# AVERAGE MEDIAN Thomas Thomas Oral 7 3.33 3.00 Schachtner Schachtner Germany Presenter Score Comments Submitter Topics LD Programs 4 3 requires further studies with a larger Cohort. 3 Left-Sided Donor Nephrectomy Predisposes Living Kidney Donors to Latent Adrenal Insufficiency with Symptoms of Fatigue and Inferior Quality of Life Thomas Schachtner1,2,3, Petra Reinke1,2. 1Nephrology and Internal Intensive Care, Charité Campus Virchow Clinic, Berlin, Germany; 2Berlin-Brandenburg Center for Regenerative Therapies, Charité Campus Virchow Clinic, Berlin, Germany; 3Berlin Institute of Health, Charite and Max Delbrück Center, Berlin, Germany Background: The rising prevalence of end-stage renal disease and the chronic organ shortage subsequently calls more people upon to consider living kidney donation. The benefits for living donor recipients and the relative low risk of physical complications for donors have been well documented. The risks of impaired quality of life and particularly symptoms of chronic fatigue, however, remain less well understood and dampen the enthusiasm of living kidney donor outcomes. Material and Methods: We hypothesized that left-sided donor nephrectomy predisposes donors to symptoms of chronic fatigue due to impairment of blood supply of the left adrenal gland. We retrospectively analyzed 356 living kidney donors undergoing nephrectomy from 1998 to 2013, and aimed to address the impact of donation on physical health and quality of life using the standardized short form-8 questionnaire (SF-8). In addition, we prospectively followed 27 living kidney donors 2014/2015 for symptoms of chronic fatigue. Morning cortisol and ACTH levels were performed at baseline, in the first week, and +6 months post donation. Data were compared between right- and left-sided donation. Results: The response rate amounted to 90.2%. Using a standardized quality of life score, left-sided donors showed a significant worse quality of life compared to right-sided donors (p=0.037). Left-sided donors were more likely to develop symptoms of chronic fatigue and less likely to develop hypertension post donation (p<0.05). Donors with symptoms of fatigue were more likely to be younger and have physically and mentally demanding jobs (p<0.05). Among our prospectively followed donors we identified 4/11 left-sided donors with self-reported fatigue symptoms compared with 1/16 right-sided donors. No differences were observed for morning cortisol and ACTH levels between right- sided and left sided donors at baseline (p>0.05). However, right-sided donors were more likely to show stable morning cortisol levels from pre to +6 months post donation, while left-sided donors showed a decline of morning cortisol levels (p<0.05). While 5/16 right-sided donors developed hypertension in the first year post donation, no left-sided donor developed hypertension (p=0.059). Conclusion: Our results strongly indicate that the side of donor nephrectomy has major impact on physical and mental quality of life in long-term follow-up. Here, impaired function of the left adrenal gland due to transection of adrenal vessels Page 1 | Abstract #7 ISODP2017 | 2017-05-17 10:55:32 AM # AVERAGE MEDIAN Thomas Thomas Oral 8 3.50 3.50 Schachtner Schachtner Germany Presenter Score Comments Submitter Topics Others 4 There needs to be a comment on the financial interest of a nephrologist, to bring patient as early as possible back to dialysis 4 3 3 Provision of Highly Specialized Aftercare by the Transplant Center Strongly Improves Patient and Allograft Survival in Long-term Follow-up After Kidney Transplantation Thomas Schachtner1,2,3, Petra Reinke1,2. 1Nephrology and Internal Intensive Care, Charité Campus Virchow Clinic, Berlin, Germany; 2Berlin-Brandenburg Center for Regenerative Therapies, Charité Campus Virchow Clinic, Berlin, Germany; 3Berlin Institute of Health, Charite and Max Delbrück Center, Berlin, Germany Background: Despite rapid medical advancements in the field of transplantation over the last decades, mean kidney allograft survival remained at a standstill. If and to what extent a highly specialized, experienced, and up-to-date aftercare of kidney transplant recipients (KTRs) impacts patient and allograft outcomes in long-term follow-up, however, remains mostly unknown. Material and Methods: We hypothesized that highly specialized aftercare of KTRs by transplant centers compared to local nephrologists ultimately improves patient and allograft survival. We retrospectively analyzed 1328 KTRs transplanted between 1998 and 2015 with regard to patient and allograft survival. KTRs treated regularly in our transplant center in long-term follow-up were compared with those KTRs followed by local nephrologists and general practitioners only. Results: In total 824 KTRs (62.0%) were followed in our transplant center and 504 KTRs (38.0%) were followed by local nephrologists/general practitioners. Multivariate analysis identified 4 independent factors, that were associated with strong adherence to the transplant center provided aftercare: shorter distance to the transplant center (p<0.001), living donation (p<0.001), early registration to the waiting list (p=0.009), and shorter initial hospital stay (p=0.004). No differences were observed for recipient age, recipient sex, and time on dialysis (p>0.05). KTRs followed in our transplant center showed a significantly better patient survival (72.7% vs. 50.4% after 15 years; p=0.001) and death-censored allograft survival (85.0% vs. 64.4% after 15 years; p<0.001) in long-term follow-up compared to KTRs followed by local nephrologists. These differences were equally observed in deceased and living donor KTRs of a first kidney allograft. Retransplant KTRs followed in our transplant center showed superior death- censored allograft survival (p=0.035), but no differences for patient survival. Conclusions: Our data strongly indicate that provision of aftercare by the transplant center is highly associated with superior patient and allograft survival. The observed wide differences may be attributed to highly specialized immunological and infectious screening protocols, careful and critical guidance of immunosuppression, and more comprehensive medical care. Despite long distances, transplant centers, local nephrologists, and health insurances must encourage patients to make use of transplant center provided aftercare. Page 2 | Abstract #8 ISODP2017 | 2017-05-17 10:55:32 AM # AVERAGE MEDIAN Fangmin Fangmin Oral or Poster 9 1.33 1.00 Ge Ge People's Republic Presenter Score Comments Submitter of ChinaTopics Education, Communication and Promotion 2 1 1 Methods part is too short, topic is in my opinion not relevant as it collides with ethical considerations Gender Difference of Attitude and Willingness towards Kidney Donation and Sale among Chinese Medical Students Fangmin Ge1,2, Gabriele Kaczmarczyk2, Nikola Biller-Andorno3. 1Department of Labor Union, Zhejiang University School of Medicine, Second Affiliated Hospital, Hangzhou City, People's Republic of China; 2Department of public health, Charité University Medicine, Campus Virchow, Berlin, Germany; 3Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland Objectives: Since kidney is the primary organ in need for transplantation, it is of significance in unveiling gender difference of willingness and attitudes towards kidney donation and sale among Chinese medical students in a hypothetical regulated kidney market. Methods: This quantitative research was studied among Chinese female and male medical students by using a 34-item piloted questionnaire. The data was analyzed by GraphPad Prism Software. Results: 320 participants at a median age of 24 years were surveyed. Twenty percent of the surveyed medical students would consider selling a kidney in a regulated kidney market. Among them, 68.2% would sell only to overcome a particularly difficult financial situation. Only 37 out of 107 (34.6%) endorsing a regulated market would be willing to sell a kidney. Gender difference had a marginal association with willingness to sell a kidney (p=0.0831), whereas the religiosity and socio-economic status of respondents were significantly related with willingness to donate a living- or posthumous kidney (see fig. 1). Conclusions: Our results preliminarily indicated the willingness and attitude of Chinese medical students toward organ sale in such a hypothetical regulated kidney market. Attitudes toward legalizing a regulated kidney market and willingness to sell a kidney are not consistent. Gender imbalance, religiosity and socio-economic status may exert different impacts on the decision-making process for organ disposition. Page 3 | Abstract #9 ISODP2017 | 2017-05-17 10:55:32 AM # AVERAGE MEDIAN Sigrid Sigrid Oral 16 2.20 2.00 Fry-Revere Fry-Revere United States Presenter Score Comments Submitter Topics Bioethics and Legal Aspects 3 3 2 2 1 Introducing an Exploitation/Fair Dealings Scale for Evaluating Living Organ Donor Compensation Policies Using Iran as the Test Case Sigrid Fry-Revere3,4, Deborah Chen2, Bahar Bastani1, Simin Golestani5, Rachana Agarwal6, Howsikan Kugathasan7. 1Internal Medicine, Saint Louis School of Medicine, St. Louis, MO, United States; 2Scholars, Center for Ethical Solutions, Lovettsville, VA, United States; 3President and CEO / Scholar, American Living Organ Donor Fund, Lovettsivlle , VA, United States; 4President and CEO / Scholar, Center for Ethical Solutions, Lovettsville, VA, United States; 5Just graduated, Arizona School of Medicine, Phenix, AZ, United States; 6Student, Fisk