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artery reconstruction, donor surgeons should weigh the potential impact of multiple arteries in the remaining kidney of the donor. Clearly longer follow-up and prospective collection of data in living kidney donors is warranted to make conclusive recommendations about which kidney should be removed for donation.

TRANSPLANT/IMMUNOLOGY IV: CLINICAL/ TOLERANCE P250. ANATOMY RECONSIDERED: DOES MULTIPLE VS. SINGLE RENAL ARTERIES MATTER FOR A KIDNEY DONOR? S. M. Bruggink, Y. T. Becker; University of Wisconsin, Madison, WI Introduction: A sizable portion of kidney donors are left post donation with a kidney containing multiple renal arteries. No current study has addressed multiple arteries as a risk factor for HTN after unilateral nephrectomy. We asked whether donors left with a kidney containing multiple renal arteries are at an increased risk for arterial HTN post donation. Methods: A crosssectional study was performed on kidney donors who underwent donor nephrectomy between 2000-2005. We compared subjects with multiple arteries (MRA) versus single artery (SRA) in the remaining kidney to determine the influence of residual arterial anatomy on the development of HTN. Patients were evaluated by review of predonation medical records, predonation CT angiogram of renal arteries, and phone interview to ascertain current blood pressure status. Groups were compared using chi-square analyses. In addition, cumulative incidence of new onset HTN was also calculated for both groups by the Kaplan-Meier method. Survival curves were analyzed by log-rank test. A Cox proportional hazards model was used to estimate the association of MRA to new onset HTN post donor nephrectomy. Results: Of 689 total kidney donors from 2000-05, we had current addresses and phone numbers for 404 patients. A total of 243 subjects participated (60% response rate) with 81 having MRA and 162 having SRA after donation. All subjects were normotensive at time of donation. Subjects in each group were similar in their demographics. Of subjects with SRAs, a total of 16 (9.9%) developed HTN while a total of 14 subjects (17.3%) with MRAs developed HTN (p ⬍ 0.03, chi-square). HTN incidence are shown in Figure 1 (RR⫽1.754 CI⫽0.856-3.594; p ⫽ 0.11). Of the 30 patients diagnosed with HTN, 18 were on one-drug therapy and 3 required 2 or more medications (diuretics, ACE inhibitors, ARB’s, and/or beta blockade). The remainder (9) were able to control their HTN with diet and exercise alone. Interestingly, the risk of new onset HTN in donors with a body mass index (BMI) above 25 was also significantly greater (RR⫽2.716, CI⫽1.109-6.651; p⫽0.0287). Conclusions: It has been a routine practice to choose kidneys with standard arterial anatomy (SRA) for the recipient. However, we have shown that leaving MRA in the donor may pose risk for the development of HTN. Given that the outcomes in kidney transplant recipients have not been affected by the need for renal

P251. EXPERIENCE WITH TRANSPLANTATION OF KIDNEYS FROM DECEASED DONORS WITH ACUTE RENAL FAILURE. S. Khan, M. S. Anil Kumar; Drexel University, Philadelphia, PA Introduction: Kidneys from deceased donors with acute renal failure (ARF) are generally not accepted for transplantation because of the expected poor outcome. This prospective study examined the outcomes after transplantation of kidneys from donors with ARF. Methods: 55 kidneys from donors with ARF were transplanted. The outcome was compared with concurrent and matched 55 recipients of standard criteria donor (SCD) kidneys. ARF kidneys were accepted from donors aged ⬍50 years, a negative history for kidney disease and a negative pre-transplant biopsy for chronic structural changes. The immunosuppression was similar both groups. The outcome measurements included 3-year patient and graft survival, biopsy proven acute rejection (BPAR), sub-clinical acute rejection (SCAR) and chronic allograft nephropathy (CAN), serum creatinine and creatinine clearance. Results: Figure 1 shows the admitting and final kidney function in ARF and SCD donors. 3-year patient and graft survival was 90% and 90% in ARF group, 100% and 89% in SCD group. BPAR, SCAR and CAN were comparable in the groups. At 3 years the mean serum creatinine levels were 1.9⫾1.1 and 1.9⫾0.9 mg/dl and the mean creatinine clearances were 66⫾15 and 68⫾14 mls/minute in ARF and SCD groups respectively as in Figure 2. Conclusions: Transplantation of kidneys from selected deceased donors with ARF expands the donor pool to overcome the current acute shortage of kidneys and provides patient and graft survival and graft function comparable to standard criteria donor kidneys.

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serum creatinine (mg/dl)

Adm itting and final s e rum cre atinine in SCD and ARF donors

5 4 3 2 1 0 Adm itting s erum creatinine

Final s erum creatinine

ARF donor

SCD donor

Creatinine clearrance in SCD and ARF donors

creatinine cleararnce (mls/minute)

140 120 100 80 60 40 20 0 Adm itting creatinine clrearance

Final creatinine clearance

ARF donor

SCD donor

Serum creainine (mg/dl)

Se rum cre atinine in SCD and ARF re cipie nts at 3 ye ars

3.5

significant. Results: During the study period a total of 184 patients met criteria for analysis. Recipients with strict glycemic control (n ⫽ 60) had a mean glucose of 135 mg/dl compared to 184 mg/dl in the poorly controlled group (n ⫽ 124). Strict glycemic control was also associated with lower preoperative blood glucose values (98 vs. 127 mg/dl; P ⬍ 0.01) and intraoperative insulin administered (13.4 vs. 23.8 units; P ⫽ 0.04). Both groups were similar in donor characteristics (age, cause of death, and liver ischemic times) and recipient characteristics (sex, body mass index, coronary artery disease, diabetes mellitus, etiology of liver failure, renal function, use of steroids, and severity of illness (Model for End-Stage Liver Disease score)). Strict glycemic control was associated with younger age (47 ⫾ 2 vs 53 ⫾ 1 years; P ⬍ 0.01). Although the incidence of postoperative complications (acute rejection, infection, myocardial infarction, renal failure, hepatic artery thrombosis, biliary complications, venous thromboembolism, and re-transplantation) was similar between the two groups, poor glycemic control was associated with a significantly increased one-year mortality (21.9% vs. 8.8%; P ⫽ 0.05). Conclusion: While most donor and recipient characteristics as well as outcomes were similar, poor intraoperative glycemic control in liver transplant recipients was associated with an increased mortality. These data suggest that strict intraoperative glycemic control, possibly using insulin infusions, may improve outcomes following liver transplantation.

3 2.5 2 1.5 1 0.5 0 1

3

6 ARF recipients

12

24 SCD recipients

36

Creatinine clearance (mls/minute)

Creatinine Clearance in ARF and SCD recipients 80 70 60 50 40 30 20 10 0

ARF group SCD group

1

3

6

12

24

36

Months

P252. IMPACT OF STRICT INTRA-OPERATIVE BLOOD GLUCOSE CONTROL DURING LIVER TRANSPLANTATION. J. B. Ammori, M. Sigakis, M. O’Reilly, S. J. Pelletier; University of Michigan, Ann Arbor, MI Introduction: Intensive blood glucose management has been shown to decrease mortality and infections in critically ill intensive care patients. The effect of intraoperative strict glucose control on surgical outcomes has not been evaluated. Because of the associated prolonged stressful state, acute blood loss, fluid shifts, and use of hyperglycemic inducing medications (steroids), liver transplantation was used as a model to evaluate the effect of strict intraoperative glycemic control on postoperative outcomes. Methods: A retrospective review of all adult liver recipients transplanted at an academic institution between January 1, 2004 and July 6, 2006 was performed. Donor and recipient demographics, intraoperative variables, and postoperative outcomes were collected. Intraoperative glucose measurements were performed by the Anesthesiology team and treated by intravenous insulin bolus or continuous infusion as indicated. Patients with strict glycemic control (mean blood glucose ⬍ 150 mg/dl) were compared with those with less stringent control (mean blood glucose ⱖ 150). Statistical analysis was performed using t-test for continuous variables and chi-square for categorical variables. Survival was evaluated using Kaplan-Meier curves with log rank test for significance. P value ⬍ 0.05 was considered statistically

P253. FLOW CYTOMETRIC CHARACTERIZATION OF T-CELLS FROM CAMPATH-1H AND TACROLIMUS TREATED KIDNEY TRANSPLANT PATIENTS. R. D. Brahmbhatt 1, D. Bloom 2, S. Knechtle 2; 1University of Wisconsin School of Medicine and Public Health, Madison, WI, 2University of Wisconsin Division of Transplantation, Madison, WI Background: Campath-1H immunodepletion /long-term monotherapy with the calcineurin inhibitors (CNI) sirolimus or tacrolimus has been successfully used in kidney transplant patients. Campath-1H is a humanized monoclonal antibody targeted to the cell surface glycoprotein CD52 and results in profound depletion of mature lymphocytes. In the face of post-depletion lymphopenia, T-lymphocytes undergo homeostatic proliferation in an effort to reconstitute the void in the T-cell compartment. In studying the expanding T-lymphocyte population, Bloom et al. (2006) demonstrated that T-lymphocytes from patients treated with Campath-1H/ rapamycin monotherapy showed hyporesponsiveness to alloantigen and intact immune responses to third party antigen. Bloom et al. suggest that regulatory T-cells (Tregs), a T-lymphocyte population with suppressive phenotype, may have a role in these phenomena. Thus, the homeostatic proliferation of Tregs following Campath/CNI treatment is of great interest. Homeostatic proliferation of T-lymphocytes is molecularly regulated. Fortner and Budd (2005) demonstrated that Fas (CD95), a proapoptotic cellular signaling molecule, is a principal regulator in homeostatic proliferation of murine peripheral T-lymphocytes. Ki-67 is a molecular marker of homeostatically proliferating T-lymphocytes. Thus, if Campath affects homeostatic proliferation of Tregs during post-transplant immunodepletion, the study of these molecular markers could give insight into the findings of Bloom et al. Furthermore, van der Mast et al. (2005) suggest that CNI treatment may hinder immune responses that improve the likelihood of graft acceptance. Therefore, they withdrew CNI use in kidney transplant patients and found a decrease in one indicator of donor-specific reactivity. Thus, a combination of Campath, which may help suppress alloreactivity, and withdrawal of CNI treatment, resulting in disinhibition of proacceptance immune responses, may alter homeoproliferation of Tregs. Methods: Peripheral blood mononuclear cells (PBMCs) were collected using a FiColl procedure from 26 kidney transplant patients who were randomized to receive either control treatment (Campath induction therapy followed by long-term monotherapy