275 RENAL (AND HERPETIC) RE-TRANSPLANTATION S SETYAPRANATA1,

KJ WIGGINS1, SG HOLT1,2, WR MULLEY3, PG KERR3, AJ LANDGREN1, A YOUNG4, H OPDAM4, A ROBERTSON1, PD HUGHES1 1Royal Melbourne Hospital, Melbourne, Victoria; Selleck Erlotinib 2The University of Melbourne, Melbourne, Victoria; 3Monash Medical Centre, Melbourne, Victoria; 4Donate Life Victoria, Melbourne, Victoria, Australia Aim: Case report of renal re-transplantation, reported only once previously. Report: A middle aged recipient received a kidney transplant from a deceased multi-organ donor. After initially doing well, the patient suffered cardiac arrest several days post-operatively and sustained hypoxic brain injury and was declared brain dead. Following the family’s consent, the allograft Apoptosis inhibitor kidney was retrieved and re-transplanted into a man with end-stage renal failure secondary to reflux nephropathy. The lungs were used in a separate recipient but the liver was not transplanted due to suspicion of fatty

changes based on macroscopic appearance. Histological analysis of the liver more than 24 hours after transplantation of the other organs revealed coagulative parenchymal necrosis with nuclear inclusions and moderate parenchymal cholestasis, suggestive of herpes viral hepatitis. Examination of the renal implantation biopsy showed histiocytes with enlarged nuclei containing viral inclusions in the capsular fibrous tissue, with positive immunostaining for herpes simplex virus (HSV). Valaciclovir was started immediately after obtaining histological evidence of donor HSV infection and this was subsequently converted to intravenous ganciclovir. Our recipient had pre-formed IgG antibodies to HSV-1 and HSV-2, and was IgM negative pre-transplant. HSV viraemia was detected day 5 post-transplant with a viral load of 7688 copies/mL by

polymerase chain reaction (PCR) assay. He completed a 30-day course of intravenous ganciclovir before switching to valganciclovir as standard cytomegalovirus prophylaxis. The HSV PCR became undetectable on day 7 of IV ganciclovir and has remained undetectable. The patient remains well with an estimated glomerular filtration rate of 61 mL/min/1.73 m2 and further investigation of the apparent viral transmission is underway. Conclusions: We report good short term results next of renal re-transplantation and HSV transmission by transplantation. 276 ACUTE KIDNEY INJURY DUE TO DECOMPRESSION ILLNESS A VIECELLI, J JAMBOTI, P FERRARI Department of Nephrology, Fremantle Hospital, Perth, Western Australia, Australia Background: Decompression illness is a rare but serious complication of diving caused by intravascular or extravascular gas bubble formation. Case Report: We report the first case of acute kidney injury in a 27-year-old diver caused by arterial gas emboli formation following three rapid uncontrolled ascents.