Page 3 - CUA2018 Abstracts - Reconstruction

Poster session 6: reconstruction/trauma/transplant

1 million iterations. UDS+SI had an 83% of being cost–effective at a (26.67% vs. 40%), although not statistically significant (p value of 0.107
WTP of $50 000/QALY. and 0.439, respectively), were lower in Hemopatch group. The transfusion
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Conclusions: In this cost–utility analysis model, SI+UDS is cost–effective rate and drain placement were also non–significantly lower in Hemopatch
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compared to SI in the pre–treatment investigation of men with PPUI. group. On performing subgroup analysis in patients receiving blood thin-
Future studies should validate these findings in a real population. ners, EBL and perigraft collection favoured Hemopatch receivers
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Conclusions: Hemopatch is safe, feasible, and has effective hemosta-
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MP–6.7 sis. One of the primary objectives of subjective evaluation by surgeon
was in favour of Hemopatch . Blood loss, perigraft collection, and blood
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Comparison of cystoscopic vs. magnetic retrieval device transfusion are not statistically significant due to small numbers in this
for removal of ureteral stents in renal transplant patients: A pilot study, but trended favourably towards the Hemopatch group. A
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randomized pilot study small sample size and confounding factors are limitations of the study.
Gaurav Vasisth , Jason Akerman , Fadil Hassan , Camilla Tajzler , Simreet This study represents the initial experience with new hemostatic product
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Hansra , Kevin Piercey , Shahid Lambe , Anil Kapoor 1 (Hemopatch ) in DDRT, suggesting encouraging results
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1 Urology, McMaster University, Hamilton, ON, Canada
Introduction: Intraoperative placement of a ureteral stent during renal
transplant has been shown to reduce urological complications. Magnetic MP–6.9
stents offer a means of bypassing flexible cystoscopy at the time of removal Transitioning from donor travel to kidney shipment for organ
with a small retrieval device. In this single–centre, prospective, random- delivery in the Canadian Kidney Paired Exchange program
ized feasibility study, we assess the use of the Black–Star stent and mag- Brian Reikie , Tadeusz Kroczak , Thomas McGregor 2
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netic retrieval device for postoperative stent removal in renal transplant 1 Surgery, University of Manitoba, Winnipeg, MB, Canada; Urology,
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patients. Queen’s University, Kingston, ON, Canada
Methods: Patients undergoing deceased donor renal transplantation were Introduction: Canada’s Kidney Paired Donation (KPD) program currently
randomized to receive either a traditional double–J ureteral stent or the sends living donors to the site of renal transplantation, but is planning
Black–Star magnetic stent. A baseline survey assessment was completed to begin shipping kidneys ex–vivo as the method of organ delivery. We
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at the time of randomization, followed by a postoperative symptom ques- aimed to examine the feasibility of shipping kidneys for the Canadian
tionnaire (Ureteral Stent Symptom Questionnaire [USSQ]) before and after KPD program, and to provide recommendations to facilitate transition to
stent removal. Patient satisfaction, time required for stent removal, urinary a kidney shipment model.
tract infection rates, and procedure costs were all recorded. Methods: Data was gathered from transport Canada and provincial min-
Results: Thirty–five patients were randomized to traditional ureteral istries of transportation for transportation by road or rail. Web searches
stent or Black–Star magnetic stent. Total time required for stent removal were performed for national air carrier flight cancellation rates, average
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under cystoscopy was significantly longer (496 seconds, standard devia- flight delay times, flight distances, and scheduled departure times.
tion [SD] 202.4) compared to magnetic stent removal (269 seconds, SD Results: 1) Travel by rail: There is greater than 48 000 km of track within
138.7; p=0.022). No significant difference was seen in all USSQ domains Canada with centrally located railway stations and negligible delay
between groups pre– and post–stent removal. No difference was observed times. 2) Travel by road: Travel times are heavily impacted by weather
in the rate of urinary tract infections or surgical complications. Stent and unpredictable delays. Provincial police and third–party organizations
removal was well–tolerated in both groups. have arranged police escorts to expedite highway travel. 3) Travel by air:
Conclusions: USSQ scores suggest that the Black–Star magnetic stent is Flight times and distance between transplant centres reach up to 7 hour
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equally well–tolerated by patients when compared to traditional ureteral 45 minutes (excluding layover time between flights in Toronto) and 4638
stents. Removal of the Black–Star magnetic stent required less time with km. Flight delay rates, average delay time, and cancellation rates reach
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no greater discomfort or complication rate compared to stent removal 71%, 54 minutes, and 9%, respectively.
under cystoscopy. A cost–savings analysis is currently underway and will Conclusions: Canada’s vast geography combined with extreme weather
be included. The Black–Star magnetic stent may offer a well–tolerated conditions presents significant obstacles for safe and timely organ delivery.
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and convenient alternative to traditional ureteral stent removal by flexible We provide recommendations: 1) utilization of all national air carriers;
cystoscopy in renal transplant patients. 2) utilization of rail transport; 3) involvement of a third–party logistical
organization; 4) adjusted nephrectomy start times and dedicated evening
MP–6.8 transplant slating; and 5) continued use of the travelling donor model in
special circumstances.
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A randomized controlled trial of Hemopatch vs. no Hemopatch
for the intraoperative hemostasis during deceased donor renal
transplant MP–6.10
Gaurav Vasisth , Yanbo Guo , Shahid Lambe , Kevin Piercey , Anil Kapoor 1 Prophylactic heparin infusion: A safe preventative measure
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1 Urology, McMaster Institute of Urology, Hamilton, ON, Canada for thrombotic complications in pediatric kidney transplant
Introduction: End–stage renal disease and deceased donor renal trans- recipients weighing <20 kg?
plant (DDRT) has been associated with deleterious effects on hemosta- Jin Kyu (Justin) Kim , Armando Lorenzo , Walid Farhat , Michael Chua ,
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sis and can impact status of recipient and graft function. To augment Jessica Ming , Chia Wei Teoh , Diane Hebert , Min Joon Lee , Amre
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intraoperative hemostasis an ideal hemostatic method is of paramount Kesavan , Martin Koyle 2,3
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importance. Hemopatch is a novel hemostatic pad that is a polyethylene 1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada;
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glycol–coated (PEG–coated) collagen patch. 2 Division of Urology, Hospital for Sick Children, Toronto, ON, Canada;
Methods: The objective of this study was to assess efficacy and safety 3 Surgery, University of Toronto, Toronto, ON, Canada; Division of
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of Hemopatch in achieving hemostasis in DDRT. We performed a pro- Nephrology, Hospital for Sick Children, Toronto, ON, Canada; School
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spective, randomized pilot trial by assigning Hemopatch by computer of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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randomization. The primary outcomes were amount of intraoperative Introduction: Small–sized children (<20 kg) who receive kidney trans-
estimated blood loss (EBL) and subjective achievement of hemostasis plants are at high risk of allograft vessel thrombosis. Heparin prophylaxis
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following Hemopatch application; secondary outcome was perigraft (HP) has been used in order to mitigate this risk, but may infer an increase
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collection in ultrasound in bleeding risks. At our institution, unfractionated heparin 10 units/
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Results: Thirty patients were enrolled with median age of 64.5 years. Fifteen kg/hour is used as HP since 2009. Therefore, this investigation aims to
were randomized to Hemopatch and 20 were on blood thinners. The sub- determine whether HP is a safe means to prevent thrombosis in small
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jective achievement of hemostasis by surgeon was in favour of Hemopatch kidney transplant patients by comparing those who have received HP and
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in all cases. The EBL (236.37 ml vs. 326.67ml) and perigraft collection those who have not received HP (NHP).
S98 CUAJ • June 2018 • Volume 12(6Suppl2)