ABSTRACTS - POSTER PRESENTATIONS (MONDAY)

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Shiraz Organ Transplant Center, Nemazee Hospital, Shiraz, Iran.

In coping with the shortage of living related and cadaveric donor groups for renal transplantation, and in the fear
of organ marketing, spousal donors are considered as an invaluable potential source. Skvival rates have been
reported to be as high as even some related groups. In this study, 1093 consecutive renal transplantations performed
in Shiraz (Southern Iran) Organ Transplant center till 2003 were studied and patient survival rates in different donor
groups were calculated using Kaplan-Meier analysis.
The three-year survival rates were 93% for kidneys from 61 spouses, 92% for kidneys from 433 living-related
donors, 91% for kidneys from 427 living-unrelated (excluding spouses) donors, and 83% for 118 cadaveric kidneys.
Such results are the same as many other similar reports that consistently show a 10% lower three-year survival for
cadaveric transplants, in addition to the fact that spousal donors are at least as good as living-related donors, and are
a reliable source in cases of organ shortage.
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126

' NOCTURNAL HEMODIALYSIS RESULTS IN STABLE CORONARY CALCIFICATION AS MEASUWD BY

HELICAL COMPUTED TOMOGRAPHY IN PATIENTS WITH END STAGE RENAL DISEASE.

I
i.
.. D. Yuen, A. Pierratos and C.T. Chan, Toronto General Hospital - University Health Network, Humber River
Regional Hospital, University of Toronto, Ontario, Canada

End stage renal disease (ESRD) patients have 5- to 10-fold more coronary calcification than age- and sex-matched
controls, and show progression of their calcification, even after 1 year. Coronary calcification scores are
significantly associated with a history of cardiovascular events in ESRD patients. Preliminary studies have
suggested an association between hyperphosphaternia, elevated calcium x phosphate product and vascular
calcification. Nocturnal hemodialysis (NHD) is a novel form of renal replacement therapy which greatly increases
dialysis dose and offers superior calcium-phosphate balance. We hypothesized that NHD would improve calcium-
phosphate balance and thus prevent progression of coronary calcification. We conducted a prospective cohort study
with a before and after design. Fourteen ESRD patients (43 f 3 yrs, mean f SEM) underwent an ECG-gated helical
computed tomography (CT) of the heart to assess for coronary calcification at the time of NHD initiation and 1 year
after. Coronary calcification scores were derived using established criteria. Patients were grouped into 4 categories
based on their calcification burden: mild (8 patients, coronary calcification score (CCS): 0 - loo), moderate (4
patients, CCS: 101 - 400), severe (0 patients, CCS: 401 - 1000), and very severe (2 patients, CCS: > 1000). After 1
year of NHD, coronary calcification scores remained stable (from 511 f 337 to 639 f 440, p = 0.54), and the
distribution of patients amongst the 4 calcification categories did not change. Serum calcium levels remained
unchanged (2.47 f 0.06 to 2.51 f 0.03 mM,p = 0.48), phosphate levels decreased (1.38 f 0.08 to 1.07 f0.08 mM,p
= 0.03), and the calcium x phosphate product levels decreased (42.5 f 2.9 to 33.4 f 2.5 mg21d~2,p = 0.04).
Secondary hyperparathyroidism control was enhanced with NHD (parathyroid hormone levels decreased from 46.5
f 17.4 to 13.4 f 6.3 pmoVL, p = 0.03). Our results suggest that NHD may prevent the progression of coronary
calcification in ESRD patients through improved control of uremia, normalization of calcium & phosphate balance,
and enhanced control of secondary hyperparathyroidism.