129 Kidney transplantation from live donors is preferred to dialysis or cadaver kidney transplants because of better graft and patient survival, and much lower costs of ESRD management after just 2.7 years. Introduction of the minimally invasive procurement technique has reduced the length of stay and recovery period of the donor. While the laparoscopic technique has gained rapid patient acceptance, many transplant professionals remain concerned about patient safety and donor organ quality. Hypothesis: Laparoscopic assisted LD transplantation is safe and effective. Methods: Between March 1996 and January 1999 (34 months) 295 laparoscopically-procured LD kidney transplants were performed (95.8% of the LD transplants at our institution). Recipient average age was 44.7 ± 0.6 yrs, 28.1% were African-American, and 59.3% were male. During this time period, several improvements were made in the laparoscopic technique, including use of the stapler to reduce ureteral ischemia, use of the harmonic scalpel to minimize heat generation, injection of the renal artery with lidocaine to reduce spasm, leaving the perinephric fat intact to reduce renal trauma, and suprapubic placement of the extraction incision to facilitate deployment of the extraction bag. Furthermore, CSA was replaced by FK as routine maintenance in 1997. Results: Kaplan-Meier one year graft survival improved over the study period, from 91.0% for the earlier CSA-treated patients to 96.3% for the FK-treated ones (p = 0.2). Acute rejection rates at 6 months for the two groups were 22% and 15%, respectively (p = NS). Overall DGF rate was 4.9%. Among the graft loses (10 death with function, 3 non-compliance, 2 early thrombosis, 2 chronic rejection, 1 infection), very few were technical or immunologic failures. Conclusions: Survival of LD kidney grafts using the laparoscopic procurement technique is as good as that with the open technique. The reduced donor recovery time has led to heightened acceptance of LD kidney transplantation. New evaluees in our program who have not previously considered the LD option can now find a living donor in more than 50% of cases, compared to 25% previously. In 1996 there were 73,091 new patients with ESRD, bringing the total in the United States to 283,932 patients (USRDS). Of those 73,091 new cases, 13,751 were under age 45 and 39,168 are under age 65. If 2/3 of all patients under age 45 and 1/3 of patients between 45 and 64 are transplant candidates, there are 22,254 new transplant candidates in the United States yearly. If half of these candidates identify a living donor, the number of LD kidney transplants performed the United States should increase from 3,200 in 1996 to 11,127 yearly. This would lead to a net ESRD savings of $150 million annually. (Figure)Figure