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Background Lung transplant survival is limited by the development of bronchiolitis obliterans syndrome (BOS). The strongest risk factor for BOS is acute rejection (AR). We have previously shown that rabbit anti-thymocyte globulin (RATG) induction therapy is associated with a decrease in early AR. Thus, we hypothesized that RATG induction would translate to reduced BOS and improved long-term graft survival. Methods Forty-four lung recipients were prospectively randomized to receive conventional immunosuppression with RATG induction (RATG group) or conventional immunosuppression alone (control group). End-points included graft survival, early and total acute rejection, BOS and treatment complications. Results There was no difference in graft survival between the groups at 8 years (RATG: 36%; control: 23%; p = 0.48). The RATG group had fewer early rejections compared with the control group (5% vs 41%; p = 0.01). However, the overall rejection incidence did not differ (RATG: 62%; control: 68%; p = 0.52). There was a trend toward a delay in BOS onset among RATG subjects compared with control subjects (2,376 days vs 1,108 days; log rank, p = 0.15). There was no difference in the incidence of infections, but the RATG group had a higher rate of malignancies. Conclusions Our results suggest that alternative approaches to anti-thymocyte induction should be pursued to reduce BOS and prolong allograft survival.

s S183 (n= 19) ExtraCorporeal Membrane Oxygenation support. The actuarial survival rates were respectively 89% (n= 162), 85,4% (n= 90), and 85,4% (n= 24) at 1, 2 and 3 years. Concerning High Emergency transplanted patients, the actuarial survival rates were respectively 80,5% (n= 34), 75,5% (n= 20), and 75,5% (n= 11) at 1, 2 and 3 years. Evolution of mean FEV1 was 76+/-19%, 81+/-22% and 69+/-26% at 1, 2 and 3 years. Conclusion: COLT is the largest study in Europe with such biocollection and prospective database. It allows establishing multicentric connections between European transplant centers, in order to identify a biological marker of CLAD. First clinical analysis of CF patients outcomes after bilateral lung transplantation are encouraging in term of morbi-mortality, even in the High Emergency LTR subgroup.

Purpose The purpose of this study is to identify risk factors and outcome implications for 30-day hospital readmission in lung transplant recipients. Methods and Materials We conducted a retrospective cohort study of lung transplant cases at a single, high-volume lung transplant program from 01/2000 to 03/2012. 30-day readmission was determined through analysis of inpatient-encounter start and end dates. Demographic and health data were reviewed for all patients. Risk factors for 30-day readmission were modeled using logistic regression, with selection of parameters by backward elimination. Results After excluding scheduled readmissions and in-hospital deaths, 795 patients were left in the sample. The overall 30-day readmission rate was 45.4% (n = 361). Readmission rates were similar across different diagnosis categories and procedure types. By univariate analysis, post-operative complications that predispose to 30-day readmission include pneumonia, any infection and atrial fibrillation (All p Conclusions The occurrence of at least one post-transplant complication increases risk for 30-day readmission in lung transplant recipients. 30-day readmission does not predispose to adverse long-term survival in this patient population.

Purpose The Modified Diet in Renal Disease (MDRD) equation is commonly used for GFR estimation, but has been questioned due to inaccuracy for GFR greater than 60ml/ (min * 1.73m2). The CKD-EPI and Wright equations have shown improved predictive capabilities in some patient populations. We compare these equations to determine which correlates best with direct GFR measurement in lung transplant candidates. Methods and Materials We conducted a retrospective cohort analysis of 274 lung transplant cases at a single, high-volume lung transplant program. GFR was directly measured using intravenous Tc-99m DTPA. Results from the following equations were compared to direct GFR measurements: Normalized and BSA adjusted versions of MDRD and CKD-EPI, and Wright. Results The BSA dependent CKD-EPI equation provided the most consistent results with low Bias (Median Standard Error = 1.34), Relative Standard Error (Median RSE = 0.02), Mean Percentage Error (MPE = 4.14), Mean Absolute Percentage Error (MAPE = 15.72%) and precision (IQR = 24.24). R^2 was highest for this equation at 0.45 and accuracy was 98.33%. MDRD parameters poorly correlated with the direct GFR measurements with R^2 = 0.36, accuracy = 98.13, Median SE = 0.77, Median RSE = 0.01, MPE = 7.15, MAPE = 18.60 and precision = 25.18. The Wright equation was least accurate with: R^2 = 0.40 and accuracy = 92.64. Bland-Altman analyses provide visual confirmation of results. [ figure 1 ] Conclusions In patients being evaluated for lung transplantation, the CKD-EPI equation is a better estimator of GFR than the more popular MDRD equation. Both CKD-EPI and MDRD perform better than the Wright formula. Pre-transplant evaluation and early postoperative management of lung recipients may be improved by the use of the CKD-EPI to estimate GFR.

cultures (cx). 33% (26/80) of MRSA colonized pts developed dz. Donor MSSA cx were protective against MSSA dz (p 0.006), likely due to tailored antibiotics post-LT. SA dz was associated with longer ICU and hospital stays (p 0.0001), acute and chronic rejection (BOS), and lower survival (MRSA MSSA). Increased mortality is apparent up to 4 yrs post-LT. Conclusions: SA largely causes PNA (VAP in particular) and tracheobronchitis early post-LT. Early-onset SA dz is associated with longer stays and increased rejection (BOS in particular) and mortality. Risks for MRSA dz are recipient nasal or sterility cx, suggesting that MRSA decolonization may reduce dz and be cost-effective.

376 (93-442) vs. 363 (156-369) days (p NS). BAL BA levels, but not pepsin levels, as well as IL-8 and neutrophils were elevated in C patients (figure 1). Generally, BA levels, but not pepsin levels, positively correlated with BAL IL8 and neutrophilia (figure 2). Conclusions: Bile acid aspiration seems to be associated with P.aeruginosa airway colonization after LTx. Their possible role for inducing neutrophilic airway inflammation in the development of BOS after LTx should be further elucidated. Research funded by Research Foundation-Flanders (FWO) and GSK Belgium.

APROTININ USE AND PRIMARY ALLOGRAFT DYSFUNCTION FOLLOWING OFF-PUMP BILATERAL ORTHOTOPIC LUNG TRANSPLANTATION K.R. Balsara, S.T. Morozowich, E.L. Bush, B. Phillips-Bute, M. Hill, R.D. Davis, S.S. Lin, I.J. Welsby, Department of Surgery, Duke University Medical Center, Durham, NC; Division of Cardiothoracic Anesthesia and Critical Care, Duke University Medical Center, Durham, NC; Department of Imunology, Duke University Medical Center, Durham, NC

Background: Historically, primary graft failure (PGF) was associated with disappointing outcomes and remains a significant cause of mortality after lung transplantation. ECMO provides treatment for severely affected recipients. We hypothesized that veno-venous (VV) ECMO may provide a safer alternative than traditional veno-arterial (VA) support for lung recipients suffering PGF. Methods: We conducted a retrospective analysis of 512 patients who underwent lung transplantation from April 1992 to July 2004. Twenty-three (4.5%) patients required ECMO secondary to PGF unresponsive to conventional treatment. Fifteen (65%) were treated with VA ECMO, while 8 (35%) underwent VV ECMO. Results: Although the mean days to ECMO initiation differed between VA (0.67) and VV (1.25) groups, this did not reach statistical significance (p 0.28). Likewise, duration of ECMO was similar (VA 4.9 and VV 4.5 days, p 1.0). 8 of 15 patients (53%) from the VA group were weaned from ECMO, with only 1 surviving greater than 45 days. This lone long-term survivor required retransplantation post-op day 2 in order to wean from ECMO. In contrast, all 8 VV ECMO patients were weaned from ECMO, with 7 of 8 surviving to hospital discharge. One-year survival for VV ECMO recipients was 75%, with one late death secondary to B. cenocepacia sepsis. In fact, 30-day survival for VV ECMO recipients (88%) approximates that of all lung recipients at our center (95%, p 0.42). Noted complications for ECMO patients included renal failure (ARF) (n 16), neurologic catastrophes (n 6), sepsis (n 4), and cannulation site injury (n 1). The VA ECMO recipients suffered 22 of the 27 total complications compared to only 5 for the VV group. Furthermore, all but one complication for VV ECMO recipients involved ARF, but by the time of discharge these patients demonstrated a mean creatinine of 0.9. Conclusions: The simple method of VV ECMO provides substantially better outcomes, with fewer complications, than those experienced with previously utilized VA ECMO support.