119: Long Term Pulmonary Graft Function in Pediatric Recipients after Living-Donor Lobar Lung Transplantation

Abstracts 118 Donation after Cardiac Death (DCD) Lung Allografts Have a Low Incidence of Primary Graft Dysfunction (PGD) after Transplantation (LTx) C.H. Wigfield,1 J.W. Smith,1 C.G. Alex,2 A. D’Allesandro,3 R.B. Love.1 1 Loyola University Medical Center, Maywood, Chicago, IL; 2Loyola University Medical Center, Maywood, Chicago, IL; 3University of Wisconsin Hospitals and Clinics, Madison, WI. Purpose: Only one in five of all organ procurement offers yields acceptable lungs for transplantation and limitations are partially attributable to brain death induced donor lung injury. The susceptibility to lung damage prior to procurement and during reperfusion may be less prevalent in DCD allografts. We reviewed the occurrence of PGD in the largest cohort of DCD lung recipients to date. We sought to corroborate anecdotal evidence that PGD is infrequent in DCD LTx. Methods and Materials: A cohort of 24 consecutive DCD lung transplant recipients was reviewed. The retrospective analysis included donor information and procurement data sets as well as post-operative PGD grading according to ISHLT criteria. Recipient cohort demographics, pre-LTx diagnoses and LAS scoring were reviewed. We extrapolated incidence and reviewed severity of reperfusion injury and other causes for PGD. The observed incidence of PGD in this DCD series was compared with the expected average PGD incidence in BD allograft recipients internationally. Results: All DCD procurements were performed with strict compliance to local OPO protocols. The cohort of 24 DCD LTx consisted of 14 STx and 10 BSLTx with a median age of donors was 37 (12-50), age of recipients 51 (14 male, 10 female). Pre-Tx LAS mean was 58.3 compared with 38 in BD allograft recipients. WIT and CIT were 35.5 & 364 min respectively. Two recipients sustained grade 3 PGD (8.3%) and a third had clinically less evident grade 2 impairment (total 12.5%). This compared favorably with the observed incidence of 25% PGD reported in most series. A further patient required retransplantation for bronchial dehiscence without significant reperfusion injury. Conclusions: The incidence of observed clinically significant PGD in DCD allograft recipients is less than expected for BD lung recipients after transplantation. Adequate procurement protocols and the utility of ex-vivo reconditioning may also help to expand the role of DCD lung transplantation. 119 Long Term Pulmonary Graft Function in Pediatric Recipients after Living-Donor Lobar Lung Transplantation M. Yamane, S. Toyooka, T. Oto, Y. Sano, S. Miyoshi. Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Purpose: Under the circumstances of the legal restriction and the number of cadaveric donor supply for transplantation in Japan, living-donor lobar lung transplantation (LDLLT) has been essential for critical pediatric patients with end-stage pulmonary disease. However, there have been few reports related with outcome and long-term pulmonary function in pediatric recipients. The purpose of this retrospective study is to assess the changes in graft function during growth in height of pediatric patients. Methods and Materials: Between October 1998 and January 2009, we have performed LDLLT for 52 patients with severe lung diseases at Okayama University Hospital. Eleven pediatric patients, less than 15 years old at operation, were identified, including 7 boys and 4 girls. Their mean age was 11.8 years, and the mean observation period was 16.5 months. Right single-lung transplantation was performed for 3, and others received bilateral LDLLT. Results: The indication for transplantation was pulmonary arterial hypertension (n⫽7), bronchiolitis obliterans (n⫽3), and idiopathic pulmonary fibrosis (n⫽1). One patient died of acute rejection at 60 days after LDLLT, and remains survived with overall survival rate of 90.9%. Three patients developed bronchiolitis obliterans syndrome during observation period. Although 6 patients have not become taller (⫹0-1.5 cm), 4 patients grow

S45 more than 10 cm (⫹11-40 cm, mean 21.6 cm) in 5 years. Among these 4 patients, the mean forced vital capacity (FVC) and the mean forced expiratory volume in 1 second (FEV1) markedly elevated from 970 ml to 1975 ml, and from 1085 ml to 2267.5 ml, respectively, during 5-year post transplant period. The mean predict %FVC was 50.3% at 3 months after transplant, and, interestingly, it remains 56% at post-growth in height 5 years after transplantation. Conclusions: Although LDLLT may be associated with the limitation of size mismatch, it holds the promise of providing well-functioning pulmonary lobar grafts to pediatric patients with poor life expectancy. 120 Gene Expression Signature in the Explanted Lung Is a Better Predictor of Primary Graft Dysfunction after Lung Transplantation than Pulmonary Artery Pressures in Patients with Pulmonary Fibrosis M. Mura,1,2 M. Anraku,1,2 Z. Yun,1 C. Chaparro,2 K. McRae,2 M. Liu,1 M. Hutcheon,2 T.K. Waddell,1,2 L.G. Singer,2 J.T. Granton,2,3 S. Keshavjee,1,2 M. de Perrot.1,2,3 1Latner Thoracic Surgery Research Laboratories, Toronto, ON, Canada; 2Toronto Lung Transplant Program, Toronto, ON, Canada; 3Pulmonary Hypertension Program, Toronto, ON, Canada. Purpose: We sought to determine if different gene expression signatures in Pulmonary Fibrosis (PF) patients could be determined based on their pulmonary arterial pressures (PAP) and to analyze their impact on Primary Graft Dysfunction (PGD) after lung transplantation (LTx). Methods and Materials: RNA was extracted from explanted lungs in 84 patients with PF (69 bilateral LTx). PAPs were recorded intraoperatively before starting LTx. 17 patients had severe Pulmonary Hypertension (PH) (mean PAPⱖ40 mmHg; PH Group), 22 had no PH (mPAPⱕ20 mmHg; NoPH Group), and 45 had intermediate mPAP (21-39 mmHg; Intermediate Group). PGD on arrival in the ICU was defined according to the ISHLT criteria. Results: Two distinct gene signatures were observed in PH and NoPH groups. PH patients showed an increased expression of genes, gene sets and networks related with myofibroblast proliferation and vascular remodeling, including Osteopontin, MMP7, MMP13, BMPR1b. In contrast, NoPH patients showed a strong expression of pro-inflammatory genes, including IL-6, PTX3, S100A8, VEGF. In the Intermediate group, twodimensional hierarchical clustering based on 233 differentially expressed genes (PH vs. NoPH group) dichotomized subjects into two distinct subgroups. Patients clustered in the subgroup with increased expression of NoPH-related genes had higher incidence of PGD II-III (52% vs.14%, p⫽0.006). Looking at the whole population, PAP did not predict PGD. However, the NoPH-related gene signature was associated with a higher incidence of PGD II-III when compared to the PH-related gene signature (40% vs.17%, p⫽0.022). A logistic regression model in the whole population showed that clustering algorithm based on PH vs NoPH gene signature was the only significant predictor of PGD (Chi square 5.6, p⫽0.017), while PAP and type of operation were not. Conclusions: Although PAP is not a predictor of PGD, PF patients exhibit two distinct gene expression profiles that are predictive of risk of PGD post-LT. 121 Soluble ST2 Is Associated with Right Heart Failure and Is independently Predictive of Event Free Survival in Pulmonary Arterial Hypertension J.E. Rame,1 D. McGlothlin,2 A.H.B. Wu,3 J.O. Hernandez,2 E. Kobashigawa,2 T. De Marco.2 1University of Pennsylvania, Philadelphia, PA; 2University of California San Francisco, San Francisco, CA; 3University of California San Francisco, San Francisco, CA. Purpose: Pulmonary arterial hypertension (PAH) is a syndrome of right ventricular (RV) failure with significant mortality. Non-invasive markersof disease progression could impact clinical decision-making. We hypothesized that baseline levels of the interleukin-1 receptor family member ST2,