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Objective:To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection.Design:Case–control study.Setting:We collected data from international participants via an online survey.Participants:In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study.Methods:Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases.Results:HCP infection was associated with non–aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04–1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1–16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2–0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4–0.7).Conclusions:COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.

COVID-19 caused a significant impact on organ transplantation. In the UK, during the peak months the number of deceased donors and transplants fell by 66% and 68% respectively compared with last year.[1][1] The lung transplant service at the Freeman Hospital, Newcastle covers a wide geographical

Purpose Anxiety associated with poor post operative outcomes has led to patients with Cystic Fibrosis Related Liver Disease (CFRLD) being denied a chance of lung transplant for fear of developing post-operative progressive hepatic impairment. Methods We studied a total of 238 transplanted patients. Patients were divided into two groups CFRLD and Non-CFRLD based on our new criterion. Groups were compared first to assess validity of the diagnosis and then survival outcomes. A predictor of hepatic injury was devised by modifying the APRI (Aspartate aminotransferase-to-Platelet Ratio Index) scores to diagnose CFRLD and predict severity of liver disease. Results The new diagnostic criteria for differentiating CFRLD from Non CFRLD was effective. This was supported by significant difference in serum Bilirubin from 6.1 to 9.4 micromole / L at 90 days post transplant (p = 0.0001). There was no significant difference in the survival between the two groups at short, medium or long term demonstrated by the Kaplan-Meier plot with survival of 85%, 73%, 47%, 18.6% and 4.7% at one, two, five, ten and 15 year respectively. A modified APRI score of greater than 0.2 had a sensitivity of 43.0% but a specificity of 82.5 % for predicting CFRLD and 46.5% sensitivity but 100% specificity in diagnosing an ultrasound/biopsy proven hepatic abnormality associated with CFRLD. Conclusion Patients with CFRLD and portal hypertension but with preserved hepatocellular function have a similar outcome to patients without CFRLD. Modified APRI sore is a highly specific non-invasive tool for diagnosis of CFRLD.

Background Methotrexate (MTX) is potential change in immunosuppression after lung transplantation that may help to slow down the decline in lung function in bronchiolitis obliterans syndrome (BOS). Methods We sought to analyze the safety and efficacy of MTX in patients with BOS, by retrospective case review. Results Thirty lung allograft patients were treated with MTX for BOS after one bilateral lower lobe, nine single, 16 bilateral, and four heart-lung transplants. Twenty-one patients had MTX treatment for a minimum of 6 months, and their serial lung function was analyzed for efficacy. In these patients, there was a significant overall increase in mean forced expiratory volume in 1 second (FEV 1 ) of 149 mL ( P 1 of 117 mL ( P 1 of 60 mL ( P = .19) observed in 18 patients who had MTX for this time period. The rate of decline in FEV 1 before MTX was 118.5 mL/month and at 3 months after MTX increased to 49.5 mL/months ( P 1 . Nine patients had been treated with MTX for less than 6 months; two died within 6 months of starting MTX, five tolerated the drug poorly with nausea and tiredness, and one developed leucopenia. One patient requested discontinuation of the medication after failing to halt the rapid progressive decline in lung function after 1 month. Conclusions Methotrexate therapy provides a potential therapeutic strategy in managing the progressive decline in lung function observed in BOS. This is hampered by the observation of poor tolerability and side effects.

Background Lung transplant recipients have reduced long-term survival compared with other solid organ recipients. There is a lack of published data on the characteristics of very long term survivors. Methods We describe the demographics, clinical history and post-procedure function of all lung transplant recipients who have survived greater than 20 years at our centre. Results At the time of analysis there were 21 (16.4%) of 128 patients who survived over 20 years. The mean age at transplantation was 31.8 ± 9.9 years. Five of 21 had undergone single-lung, eight double-lung and eight heart-lung transplant procedures. At the last evaluation, mean percentage predicted FEV1 in recipients of single and double lung were 51.3% and 57.9% respectively. By 20 years, 19 (90.5%) patients had developed bronchiolitis obliterans syndrome (BOS) with three (14%) BOS 1, six (29%) BOS 2 and 10 (48%) BOS 3 and two (9.5%) free from BOS. The median time to onset of BOS was 9.7 years (range 1.6–17.9). Of eight patients (38%) who required renal replacement, four (19%) had successfully undergone renal transplantation and four (19%) were on haemodialysis. Only one patient (5%) had symptomatic osteoporosis. Nineteen patients (90%) were treated for hypertension. Five patients (24%) had diabetes, all with an underlying diagnosis of cystic fibrosis and four of them developing diabetes post operatively. Conclusions In our experience, 20-year survivors of lung transplantation had a delayed onset of BOS and morbidities due to immunosuppression that can be appropriately managed leading to long-term survival.

IntroductionAzithromycin stabilises and improves lung function forced expiratory volume in one second (FEV1) in lung transplantation patients with bronchiolitis obliterans syndrome (BOS). A post hoc analysis was performed to assess the long-term effect of azithromycin on FEV1, BOS progression and survival .MethodsEligible patients recruited for the initial randomised placebo-controlled trial received open-label azithromycin after 3 months and were followed up until 6 years after inclusion (n=45) to assess FEV1, BOS free progression and overall survival.ResultsFEV1 in the placebo group improved after open-label azithromycin and was comparable with the treatment group by 6 months. FEV1 decreased after 1 and 5 years and was not different between groups. Patients (n=18) with rapid progression of BOS underwent total lymphoid irradiation (TLI). Progression-free survival (log-rank test p=0.40) and overall survival (log-rank test p=0.28) were comparable. Survival of patients with early BOS was similar to late-onset BOS (log-rank test p=0.74).DiscussionLong-term treatment with azithromycin slows down the progression of BOS, although the effect of TLI may affect the observed attenuation of FEV1 decline. BOS progression and long-term survival were not affected by randomisation to the placebo group, given the early cross-over to azithromycin and possibly due to TLI in case of further progression. Performing randomised placebo-controlled trials in lung transplantation patients with BOS with a blinded trial duration is feasible, effective and safe.

BACKGROUND: Lung transplantation is a well-established treatment for end-stage non-cystic fibrosis bronchiectasis (BR), though information regarding outcomes of transplantation remains limited. Our results of lung transplantation for Br are reported here.\ud \ud METHODS: A retrospective review of case notes and transplantation databases was conducted for patients that had underwent lung transplantation for bronchiectasis at the Freeman Hospital between 1990 and 2013.\ud \ud RESULTS: Fourty two BR patients underwent lung transplantation, the majority (39) having bilateral sequential lung transplantation. Mean age at transplantation was 47.1 years. Pre-transplantation osteoporosis was a significant non-pulmonary morbidity (48%). Polymicrobial infection was common, with Pseudomonas aeruginosa infection frequently but not universally observed (67%). Forced expiratory volume in 1 second (% predicted) improved from a pre-transplantation mean of 0.71 L (22% predicted) to 2.56 L (79 % predicted) at 1-year post-transplantation. Our survival results were 74% at 1 year, 64% at 3 years, 61% at 5 years and 48% at 10 years. Sepsis was a common cause of early post-transplantation deaths.\ud \ud CONCLUSIONS: Lung transplantation for end-stage BR is a useful therapeutic option, with good survival and lung function outcomes. Survival values were similar to other bilateral lung transplants at our centre. Pre-transplantation Pseudomonas infection is common.

Purpose Exophiala dermatitidis is a black fungus that frequently colonises the lungs of people with cystic fibrosis (CF). Mucoid and non-mucoid variants can be detected from the same sputum for some patients, but their role in chronic CF lung disease is not fully understood and attempts at early eradication are not routinely performed. Invasive infections with this species are rare; however in 2014 we reported our first case of fatal, invasive infection with a highly mucoid strain of E. dermatitidis in a 34 year old post lung transplant patient with CF. This prompted us to include peri-operative antifungal prophylaxis for all patients colonised with this species. To inform the choice of optimal antifungal, we performed susceptibility testing of 38 isolates from 34 patients including lung transplant patients. The ability of these isolates to produce biofilm was also investigated. Methods The minimum inhibitory concentration (MIC) of 8 antifungal agents was measured using a commercial broth microdilution assay. Biofilm formation was assessed using a standard in vitro assay using staining with crystal violet. Results Using breakpoints for Candida albicans, all isolates were susceptible to voriconazole and amphotericin B with most isolates also susceptible to itraconazole (89% of isolates) and posaconazole (71% of isolates). In contrast, all isolates were non-susceptible to caspofungin and most isolates (92%) non-susceptible to fluconazole. All strains were inhibited by ketoconazole at ≤0.25 mg/ L whereas MICs of 5-fluorocytosine ranged from 1->64 mg/ L. 31 of 38 isolates were biofilm producers including 4 isolates that were classified as strong biofilm producers. We did not find a correlation between mucoid phenotype and biofilm production. Conclusion E. dermatitidis is commonly found to colonise the lungs of patients with CF, typically produces biofilm, and may rarely produce serious infection post transplantation. We demonstrate in vitro susceptibility to voriconazole and amphotericin B. For patients colonised with this species, we now elect to include voriconazole as part of the peri-operative prophylactic regimen.

Single- and double-lung transplantation epitomize the final therapeutic options available to selected patients with advanced, end-stage lung disease refractory to all methods of available medical management. The lack of evidence supporting effective lung transplant practices is widely acknowledged, necessitating the need for expert opinion practice guidelines. In this chapter we present the key recommendations for consideration when referring and listing an individual for lung transplantation. We critique seminal papers that have revised our selection process for single- and bilateral lung transplant recipients and outline the indications and contraindications unique to different lung pathologies. We define our current clinical practice based on the best available international expert opinions and review future developments of treatments and novel approaches to deal with the continued lack of suitable donor organs.

Background We conducted a placebo-controlled trial of azithromycin therapy in bronchiolitis obliterans syndrome (BOS) post lung transplantation. Methods We compared azithromycin (250 mg alternate days, 12 weeks) with placebo. Primary outcome was FEV1 change at 12 weeks. Results 48 patients were randomised; (25 azithromycin, 23 placebo). It was established, post randomisation that two did not have BOS. 46 patients were analysed as intention to treat (ITT) with 33 ‘Completers’. ITT analysis included placebo patients treated with open-label azithromycin after study withdrawal. Outcome The ITT analysis (n=46, 177 observations) estimated mean difference in FEV1 between treatments (azithromycin minus placebo) was 0.035 L, with a 95% CI of −0.112 L to 0.182 L (p=0.6). Five withdrawals, who were identified at the end of the study as having been randomised to placebo (four with rapid loss in FEV1, one withdrawn consent) had received rescue open-label azithromycin, with improvement in subsequent FEV1 at 12 weeks. Study Completers showed an estimated mean difference in FEV1 between treatment groups (azithromycin minus placebo) of 0.278 L, with 95% CI for the mean difference: 0.170 L to 0.386 L (p=

Background Advances in lung transplantation have enabled women to successfully undertake pregnancies. This study explored outcomes in this group, including changes in lung function, kidney function, and calcineurin inhibitor (CNI) levels. Methods A retrospective review identified 19 transplant recipients who had ever become pregnant at our center, and manual reviews of their medical records were completed for 14. Results of spirometry, serum creatinine, CNI doses and trough levels, and comorbidities were collected. Results Eight births occurred (42% success rate). Six patients have since died, with pregnancy contributing to 1 death. Five pregnancies were unplanned, with only 1 resulting in birth. Six pregnancies ended with spontaneous termination, and 2 were terminated for medical reasons. Mean age was 31.4 years (range, 22–39 years), and mean time from transplant was 76.2 months (range, 26–139 months). Complications included preeclampsia in 2, diabetes of pregnancy in 1, and abnormal liver enzymes in 1. Within 6 months of delivery, there were 2 cases of pneumonia, 2 cases of obliterative bronchiolitis, 1 case of tuberculosis, and 1 case of mild acute rejection. Forced expiratory volume in 1 second was stable at 3 (–1.5%; p = 0.55) and 12 months (1.4%; p = 0.84) after pregnancy. Mean change in Forced expiratory volume in 1 second during full-term pregnancies was –2.4% ( p = 0.29), and the mean change in forced vital capacity was –0.8% ( p = 0.55). In the first trimester, 83% of patients had a fall in creatinine, and a universal fall in CNI trough levels was seen. Conclusions In carefully selected patients, planned pregnancy after lung transplant can be successful. Complications are common, and close monitoring of immunosuppression and renal function is needed.

Air pollution from road traffic is a serious health risk, especially for susceptible individuals. Single-centre studies showed an association with chronic lung allograft dysfunction (CLAD) and survival after lung transplantation, but there are no large studies.13 lung transplant centres in 10 European countries created a cohort of 5707 patients. For each patient, we quantified residential particulate matter with aerodynamic diameter ≤10 µm (PM10) by land use regression models, and the traffic exposure by quantifying total road length within buffer zones around the home addresses of patients and distance to a major road or freeway.After correction for macrolide use, we found associations between air pollution variables and CLAD/mortality. Given the important interaction with macrolides, we stratified according to macrolide use. No associations were observed in 2151 patients taking macrolides. However, in 3556 patients not taking macrolides, mortality was associated with PM10 (hazard ratio 1.081, 95% CI 1.000–1.167); similarly, CLAD and mortality were associated with road lengths in buffers of 200–1000 and 100–500 m, respectively (hazard ratio 1.085– 1.130). Sensitivity analyses for various possible confounders confirmed the robustness of these associations.Long-term residential air pollution and traffic exposure were associated with CLAD and survival after lung transplantation, but only in patients not taking macrolides.

Background Pre-operative infection with organisms from the Burkholderia cepacia complex (BCC), particularly B cenocepacia , has been linked with a poorer prognosis after transplantation compared to patients with cystic fibrosis (CF) without this infection. Therefore, many transplant centers do not list these patients for transplantation. Methods We report the early and long-term results of a cohort of lung transplant recipients with CF and pre-operative BCC infection. Patients with pre-transplantation BCC infection were identified by case-note review. BCC species status was assigned by polymerase chain reaction (PCR)-based techniques. Survival rates were compared to recipients with CF without BCC infection. Survival rates in BCC subgroups were also compared, and then further analyzed pre- and post-2001, when a new immunosuppressive and antibiotic regime was introduced for such patients. Results Two hundred sixteen patients with CF underwent lung transplantation and 22 had confirmed pre-operative BCC infection, with 12 of these being B cenocepacia. Nine B cenocepacia –infected recipients died within the first year, and in 8 BCC sepsis was considered to be the cause of death. Despite instituting a tailored peri-operative immunosuppressive and microbiologic care approach for such patients, post-transplantation BCC septic deaths occurred frequently in those with pre-transplantation B cenocepacia infection. In contrast, recipients infected with other BCC species had significantly better outcomes, with post-transplantation survival comparable to other recipients with CF. Conclusions Mortality in patients with B cenocepacia infection was unacceptably high and has led to our center no longer accepting patients with this condition onto the lung transplant waiting list. Long-term survival in the non– B cenocepacia BCC group was excellent, without high rates of acute rejection or bronchiolitis obliterans syndrome (BOS) longer term, and these patients continue to be considered for lung transplantation.

It has been suggested that air pollution influences survival after lung transplantation (LTx).We investigated the association of long-term exposure to fine particles and traffic with mortality and chronic lung allograft dysfunction (CLAD).In 13 European LTx centers, patient characteristics were retrospectively collected. Patients transplanted 700 km from LTx center were excluded, resulting in 5,707 LTx patients. We estimated long-term particulate matter (PM 10 ) exposure at home addresses with temporally adjusted land-use regression models and total road length within buffers zones around the home and using Cox regression. We associated this with incidence of CLAD and mortality, separately for patients taking macrolides or not. During follow-up (median 4.2 y), 2,767 patients developed CLAD and 2,718 died. In patients not taking AZI (n=3,551) air-pollution was associated with mortality and CLAD independent of covariates.The risk for dying increased by 22.0% for patients living in an area above the WHO air pollution standards (20 µg/m³) compared with residence

120 Canine detection of Pseudomonas aeruginosa (PA) volatile organic compounds (VOC’s) N.V. Johnston1, J. Rao2, J.S. Elborn3,4, J.E. Moore5. 1Dogs Nose Ltd, Portadown, United Kingdom; 2University of Ulster, School of Biomedical Sciences, Coleraine, United Kingdom; 3Queen’s University Belfast, Centre for Infection and Immunity, Belfast, United Kingdom; 4Belfast City Hospital, Regional Adult Cystic Fibrosis Centre, Belfast, United Kingdom; 5Belfast City Hospital, Department of Bacteriology, Belfast, United Kingdom

Early infection is a recognised complication after lung transplantation in patients with cystic fibrosis (CF). Our centre uses multiple combination bactericidal testing (MCBT) when determining appropriate peritransplant prophylactic regimens. To evaluate our strategy, we compared the incidence of posttransplant infection in patients whose peritransplant antimicrobial regimens were determined using MCBT versus standard sensitivity testing. Patients with CF who were infected withPseudomonas aeruginosaand underwent lung transplantations between 2000 and 2010 were included. Data was collected from clinical records and our microbiology database. Microorganisms cultured were mapped against antibiotic resistance, method of sensitivity testing, and antibiotics administered peritransplant. 129 patients were identified (mean age 28, male : female, 63 : 66). Fifty patients (38.8%) had antibiotics determined by MCBT. Two patients in the MCBT group developed septicaemia, 13 in the conventional group (P≤0.05, 2-tailed Fisher's test). Sepsis was attributable toP. aeruginosain one patient from the MCBT group and seven patients in the conventional group (P=0.15).P. aeruginosawas recovered from the posttransplant pleural fluid of one patient who received MCBT-guided prophylaxis, six patients in the conventional group (P=0.25). Patients given antibiotics based on MCBT had significantly lower rates of septicaemia and lower rates of empyema.

Introduction and objectives Lung transplant patients have a reduced survival rate compared to other solid organ recipients. Chronic lung allograft dysfunction (CLAD) remains the main factor in limiting longevity in lung transplant patients, with 50% of recipients developing Bronchiolitis Obliterans Syndrome (BOS) by 5.6 years. There is a lack of published data on the course and history of long term survivors and we describe characteristics and outcomes of all lung transplant recipients who have survived greater than 20 years at our centre. Results Twenty-one (16.2%) out of a possible total of 121 transplant patients survived at least 20 years with an overall median survival of 21.3 (range 20.1–24.9) years. The mean age at transplantation was 31.8 ± 9.9 years and 13 (61.9%) were male. The most common indication for transplantation in the group was Cystic Fibrosis (33.3%); heart-lung and bilateral lung transplant operations were equally the most commonly performed. The median six-minute walk distance (6MWD) was 600m (range 419–785m). The median time to the development of BOS was 9.7 years. At time of evaluation, 2 (10%) patients had BOS score 0, 3 (14%) BOS 1, 6 (29%) BOS 2 and 10 (48%) BOS 3. The total number of rejections requiring augmentation with corticosteroids was 30 episodes in 21 patients with an average of 1.4 (range 0–3) episodes per patient. Eighteen patients had at least one episode of rejection needing corticosteroids. No patient developed symptomatic ischaemic heart disease; systemic hypertension was found in 19 (90.5%) patients. Two (9.5%) patients developed post-transplant lymphoproliferative disease. Four patients developed other malignancies, 3 of which were skin cancers and 1 renal cancer. All 4 cases of diabetes post transplantation occurred in patients with Cystic Fibrosis. Eight patients required renal replacement therapy as a result of ciclosporin toxicity and four underwent renal transplantation. Conclusion Twenty-one (16.2%) patients in our cohort survived 20 years. Although nearly all patients developed an element of CLAD, exercise tolerance was preserved as judged by 6MWD. Hypertension was common and renal failure remained the most problematic complication of immunosuppression.

Background: Lung transplantation is an important option to treat patients with advanced Cystic Fibrosis (CF) lung disease. We report the outcomes of a large UK cohort of CF lung transplantation recipients. Methods: Retrospective review of case notes and transplantation databases. Results 176 patients with CF underwent lung transplantation at our centre. The majority (168) had bilateral sequential lung transplantation. Median age at transplantation was 26 years. Diabetes was common pre-transplantation (40%). Polymicrobial infection was common in individual recipients. A diverse range of pathogens were encountered including the Burkholderia cepacia complex (BCC). The bronchial anastomotic complication rate was 2%. Pulmonary function (FEV1% predicted) improved from pre-transplantation median 0.8 litres (21% predicted) to 2.95 litres (78% predicted) at one year following transplantation. We noted an acute rejection rate of 41% within the first month. Our survival figures were 82% survival at one year, 70% at three years, 62% at five years and 51% at ten years. Patients with BCC infection had poorer outcomes and represented the majority of those who had a septic death. We present data on those free from these infections. Bronchiolitis Obliterans Syndrome (BOS) and sepsis were common causes of death. Freedom from BOS was 74% at five years and 38 % at ten years. Biochemical evidence of renal dysfunction was common though renal replacement was infrequently required (

s S307 (p= 6.22e-06 for interaction) and may play a role in disease progression and impaired myocardial energetics. Conclusion: A bioinformatic analysis may identify previously unreported miRs potentially involved in HF development. This is a novel approach using public access data for identify potential biomarkers of subjects with high risk for HF development or progression. FONDAP 15130011 ACCDIS.

Purpose We report outcomes of a large UK cohort of adult Cystic Fibrosis(CF) patients undergoing bilateral sequential lung transplantation(BLT) at a single institution. Methods and Materials We searched our prospectively maintained database for patients undergoing lung transplantation (LT) for CF between 01/89-11/12. Survival was censored at 7/11/12. A unified approach to BLT has been undertaken in these patients. Including targeted antibiotic prophylaxis, pleural cavity and central airway taurolidine irrigation, surgery (clamshell incision) on full cardiopulmonary bypass (CPB) (off-pump or extra-corporeal membrane oxygenation (ECMO) not used), bilateral pneumonectomy prior to donor implant and synchronous controlled reperfusion. Since 12/07, a genomovar specific policy has been adopted and patients colonized with Burkholderia cenocepacia have been excluded from LT. Results A total of 270 LT for CF were performed during this period. Included in this were two single lungs (with synchronous pneumonectomy), one living donor lobar transplant, four heart-lung (pre-1990) and two lung-liver. Of the 261 remaining, 253 were performed in adults (cohort analyzed). There were 118 (47%) males, median (range) age 27.4 (16.5-32.7) years. Mean [95%CI] BMI at assessment was 19.6 [19.2-19.9]. Median time to transplantation from listing was 305 (4-2190) days. Median ischemic time was 340 (131-601) mins. Survival at 1, 3, 5 and 10 years was 83%, 74%, 65% and 53%. There was a trend to improved late survival for patients transplanted post vs. pre-2000; 84 vs. 79%, 76 vs. 68%, 67 vs. 58% and 56 vs. 45% (p = 0.106). Conclusions In this large single centre experience of BLT for CF, our institutional operative strategy utilizing full CPB(not ECMO) for all cases, with recipient bilateral pneumonectomy prior to implantation simplifies airway management, virtually eliminates pleural spillage and excludes possible spillage from recipient to donor lung. Our standardized and simplified approach yields excellent and improving results in this challenging group of patients.

32% vs 44%; IPF 29% vs 25%; Bronchiectasis 23% vs 13%; NS), Pre-LTx PaO2 (49 vs 49 mmHg) 6MWT distance (292 vs 276 mts) or LTx procedure (BLTx 65% vs 69%). 51% of patients developed episodes of acute rejection, 52% EED and 44% NHBD (NS). Grade A2 or greater rejection was observed in 39% EDD and 38% NHBS (NS). No significant differences were observed in long term survival (Figure 1) or BOS (Figure 2). Conclusions: These data show that NHBD are similar to EDD in terms of long term survival and chronic rejection.

Introduction In March 2013, 12 patients on a single ward in a tertiary respiratory transplant centre contracted influenza within 72 hours. There was no corresponding community outbreak. Staff with symptoms went off sick. Trust policies outlining respiratory infection and isolation existed but there were no guidelines for this specific novel situation. We found no published reports of such an event in England. Methods Patients quickly developed pyrexias and respiratory symptoms. All had throat swabs and blood cultures. Influenza A, H3N2 variant, was identified. A team of infection control and respiratory physicians, nurses and managers met regularly to implement these measures: Closure of ward and cohorting of bays Ward avoidance for non-essential personnel and anyone with symptoms Cancellation of non-essential procedures Strict hand hygiene and use of PPE and FFP3 masks Stockage of oseltamivir for treatment for all affected high risk staff and patients and prophylaxis offered to all ward patients and exposed high risk staff. No crossover of ward staff to transplant patients. Contact tracing of all immunocompromised patients on ward up to one week and all high risk patients 48 hours prior to the index case; advice on prophylaxis and their GPs contacted. Writing an information sheet for staff and GPs Increased and terminal ward cleaning Results On the respiratory ward, 151 bed days were lost and 53 on two other wards. Fourteen patients (including two on another ward) had positive swabs for H3N2. There were 27 symptomatic staff members; 15 had swabs, two were positive. All patients and two staff members were given treatment oseltamivir. Fourteen patients and two staff members had prophylaxis. No influenza complications or deaths occurred. The department staff had 45% influenza vaccination uptake in 2012/2013. All affected patients had been vaccinated. Conclusions Containment, pathogen identification, prompt treatment and contact tracing were priorities, to limit number of individuals affected. This is widely applicable. Our departmental staff vaccination rate is below Department of Health targets. Importance of vaccination needs emphasising, whilst recognising that vaccine effectiveness against all laboratory-confirmed influenza in primary care is 51% for 2012/2013.

Purpose Advances in lung transplantation have enabled women to successfully undertake pregnancies. We maintain they be at least 2 years post transplant and complication free before pregnancy. This study explores maternal outcomes in pregnancy, including changes in lung and renal function, and calcineurin inhibitor (CNI) levels. Methods and Materials A retrospective audit of lung transplants in Newcastle was undertaken. We identified patients who had ever become pregnant; manual reviews of their medical records were completed. Results of spirometry, serum creatinine, CNI doses and trough levels, and comorbidities were collected. Changes in spirometry were compared using a student t-test; p-values Results There have been 16 pregnancies (complete records available for 12), with 7 live births (44% success rate), amongst 13 patients. Six patients have since died, with one death occurring early post-pregnancy. 5 pregnancies were unplanned, with only one resulting in birth. In all, 5 pregnancies ended with spontaneous miscarriage, while 2 were terminated for medical reasons (one ectopic, one for unstable BOS preconception). Mean age at time of pregnancy was 30.4 years (range 22–39), and mean time from transplant was 35.9 months (range 26–139). Complications included preeclampsia (2, 17%), diabetes of pregnancy (1, 8%), and abnormal liver enzymes (1, 8%). Within six months of delivery, there were 2 pneumonias (17%), 2 cases of BOS (17%), one case of TB (8%) and one case of mild acute rejection (8%). Mean change in FEV1 during full-term pregnancies was -2.4% (range -8.7% to 12.4%, p=0.42) and mean change in FVC was +2.7% (range -1.7% to 11.2%, p=0.55). FEV1 was stable 3 and 12 months after pregnancy (-0.3%, p=0.55 and +2.5%, p=0.69). In the first trimester, 60% had a fall in creatinine and a universal fall in CNI trough levels (mean change -42%) was seen. Conclusions In carefully selected patients, pregnancy after lung transplant can be successful. However, complications are common and close monitoring of immunosuppression levels and renal function are needed.

Prospective Evaluation of Alveolar and Bronchiolar C4d Expression in Transbronchial Biopsies from Lung Transplanted Recipients J. Majo, R. Mahida, N. Thampy, F. Black, G. Meachery, J.L. Lordan, P.A. Corris, A.J. Fisher. Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, England, United Kingdom; Institute of Cellular Medecine, Newcastle University, Newcastle upon Tyne, England, United Kingdom.