186

S108

Abstracts

The Journal of Heart and Lung Transplantation February 2006

185 HEPATITIS C VIRUS ANTIBODY POSITIVE DONORS (DHCVⴙ): IMPACT ON SURVIVAL DEPENDS ON RECIPIENT AGE L.B. Gasink,1 E.A. Blumberg,1 A.K. Israni,2 S.S. Desai,1 A.R. Localio,3 E. Lautenbach,1,3 1Department of Medicine, University of Pennsylvania, Philadephia, PA; 2Department of Medicine, University of Minnesota, Rochester, MN; 3Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA Purpose: Liberalization of donor criteria could expand the donor pool, but the use of certain “marginal donors”, such as those who are HCV⫹ is controversial. Little is known about the association between DHCV status and survival following cardiac transplant. Methods: Using the Scientific Registry of Transplant Recipients, a cohort study was performed to determine the association between DHCV⫹ and survival. Heart transplant recipients surviving ⬎30 days who were transplanted at centers utilizing DHCV⫹ during the study period (April 15, 1994 —August 1, 2003) were evaluated. Exclusion criteria included age ⬍18, concurrent multiorgan transplant and unknown DHCV status. To adjust for baseline differences between recipients with and without DHCV⫹, a propensity score (PS) was developed to assign each individual a conditional probability of receiving a DHCV⫹ heart. PS were categorized into quintiles. Survival analyses were then conducted using Cox regression to adjust for PS quintile and additional potential confounders. Results: Of 10,463 subjects meeting entry criteria, 262 received a DHCV⫹ heart. Subjects with DHCV⫹ were more often HCV infected pretransplant (14.0% vs 2.6%; p ⬍0.001). The unadjusted mortality hazard ratio (HR) for DHCV⫹ versus DHCV- was 2.11 (95% CI 1.95–2.74; p ⬍0.001). In multivariate models adjusting for PS quintile, the adjusted HR varied by recipient age (table 1). Recipient HCV status did not confound the association between DHCV⫹ and survival. Models controlling for transplant center and covariates not well distrubuted within PS strata yielded similar findings. Table 1 Recipient Age

Adjusted HR

p-value

18–39 40–59 60⫹

1.32 2.52 1.90

0.32 ⬍ 0.001 ⬍ 0.001

Conclusion: A survival disadvantage associated with DHCV⫹ exists, even after adjusting for multiple potential confounders using a PS. However, the effects of DHCV⫹ on survival are not uniform across age groups. Caution should be exercised before utilizing DHCV⫹ hearts, especially in recipients older than 40. 186 MID-TERM RESULTS WITH NON-HEART-BEATING DONORS LUNG TRANSPLANTATION D. Go ´ mez de Antonio,1 R. Laporta,2 G. Mora,2 C. Lo ´ pez Garcı´a-Gallo,2 J. Moradiellos,1 P. Gamez,1 M. Co ´ rdoba,1 A. de Pablo,2 P. Ussetti,2 M.C. Carren ˜ o,3 A. Varela,1 1Thoracic Surgery, Clı´nica Puerta de Hierro, Madrid, Spain; 2Pneumology, Clı´nica Puerta de Hierro, Madrid, Spain; 3Internal Medicine, Clı´nica Puerta de Hierro, Madrid, Spain Purpose: Describe our clinical experience since 2002 with nonheart-beating-donors in lung transplantation. Procedures: Analysis of 16 primary lung transplantations from 16 donors since 11/2002 to 9/2005.We present provisional records about donors age, gender, cause of death, PaO2, comorbidity and ischemic times; concerning recipients we present data about tipe of surgery, ischemic times, postoperative surgical and infectious com-

plications, lung reperfusion injury, extubation time, airway complications, BOS and survival. Results: Donors mean age was 39,37 years (standar deviation (SD) 12,06). 100% were males, among the causes of death were one aortic dissection, 2 electrocutions and 13 sudden arrests. Mean PaO2 before retrieval was 475,78 mmHg (SD 107,2). Mean warm ischemic time was 115,9 minutes (SD 37,87), mean preservation time was 175,83 minutes (SD 45,11) and mean cold ischemic time was 333 minutes (SD 106,58) for the first lung and 398,33 minutes (SD 86,07) for the second. Recipients data: We performed 10 double lung transplantation, 4 right lung transplantation and 2 left lung transplantation, 3 of the procedures were performed with the assistance of extracorporeal circulation. 7 patients (43,75%) had COPD, 6 (37,5%) Pulmonary Fibrosis, 2 (12,5%) Bronchiectasias and 1 (6,25%) sarcoidosis. There was one postoperative hemothorax and 3 (18,75%) lung reperfusion injuries. Mean extubation time was 102,5 hours (DS 148,69) and we have found 2 cases (12,5 %) of symptomatic airway stenosis.There were 8 postoperative bacterial infections (50%), one fungal and 2 (12,5%) from CMV. For the present moment there is one case of BOS (9th month). The 30 days mortality rate is 18,75% (3 patients died). Conclusions: Non-heart-beating donors seem to be a reasonable option to increase the pool of lung donors and to decrease both waiting list time and patients deaths waiting for an organ. 187 FLOW-CYTOMETRY POSITIVE, CYTOTOXICITY-NEGATIVE DONOR-SPECIFIC CROSSMATCH: TO TRANSPLANT OR NOT TO TRANSPLANT, THAT IS THE QUESTION J.K. Patel,1 E. Reed,1 D. Gjertson,1 G.W. Wu,1 H. Laks,1 J.A. Kobashigawa,1 1Medicine, University of California at Los Angeles, Los Angeles, CA The phone rings at night. You are asked whether to proceed with heart transplant if the donor-specific crossmatch is flow cytometry (flow) T cell positive, cytotoxicity (cyto) negative. What do you do? The importance of positive T-cell donor-specific crossmatch by flow cytometry, yet cytotoxicity negative, has not yet been established. Furthermore, outcome for these patients after heart transplant may be poor. To evaluate this, we reviewed 216 patients who underwent heart transplant (with non-induction immunosuppression) between June 2000 to August 2003 in our program. We found 13 heart transplant patients who were retrospectively-tested and found to be flow T-cell positive yet cyto negative. Results: None of the flow positive, cyto negative patients had hyperacute or delayed hyperacute rejection. Survival at 2 years was 100%. Only 1 of 13 patients had biopsy-proven rejection while 4 of 13 patients had any treated rejection (suggesting these patients had humoral rejection). No patients developed cardiac allograft vasculopathy within 2 years. For 203 control patients during the same time period, freedom from rejection was comparable (see table). Of these 13 study patients, 5 were also found to be B-cell positive by flow cytometry and cyto negative. Only 1 patient was found to be B-cell flow cytometry positive and cytotoxicity positive. This had no impact on outcome. Conclusion: T-cell flow cytometry postive, cytotoxicity negative donor-specific crossmatch appears safe to allow heart transplantation. A larger cohort of patients is needed to confirm this finding. T Cell Flowⴙ/Cyto- Patients vs Control Patients at 2 Years

T Cell Flow⫹/Cyto⫺ Controls p-value

Patients

Surviving

Proven Rejection

Treated Rejection

13 203 N/A

13 (100%) 168 (82.8%) 0.09

1 (7.7%) 8 (3.9%) 0.43

4 (30.8%) 34 (16.7%) 0.21