Vol. 179, No. 4, Supplement, Wednesday, May 21, 2008 THE JOURNAL OF UROLOGY ® 665 METHODS: From January 2001 to July 2007, 23 of 450 transplants performed at our center developed biopsy-proven C4d+ C4d+) and no improvement in renal function. Patients received 1-3 doses of CYP iv (500 mg). Herein, we compared functional outcomes achieved in CYP-treated patients with ST-responders. Mean follow-up was 19±15 and 30±26 mo in CYP and ST groups, respectively. RESULTS: All patients were transplanted through a negative preoperative AHG-CDC T cell cross-match. As expected, patients salvaged with CYP received more IVIG (446±121 vs 236±174 g, p=0.004) and PLEX (25±9 vs 11±9, p=0.003) in comparison to ST-treated patients. In the CYP-treated group, sCr following ST did not initially improve (346±256 µmol/L at diagnosis vs. 337±171 µmol/L one day before CYP). However, CYP administration was effective in treating refractory AMR as demonstrated by 6 month sCr (152±44 µmol/L, p=0.02 vs. pre- (174±69 µmol/L, p=NS). One-year estimated creatinine clearance and graft survival, following the AMR episodes, were equivalent between the two groups as well. Importantly, CYP was well tolerated and no serious adverse effects were attributed to CYP. is capable of salvaging ST-resistant AMR with excellent functional outcomes and minimal morbidity. Its eventual role in relation with anti- CD20 therapy and splenectomy for ST-resistant AMR remains to be determined. Source of Funding: None 1934 DOUBLE KIDNEY TRANSPLANTATION: A MULTICENTRIC STUDY Riccardo Bertelli, Matvey Tsivian*, Bruno Nardo, Chiara Gilioli, Luisa Benozzi, Enzo Capocasale, Roberto Dalla Valle, Flavia Neri, Giuseppe Cavallari, Alessandro Faenza. Bologna, Italy, Modena, Italy, and Parma, Italy. bioptically as not suitable for single kidney transplantation may be considered for double kidney transplantation (DKT). The aim of this study is to assess long term results of DKT in a multicentric experience. METHODS: From 2001 to 2007, 80 DKT were performed in the transplant centers of Bologna, Parma and Modena, using organs with mean bioptic score of 4.4. Recipients’ mean age was 61±5 years. The main indications for transplant were glomerular nephropathy(33) and hypertensive nephroangiosclerosis(14). Mean HLA A,B,DR mismatches: min. Nearly all grafts were perfused with Celsior solution (mean cold ischemia time: 17±4h). Immunosuppression regimens were based on tacrolimus(55) or cyclosporine(25). RESULTS: Fifty patients had a good postoperative renal 8(10%) acute rejections occurred. Urinary complications rate was 16%: 6(7.5%) surgical revisions for bowel perforation(2), hemorrhage(3) and lymphocele(1). Two patients underwent immediate bilateral transplantecomy due to massive thrombosis. Four patients underwent transplantectomy of single graft due to bleeding(1), vascular(2) and infective complications(1). Graft and patient survival was 95% and 100%, 95% and 96% at 3 and 36 months, respectively. CONCLUSIONS: DKT allows to use organs of marginal donors that otherwise would not be accepted for transplantation. In our experience this solution is an effective strategy to face organ shortage with good outcomes. Source of Funding: None 1935 CLINICAL AND GENETIC RISK FACTORS FOR POSTTRANSPLANT DIABETES MELLITUS IN ADULT RENAL TRANSPLANT RECIPIENTS TREATED WITH TACROLIMUS AND MYCOPHENOLATE MOFETIL Shigeru Satoh*, Kazuyuki Numakura, Mitsuru Saito, Takamitsu Inoue, Kazuyuki Inoue, Masatomo Miura, Hideaki Kagaya, Hiroshi Tsuruta, Takashi Obara, Teruaki Kumazawa, Takashi Yuasa, Norihiko Tsuchiya, Toshio Suzuki, Tomonori Habuchi. Akita, Japan. INTRODUCTION AND OBJECTIVE: The present study investigated the incidence of posttransplant diabetes mellitus (PTDM) and calculated the risk of developing PTDM under a tacrolimus and mycophenolate mofetil (MMF)-based immunosuppression based on clinical characteristics, tacrolimus-pharmacokinetics, and genetic polymorphisms related to tacrolimus-pharmacokinetics, cytokines and diabetes mellitus. METHODS: Seventy-one non-diabetic adult kidney recipients (male 37, female 34) were studied. Patients with continuous high plasma glucose levels, over 6.5mg/dl of hemoglobin A1c, or requiring insulin and/ or oral anti-diabetic agents for more than 3 months after transplantation at 1-year after transplantation were diagnosed as having PTDM. Fifteen genomic polymorphisms were assessed. RESULTS: One year after transplantation, 21 recipients (29.6%) developed PTDM. Positive risk factors were age (p=0.028) in acute rejection rate, total steroid doses, tacrolimus-pharmacokinetics or its related to genetic polymorphisms between the two groups. adiponectin T45G TT genotype than in those with the G allele (p=0.034), and in patients with glucocorticoid receptor (NR3C1) Bcl I CC genotype than in those with the G allele (p=0.004). CONCLUSIONS: The incidence of PTDM at 1-yr after transplantation was 29.3% in our cohort. Elder or obese patients were risky for the development of PTDM. The presence of the adiponectin T45G TT or NR3C1 Bcl I CC genotype may also be risk factors for PTDM, suggesting that insulin and glucocorticoid sensitivity-related genes are associated with the development of PTDM. Analysis of these genotypes is a possible method of predicting a patient’s risk for developing PTDM and would be a valuable asset in selecting appropriate immunosuppressive regimens for individuals. Source of Funding: None 1936 C4D BINDING CORRELATED WITH STRONG HLA ANTIBODIES INVOLVED IN GRAFT FAILURES Kazuo Mizutani*, Paul Terasaki, Momokazu Gotoh. Los Angeles, CA, and Nagoya, Aichi, Japan. INTRODUCTION AND OBJECTIVE: Capillary C4d was an established marker of antibody-mediated rejection in kidney transplants. cytometry beads after C4 was bound to anti-HLA antibodies, and C4d this assay may detect antibodies which are complement-activating or non-complement-activating, therefore revealing the antibodies which play an important role in graft rejection. Our aim in this study is to check the possibility that this assay might be useful in distinguishing two types of antibodies. METHODS: We applied this with FlowPRA® and LABScreen® (One Lambda,Inc., Canoga Park, CA) to sera from patients who had either failed grafts (n=101) or functioning grafts(n=108) , to check the possibility that this assay might be useful in distinguishing two types