Background: Kidney transplantation in small children is technically challenging.Consideration of whether to use intraperitoneal versus extraperitoneal placement of the graft depends on patient size, clinical history, anatomy, and surgical preference.We report a large single-center experience of intraperitoneal kidney transplantation and their outcomes. Methods:We conducted a retrospective review of pediatric patients who underwent kidney transplantation from April 2011 to March 2018 at a single large volume center.We identified those with intraperitoneal placement and assessed their outcomes, including graft and patient survival, rejection episodes, and surgical or non-surgical complications.Results: Forty-six of 168 pediatric kidney transplants (27%) were placed intraperitoneally in children mean age 5.5 ± 2.3 years (range 1.6-10 years) with median body weight 18.2 ± 5 kg (range 11.4-28.6 kg) during the study period. Two patients (4%) had vascular complications; 10 (22%) had urologic complications requiring intervention; all retained graft function. Thirteen patients (28%) had prolonged post-operative ileus. Eight (17%) patients had rejection episodes ≤6 months post-transplant. Only one case resulted in graft loss and was associated with recurrent focal segmental glomerular sclerosis (FSGS). Two patients (4%) had chronic rejection and subsequent graft loss by 5-year follow-up. At 7-year follow-up, graft survival was 93% and patient survival was 98%. Conclusions:The intraperitoneal approach offers access to the great vessels, which allows greater inflow and outflow and more abdominal capacity for an adult donor kidney, which is beneficial in very small patients. Risk of graft failure and surgical Pediatric patients constitute <2% of the kidney transplant recipients in the United States and offer unique surgical challenges for transplant. 1 Historically, matching donor size and age for pediatric patients led to significant graft loss, largely a result of vessel thromboses when small, pediatric kidneys were implanted in small, pediatric recipients. 2 Kidney transplants from larger and older donors are now routinely used in small pediatric patients, necessitating renal artery and vein anastomoses to larger recipient blood vessels, usually the aorta and inferior vena cava (IVC) depending on the recipient size, anatomical limitations and surgeon's preference. 3 In the current era, patient and graft survival for small pediatric patients weighing <30 kg is similar to adult outcomes, though smaller patients may still be at increased risk for vascular complications. [4][5][6][7][8] Several studies indicate that vascular complications are more common in pediatric than adult transplant recipients 7 and may be the most frequent complication in pediatric patients, with one study reporting vascular complication rates as high as 13.8%. 7,9 Additionally, renal vein thrombosis has been a major cause of firstyear graft failure in pediatric patients with increased risk in those <4 years old and those with lower body weight. 10,11 ...

578 Background: Advances in radiotherapy allow the ability to deliver ablative treatments without compromising outcomes, but there has been limited application of these treatments to early-stage breast cancers. The purpose of this study was to explore patients’ interest in pursuing nonsurgical treatment approaches for their early-stage breast cancer. Methods: Investigators conducted a qualitative descriptive study involving semi-structured interviews with 21 early-stage breast cancer patients eligible for participation in a phase 2 trial offering omission of surgery. Interviews were transcribed, and three independent reviewers performed an inductive, thematic analysis to generate themes and subthemes. Results: Data analysis revealed the following factors that impacted patients’ willingness and desire to explore nonsurgical treatment options: Perceptions and feelings about their cancer; Current quality of life and the level of support available in their daily life; External conversations focusing on family members’ and friends’ experiences with cancer and/or cancer treatments; Personal healthcare experiences, including with their current breast cancer diagnosis; Perceptions and feelings about their physicians; Conversations with their physicians about their treatment options; and Self-identified desire to direct care decisions. Specifically, patients described fearing surgery and surgical recovery and wanting to avoid negative surgery-related events previously experienced by friends, family, and themselves. Participants also expressed a desire to preserve their breast(s), receive treatment per the latest research, match the level of treatment with the severity of their cancer, and avoid other comorbidities as reasons for omitting surgery. Patient reasons for pursuing surgery included the desire to remove their cancer immediately, prior positive experiences of friends, family, and themselves with surgery, lack of concern about preserving their breast(s), and prior negative experiences of friends, family, and themselves with radiation. Conclusions: The results of this study highlight that there is patient interest in nonsurgical options for biologically favorable early stage breast cancers. A key factor hindering patient education and awareness of nonsurgical options is how the physician frames the discussion and presents treatment options. In addition, patients’ self-identity and the prior experiences of friends, family, and self with cancer treatment and surgery in general appear to be key factors in their decision-making. The findings from this study demonstrate an unmet need to explore nonsurgical options for early-stage breast cancer. Study results can help shape conversations around shared decision making and clinical trial design and result in more personalized treatment options for women with early-stage breast cancer.

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Introduction: The aim of this study was to explore the barriers to implementing an infection prevention and control (IPC) programme in three public district hospitals in Tamil Nadu by interviewing key stakeholders involved in the roll-out of the programme. Materials and methods: Investigators conducted interviews (n = 17) with chief medical officers (CMOs), physicians, and IPC nurses at three secondary public district hospitals and their affiliated primary health centres (PHCs). Results: Six major themes emerged from the interviews: (1) prevalent IPC practices before the programme began; (2) barriers to implementation; (3) perceptions of the effectiveness of the IPC programme; (4) suggestions for future expansion of the programme; (5) the role of healthcare sanitation workers, and (6) water, sanitation and hygiene (WaSH) infrastructure. Stakeholders noted improvements in IPC knowledge, infection control related behaviour, and overall healthcare quality in the three hospitals. In regards to the future of this programme, stakeholders noted the need for more institutional support, a staff nurse solely dedicated to IPC, and the continued training of all staff members. Discussion: The results of this study highlight the importance of having high-functioning WaSH infrastructure and training for hospital sanitary workers in order to have an effective IPC programme. While the scale-up of this IPC programme is warranted, the barriers to implementation outlined in this study should be considered. To achieve a more effective IPC programme, we suggest that the following steps be carried out: (1) dedicate at least one full-time nurse to implementing IPC activities at each district hospital; (2) ensure that state and national policies for IPC are synchronised, and (3) provide sufficient and consistent funding for IPC activities.