Poster Abstracts

Thursday 14 August 2008

CONCURRENT ORAL SESSION 155: LATE BREAKING

POSTER BOARD NUMBER P4 373
2323 POST TRANSPLANTATION LYMPHOPROLIFERATIVE
DISORDER AFTER LIVER TRANSPLANTATION: A SINGLE
CENTER EXPERIENCE AMONG 400 PATIENT SERIES
S. Marzban, B. Geramizadeh, S-A. Malek-Hosseini, A. Bahador, H. Salahi, K.
Bagheri-Lankarani, M-H. Imanieh
Transplant Research Center, Shiraz University of Medical Sciences
Introduction: Post transplant lymphoproliferative disorders (PTLD) are a
heterogenous group of lymphoid proliferation occurring in the setting of solid
organ or BM transplantation.
In this review we will consider the incidence and clinical features of this group
of patients in our center.
Material and Methods: In this study, we present the clinical and pathologic
features of PTLD cases after liver transplantation (LT). In the period of liver
transplantation we had 3 pathology conrmed cases of PTLD out of 430 liver
transplant cases.
Results: Among 430 liver transplantation 3 cases were diagnosed as PTLD. Two
of the patients were child (both 6 year-old) and the other was adult (45 year-old).
One of the children was presented with diarrhea after 6 months of transplant and
PTLD (polymorphic type) was diagnosed on duodenal biopsy, she expired despite
of reducing the immunosuppressive therapy and starting of chemotherapy. The
other child was present with cervical lymphadenopathy one year after transplant.
He was also expired. The reason of liver transplantation was biliary atresia in
both of them. The last one was an HCV positive male patient who presented
with a very small cervical lymphnode( 1 cm) 1 year after liver transplant. He was
diagnosed as Hodgkins-like type of PTLD, now after 3 years he is doing well. In
all the three case EBV was positive in the involved tissue.
Conclusion: In conclusion, PTLD is a life treating disorder in liver transplant
patients. According to the present data (3/430) it seems that the incidence of
this disorder is lower than other parts of the world.

POSTER BOARD NUMBER P4 374

2324 ASSESSMENT OF CAUSATIVE FACTORS FOR
LYMPHOCELE FORMATION FOLLOWING RENAL
TRANSPLANTATION
J. Kothari, H. Talreja, A. Supariwala, R. Sirsat, A. Almeida
Pd Hinduja Hospital
Introduction: Lymphocele is a uid collection between the renal graft and the
urinary bladder. It is an uncommon complication (0.6% to 18%) following renal
transplantation. It is associated with incomplete ligation of lymphatic vessels
of graft, extensive perivascular dissection in the recipient, acute rejection and
use of high dose steroids.
Objective: To determine the incidence of lymphocele in post renal transplant
patients at our center and identify potential factors responsible or associated to
its development.
Materials and Methods: All patients who underwent renal transplantation at
our centre from Jan 2004 to Oct 2007 with complete medical records were
reviewed.
Results: Out of 138 patients who had undergone renal transplantation, 48
developed lymphocele(34.7%).28 patients (58%) required surgical drainage
or pigtail catherization. Signicant variation was noted in yearly incidence of
lymphocele which coincided with the yearly change in the surgical registrar
preparing the bed for the recipient. Signicantly, 25 out of 52 patients with
urinary tract infection developed lymphocele as compared to 23 out of 86
without evidence of urinary infection (p=0.016) . A total of 25 Acute rejection
episodes was seen in total with similar incidence in the two groups, with &
without lymphocele. Gram negative bacteria causing UTI, especially those
resistant to beta lactam antibiotics (ESBL) were the commonest organisms
isolated in patients with lymphocele formation.Use of IL-2R antagonists for
induction was not associated with increased incidence of lymphocele. There is
no association of lymphocele formation with the different immunosuppressive
regimens used at our center. Diabetic patients had a higher incidence of
lymphocele, but the difference was statistically insignicant (p=0.056).
Conclusion: More attention to careful ligation of lymphatic vessels both during

graft bed preparation and during graft implantation can signicantly contribute
to reducing the incidence of lymphocele following renal transplantation. Cases
requiring surgical treatment cause signicant morbidity. Preventive methods,
such as laparoscopic fenestration need to be done routinely to minimise
lymphocele formation. Urinary infections post-transplant is associated with
increased incidence of lymphocele formation. Diabetics may be more prone
for higher lymph collection, probably due to delayed healing of the dissected
lymphatics, but that remains to be proven conclusively.

POSTER BOARD NUMBER P4 375

2325 LAPAROTOMIC LIVE DONOR NEPHRECTOMY: IS IT
STILL JUSTIFIED?
M.A. Zargar, H. Shahrokh, M.J. Soleimani, K. Kamali, S.K. Hosseini, S.M.R.
Rabani, A. Barzegarnejad, E. Azimi
Shaheed Hasheminejad Hospital, Iran University of Medical Sciences
Purpose: We report our experience with laparatomic Live Donor Nephretomy
during the last 23 years.
Patents and methods: Between August 1985 and November 2007, 2260
consecutive live donors who underwent laparatomic nephrectomy at the
university hospital of Hasheminejad in Tehran, were included in this audit.
All donors underwent routine preoperative assessments including renal
angiography, to evaluate the anatomy of the renal arteries. Patients underwent
a high midline laparatomy under general anesthesia. Principally the left kidney
was the preferred side unless multiple left sided renal arteries were present.
For the left kidney, in most cases, the inferior mesenteric vein was ligated and
the retroperitoneum entered with a good access to left kidney and its pedicle.
On the right side after duodenal kocherization, the right kidney and its pedicel
were easily accessible. After removal of the kidney the posterior peritoneum
defect is closed and a short term drain is placed.
Result: 2260 live donors underwent laparatomy during a period of near 23
years. They were 1440 male and 820 female. Left kidney was used in 95% of
the cases. The mean donor age was 26 years (20-48 years). The mean hospital
stay was 3 days (2-5 days). The mean incisional length was 12 cm ( 2.5 cm).
The mean warm ischemia time was always less than 1 minute. The mean
operation time was 55 minutes (40-70 minutes). The mean intraoperative blood
loss was 200mls and there were no post operative transfusions. There were no
signicant gastrointestinal complications. Postoperative morality occurred in
one case with sudden death of a 31 years old male who developed abdominal
pain 16 hours after operation. He was suspected of massive bleeding from renal
artery stump. Incision hernia in four cases, which required operative repair.
Signicant lymphocele occurred in one case, which responded well to surgical
intervention.
Conclusion: In our experience midline laparatomy, is a very safe and efcacious
approach for live donor nephrectomy. It is associated with short operative
time and low morbidity rates and despite the rapid development of minimally
invasive techniques, this approach will continue to have a denite place in high
volume units such as ours. In our experience the only long-term disadvantage
of laparatomic donor nephrectomy has been in the cosmetic results.

POSTER BOARD NUMBER P4 376

2326 PROTEIN TRANSDUCTION TECHNOLOGY FOR STEM
CELL REPROGRAMMING: A NOVEL STRATEGY TO OBTAIN
INSULIN-PRODUCING CELLS
M. Ramrez-Domnguez1,2, N. Vicente-Salar2, A. Santana3, J. DomnguezBendala1, L. Inverardi1, C. Ricordi1, K. Hmadcha4, B. Soria4, E. Roche2
1
Diabetes Research Institute. University of Miami, 2 Instituto de
Bioingenieria.Universidad Miguel Hernandez de Elche, Spain, 3 Hospital
Universitario de Las Palmas, Spain, 4 Centro Andaluz de Biologia Molecular
y Medicina Regenerativa (CABIMER), Sevilla, Spain
Several reports have demonstrated the potential of mouse and human embryonic
stem (ES) cells to differentiate into insulin-producing cells and revert diabetes
in transplanted animal models. However, in vitro protocols are still inefcient,
as they give rise to heterogeneous cell populations that include undifferentiated
cells and derivatives of the three embryonic layers. Thus, there is a need for
alternative approaches to improve the efciency of beta cell differentiation.
The feasibility of reprogramming strategies has already been demonstrated.

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THURSDAY

Supplement to Transplantation July 27, 2008, Volume 86 Number 2S