Poster Sessions Clinical Cases – Kidney – surgical P-001 INCARCERATED SMALL BOWEL THROUGH A RENAL PARATRANSPLANT HERNIA AFTER KIDNEY TRANSPLANTATION Eneida Bra, Naim Fakih, Iago Justo, Oscar Caso, Maria Garcia, Sergio Olivares, Alejandro Manrique, Felix Cambra, Jorge Calvo, Enrique Moreno, Carlos Jimenez. General Surgery & Abdominal Organ Trasplantation, “12 de octubre” University Hospital, Madrid, Spain Background: Renal paratransplant hernia occurs when bowel herniates through a defect in the peritoneum over the transplanted kidney and becomes trapped. It is an uncommon and potentially fatal complication of renal trans- plantation. Less than 10 cases have been described in the literature. Clinical case: We present the case of a 74 year old female patient, who one month before underwent a deceased donor kidney transplantation because of an interstitial nephropathy and nephroangiosclerosis. The patient comes to the ER department with acute intense right abdominal pain with nauseas and vomiting. Her creatinine levels were normal. A CT scan is done and a small bowel closed loop obstruction is identified in relation with the incision. The small bowel had radiological signs of ischemia. The patient underwent surgery through the oblique incision in the right iliac fossa with resection of the necrotic small bowel herniated through the defect in the peritoneum and primary anastomosis. The defect was closed with a con- tinuous suture. The postoperative evolution was uneventful with normal renal function at discharge. Conclusion: Paratransplant hernia associated with ischemic bowel is a sur- gical emergency and is associated with a high morbidity and mortality. Thus, early diagnosis and surgery are critical. Moreover, meticulous surgical tech- nique during transplantation may help avoid this complication. P-002 RENAL TRANSPLANTATION WITH ARTERIAL INFLOW FROM AN AXILLO-FEMORAL GRAFT Jodie H. Frost, U. Mathuram Thiagarajan, Atul Bagul, Michael L. Nicholson. Renal Transplant, University Hospitals Leicester, Leicester, United Kingdom Aims: Haemodialysis is associated with increased cardiovascular morbidity and many patients being presented for transplant assessment are found to have advanced peripheral atherosclerotic arterial disease and for a success- ful renal transplant, patency and adequate blood flow in the iliac arterial and venous systems is required. Herein, we report a renal transplantation, vas- cularised by a femero-femoral crossover graft and contralateral axillo-femoral graft. Methods: A retrospective case-note review was carried out. The patient a 54- year old woman who developed renal failure due to aortic occlusion. This lady had undergone a left sided axillo-superior mesenteric bypass graft to revas- cularise her gut and was established on haemodialysis through a brachio- cephalic AV fistula. After extensive work up the patient was deemed fit for transplantation, as long as the iliac arterial systems could be revascularised. This was achieved via a right axillo-bifemoral bypass graft. The kidney trans- plant was performed. Results: The anastomosis time was 32 minutes and the cold ischaemia time was 10 hours 33 minutes. Post-operatively the patient was managed in the intensive care unit and required inotropic support with noradrenaline for the first 24 hours. The patient was transferred to the ward after 48 hours and be- came dialysis independent on the fifth post-operative day and at three-month follow-up, the serum creatinine was 104µmol/L. On ultrasound scanning there was a slight suggestion of renal artery stenosis which was ruled out by CT angiogram. Conclusions: This report clearly demonstrates that renal transplantation can be successfully achieved in patients with extensive aortio-iliac disease requir- ing axillo-femoral bypass grafting. P-003 MANAGING EARLY SURGICAL COMPLICATIONS BY KIDNEY GRAFT REPERFUSION WITH A COLD STORAGE SOLUTION Libor Janousek, Michal Kudla. Transplantation, Institute for Clinical and Experimental Medicine, Prague, Czech Republic We report on five patients with early surgical complications posing a threat to future graft function or even the patient’s life. Two recipients were treated for renal vein stenosis, another two for renal vein laceration, and a renal vein thrombectomy was undertaken in one patient.These grafts were explanted, reperfused with a cold storage solution (Custodiol, 1000 ml) and reimplanted upon repairing the damaged vessels. The renal vein was reconstructed using a tubulized graft of the donor inferior caval or vein in three patients. A lacerated renal vein was repaired using a donor internal iliac vein graft in one case. Additionally, a renal vein thrombectomy ex vivo was performed in one case.The mean age of organ donors was 38.8 years (range, 29-55), with creatitine levels on harvesting being 81 µmol/l (65-108), and glomerular filtration rate 1.46 ml/s (0.82-1.83). The technical success rate of procedures indicated in our center was 100%. After the operation, diuresis increased and mean serum creatinine fell to 127 µmol/l within 1 year and glomerular filtration was 1,4 ml/s. Our tactics allows for quick control of life-threatening bleeding and offers a chance for renal graft salvage. P-004 ULCUS CRURIS DUE TO PSEUDALLESCHERIA BOYDII INFECTION AFTER RENAL TRANSPLANTATION – A RARE DIFFERENTIAL DIAGNOSIS IN A COMMON LESION Martin Jazra 1 , Peter Schenker 1 , Claudia Hempel 1 , Andreas Wunsch 1 , Christian Altenhenne 2 , Agnes Anders 3 , Richard Viebahn 1 . 1 Department of Surgery, Knappschafts-Hospital, Ruhr-University Bochum, Bochum, Germany; 2 Department of Nephrology, Marien-Hospital Herne, Ruhr-University Bochum, Herne, Germany; 3 Microbiological Institute, Ruhr-University Bochum, Bochum, Germany We report the case of a 66 year old male renal transplant recipient who de- veloped painful ulcerous lesions in his right lower leg 10 months after trans- plantation. Immunosuppressive therapy consisted of tacrolimus, mycophenolat mofetil and steroids. His general condition was not compromised, the function of the kidney trans- plant was stable. There was no history of trauma. A vascular genesis was excluded by ultrasound, there were no specific laboratory findings indicating a rheumatic or immunologic disorder. The microbiological swabs revealed pseu- dallescheria boydii, the histologic skin biopsy proved a fungal infection. We started an antimycotic therapy using voriconazole 400mg/day and reduced the immunosuppression. The lesions healed slowly and the patient did not develop new ulcers. Opportunistic infections have become more important since the number of im- munocompromised patients increases. Therefore, the knowledge of less fre- quent infectious pathogens and the sampling of microbiological specimen on a routine basis are crucial in the treatment of transplant patients. 230