Conflicting evidence surrounds clinical outcomes in obese individuals after transplantation; nonetheless, many are denied the opportunity to receive a transplant. Allografts with complex vascular anatomy are regularly used in both deceased and living donor settings. We established the risk of transplanting kidneys with multiple renal arteries into obese recipients. A retrospective analysis of data from 1095 patients undergoing renal transplantation between January 2004 and July 2013 at a single centre was conducted. Of these, 24.2% were obese (body mass index >30 kg/m(2)), whereas 25.1% of kidneys transplanted had multiple arteries, thereby making the transplantation of kidneys of complex anatomy into obese recipients a relatively common clinical occurrence. Vessel multiplicity was associated with inferior 1-year graft survival (85.8.% vs 92.1%, P = .004). Obese patients had worse 1-graft survival compared to those of normal BMI (86.8% vs 93.8%, P = .001). The risk of vascular complications and of graft loss within a year after transplantation were greater when grafts with multiple arteries were transplanted into obese recipients as compared to their nonobese counterparts (RR 2.00, CI 95% 1.07-3.65, and RR 1.95, CI 95% 1.02-3.65). Additionally, obese patients faced significantly higher risk of graft loss if receiving a kidney with multiple arteries compared to one of normal anatomy (RR 1.97, 95% CI 1.02-3.72). Thus, obese patients receiving complex anatomy kidneys face poorer outcomes, which should be considered when allocating organs, seeking consent, and arranging for aftercare.

Purpose The logistics of cadaveric renal transplantation are largely driven by Cold Ischemic Time (CIT). However, to achieve successful outcomes in increasingly complex donor-recipient combinations, recipient and operative issues demand equal consideration. Extending CIT without detriment to graft function would therefore be of value. We have investigated the role of Hypothermic Machine Perfusion (HMP) as a tool by which such an extension might be obtained. Methods Cadaveric kidneys were allocated to a storage method depending on predicted time to theatre. Kidneys to be transplanted between 8am-8pm in the dedicated transplant theatre remained in Static Cold Storage (SCS). If predicted operating time was out-of-hours, the kidney was transferred to HMP and transplanted at the earliest opportunity on the elective transplant list. Data were collected prospectively including donor and recipient demographics, CIT, operative factors and post-transplant outcomes. Results During the study period (Jan 2012-Dec 2013 inclusive) 74 kidneys were transplanted from HMP and 101 from SCS. Median CIT was 23.85 hours in the HMP group compared to 13 hours in the SCS group (p=<0.0001). 20 HMP kidneys suffered from DGF (27%) compared to 47 (47%) in the SCS group (p=0.012). For DBD kidneys only, 15 of the 65 (23%) HMP kidneys developed DGF compared to 30 of the 75 (40%) SCS kidneys (p=0.046). DGF rates were equivalent for the small number of DCD kidneys in the study. There were no other significant differences in graft or post-operative complications. Conclusions This study demonstrates that improved early graft outcomes can be achieved following longer CITs by utilising HMP storage rather than traditional SCS. This effect is likely to be multi-factorial; including improved recipient preparation, better peri-operative conditions and the inherent effects of HMP itself. Preferences§1234567890-=Backspace Tabqwertyuiop[] Return capslockasdfghjkl;' shift'zxcvbnm,./shift English Deutsch Español Français Italiano Português PyCCKNN alt alt Preferences DISCLOSURES:Guy, A.: Grant/Research Support, Organ Recovery Systems. Inston, N.: Grant/Research Support, Organ Recovery Systems. Ready, A.: Grant/Research Support, Organ Recovery Systems.

Introduction: Preoperative over-ordering of blood is common and leads to the wastage of blood bank resources. The preoperative blood-ordering and transfusion practices for common elective general surgical procedures were evaluated in our trust to formulate a maximum surgical blood-order schedule (MSBOS) Method: We evaluated blood-ordering practises in elective general surgical procedures in our institution over a 6-month period. Cross-match to transfusion ratios (C:T) were calculated and compared to current trust and the British Society of Haematology (BSH) guidelines. Results: 541 patients were identified during the 6-month period. There were 314 minor and 227 major surgeries carried out. 99.6%(n1⁄4226) patients who underwent major surgery and 95.5%(n1⁄4300) of the patients having minor surgery had at least a G&S pre-operatively. A total of 507 units of blood were cross-matched and 238 units were used. The overall C:T ratio was therefore 2.1:1 which corresponds to a 46.9% red cell usage. C:T ratio varied between 3.75-37 depending on the type of surgery performed. Conclusion: Complaince with guidelines is poor and over-ordering of blood products common. Implementation of the updated recommended MSBOS and introduction of G&S for eligible surgical procedures is safe. Savings of £8596/annum are achievable with the incorporation of updated evidence based guidelines.

AIMS:Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy. METHODS:Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data. RESULTS:Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2-10) days for the pulmonary and 7 (1-23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to metastasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8-87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%. CONCLUSION:We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival.

Leiomyoma of the rectum is rare and this is the first case reported where such a tumour has passed per rectum, resulting in heavy bleeding. The management of the acute surgical problem as well as rectal leiomyoma per se is discussed.