578; Fig. 1a and b). CONCLUSIONS: Blacks have 3-fold higher incidence of ESRD when compared to Whites. Our study for the first time shows that there is an encouraging attenuation in racial disparities in KT; nonetheless, the rates of live donation and living-donor KT remain low in Blacks and disparities persist. These findings call for initiation of more aggressive outreach programs and improvement in