TITLE: Transvaginal Extraction at Donor Nephrectomy Objective: To review a case of transvaginal extraction at living donor nephrectomy. Methods: A laparoscopic live-donor nephrectomy with transvaginal extraction of the right kidney was performed in a 47-year-old woman. The donor had previously undergone hysterectomy for leiomyomata. The kidney was removed intact via a colpotomy incision. Results: Warm ischemia time was limited to less than 3 minutes. No intraoperative complications occurred. The donor was discharged on the first postoperative day and was recovering well at last follow-up at 4 weeks. The recipients postoperative course was uneventful. The graft demonstrated excellent function with a creatinine nadir of 0.6mg/dL. The recipient was discharged on postoperative day 7 and was recovering well at follow-up at 12 weeks. Conclusions: Transvaginal extraction can be successfully applied to living donor nephrectomy. Further investigation is required to determine the risk of infection for the recipient and parameters for optimal donor candidates. Additionally, outcomes need to be followed to determine whether this technique could be generalized to organ donation. Transvaginal extraction has the potential to serve as a bridge to the realization of natural orifice transluminal endoscopic surgery (NOTES). Finally, this approach may address barriers to organ donation by offering another degree of minimally invasive surgery. Abs# 9369MUL Authors: Isabel C. Green MD, Wen Shen MD, Robert Montgomery MD, Mohamad Allaf MD