Most non-directed kidney donors in upper end of economic spectrum

Hannah R. Choate, MDA report on the Global Kidney Exchange and the finding that robot-assisted reconstruction of the transplant ureter is feasible were among the noteworthy research in transplantation at the AUA annual meeting in Boston. The take-home messages were presented by Hannah R. Choate, MD, of Albuquerque Urology Associates, Albuquerque, NM.

The first U.S. penile transplantation occurred in a patient with a subtotal penectomy for penile cancer. Researchers report successful short-term results with voiding, sensation, and tumescence, using conventional immunosuppression.

At 1 year, living Asian kidney donors with visceral obesity experienced a more significant decline in kidney function. Clinicians should consider incorporating adiposity markers, as measured by cross-sectional computed tomography, into preoperative kidney donor evaluation.

Pre-transplant antibody removal could be eliminated as a requirement if serum antibody titers are low enough.

The Global Kidney Exchange has generated 27 transplants to date. Each chain has produced 12, nine, and six transplants respectively, and six patients have been transplanted with a panel reactive antibody above 80.

Caution is recommended when utilizing donor after cardiac death grafts when the donor is >60 years of age.

Continue to the next page for more take-home messages.

• Most non-directed kidney donors are in the upper end of the economic spectrum. Removal of financial disincentives may increase the number of donors.

• Pre-transplant programmed bladder cycling does not confer any clinical advantage regarding postoperative urologic complications, graft function, lower urinary tract symptoms, or cystometric capacity.

• Perinephric fluid collections are common. The majority of collections do not require intervention. Larger volume collections are associated with intervention and are usually secondary to lymphoceles.

• Robot-assisted reconstruction of the transplant ureter is feasible and can be safely performed with excellent graft survival and low complication rates.

• Renal malignancy-related end-stage renal disease patients who had shorter waiting periods for transplants (0-2 years) had better overall survival than those who waited longer (>2 years), with similar cancer-specific mortality.

• The time to become eligible for transplant in patients with cT1a renal cell carcinoma was affected by treatment modality, with a shorter eligibility time for radical nephrectomy and a longer time for focal ablation. Tumor size and the experience of the transplant program also affected eligibility time.

• A retrospective review examined complexities associated with pediatric transplantation.

• A literature review of cases of kidneys transplanted from donors with small renal masses found that 131 tumorecomtized kidneys have been transplanted, 65% from living donors, and that 27 contralateral kidneys have been transplanted. Tumor recurrence rate was approximately 1.5%.

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