Clinical Outcomes in Lung Retransplantation

Abstracts S297 Monash University, Melbourne, Australia; 3Lung Transplant Service, The Alfred Hospital, Melbourne, Australia; 4Nutrition and Dietetics, Monash University, Melbourne, Australia. Purpose: To determine the change in weight and BMI over the first year after lung transplant (LTx) (i) overall, (ii) according to pre-Tx BMI and (iii) according to underlying lung disease. The association between prednisolone dose and weight change was also examined. Methods: All 147 consecutive LTx recipients from Aug 2010 - Oct 2012 were included. We prospectively determined weight, BMI & prednisolone dose before and 3- & 12-months after LTx. Patients were categorised according to BMI (< 18.5 kg/ m2 =  underweight, 18.5 - 24.9 =  normal, 25-29.9 =  overweight, > 30 =  obese) and underlying lung disease. Wilcoxon signed rank test was used to determine differences in BMI pre- vs 12-months post, and 3- vs 12-months post LTx. Chi square analyses were used to determine differences in categorical variables. Results: 147 consecutive patients were included, of whom 140 survived 12 months. Overall BMI did not change from baseline to 3 months (23.4 (SD 4.1) vs 23.6 (SD 4.0) kg/m2, p= 0.513) but increased by 2.4 between 3- & 12- months (23.6 (4.0) to 26.0 (4.5) kg/m2, p= 0.005). Of the 18 patients who were underweight pre-Tx, 70% achieved normal weight by 12 months and 15% became overweight. Of the 67 normal weight patients, 37% became overweight or obese. 56 patients were overweight preTx of whom 40% became obese and half remained overweight. All 6 obese patients remained overweight or obese. Patients with CF and obstructive lung disease (OLD) had the largest gains in BMI between pre- and 12 months post LTx, increasing from 20.4 (3.1) to 23.0 (3.8), p< 0.001, and 24.0 (3.6) to 27.3 (3.9) kg/m2, p< 0.001 in patients with CF and OLD respectively. Patients with restrictive lung disease were overweight pre-Tx and did not have a statistically significant increase in BMI at 12 months (26.0 (4.2) to 26.9 (4.7) kg/m2, p=  0.06). Prednisolone dose had no effect on weight change (p= 0.20). Conclusion: Significant weight gain occurs in the first year post LTx, with more than 1/3 of patients becoming overweight or obese. Whilst weight increase is desirable in underweight patients, the significant increase in overweight and obesity is of concern. Patients with OLD were the most likely to become overweight. Further studies to determine the factors contributing to weight gain and the possible benefits of early nutritional counselling are warranted. 8( 20) Clinical Outcomes in Lung Retransplantation K. Halloran , S. Keshavjee, C. Chaparro, C. Chow, M. Binnie, T. Waddell, A. Pierre, M. de Perrot, M. Cypel, K. Yasufuku, S. Azad, L.G. Singer.  Toronto Lung Transplant program, University of Toronto, Toronto, ON, Canada. Purpose: As the population of transplanted patients grows, so does the demand for retransplantation. Lung retransplantation is feasible in select patients, but survival has been inferior compared to initial transplants. Studies of retransplant recipients have generally focused on graft function and survival. Our objective was to perform a detailed analysis of this patient group, including novel variables such as functional status, renal function, HLA antibodies and quality of life. Methods: A retrospective review was performed of patients (n= 38) retransplanted in our program between 06/2001 and 08/2013. Variables assessed are outlined in Table 1. We compared best quality of life measurements after the first and second transplants. We used Kaplan-Meier curves with log-rank tests to assess survival and paired t tests for within-patient comparison. Results: Mean age at retransplant was 37y (range 19-60) and median time from first transplant was 54.5 months (0.5-266). Mean preoperative 6MWD was 339m (SD 143). Indications for retransplant were: 36 BOS (94.8), 1 primary graft failure (2.6), 1 recurrent BAC. Median follow up duration was 15.5 months (2-148). Outcomes are detailed in Table 1. DSA post retransplant was present in 12 of 25 (48%) patients with available data. Quality of life scores were similar when compared with initial transplant for either SF-36 (p= 0.7) or SGRQ (p= 0.9). Survival is shown in Figure 1. Median survival was 4.0 years. Conclusion: Lung retransplantation is more challenging than first time transplantation. Despite this, our results show that with experience, acceptable clinical, functional and quality of life outcomes are achievable in carefully selected patients.

8( 21) Donor and Recipient Risk Factors for Early Airway Dehiscence Following Lung Transplantation Z.N. Kon , G.J. Bittle, C.F. Evans, K. Rajagopal, S.M. Pham, B.P. Griffith.   University of Maryland School of Medicine, Baltimore, MD. Purpose: Anastomotic complications affect approximately 20% of lung transplant patients and continue to be a significant cause of morbidity and mortality in this population. Airway dehiscence (AD) is a particularly difficult condition to treat, with large defects requiring aggressive surgical intervention. Many surgical and post-operative risk factors for AD have been described, but there have been no analyses to examine these factors along with pre-operative donor/recipient characteristics on a large, multiinstitutional scale. Methods: The United Network for Organ Sharing database was reviewed for all adult lung transplants performed between 2000 and 2010. Donor/ recipient demographics, comorbidities, and transplant data were compared between those patients with and without AD before initial hospital discharge. Multivariable logistic regression was utilized to identify independent risk factors for AD.