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320 Quality of Life in Pediatric Lung Transplantation: Comparing Recipients to Population Mean Values
S114
The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012
Purpose: Mycobacterium abscessus (M. abscessus) is an emerging respiratory pathogen in cystic fibrosis (CF) patients, but consensus regarding post-lung transplant outcome is unclear. Once classified as a single species M. abscessus is now defined as three closely related species: M. abscessus (sensu stricto); M. massiliense; and M. bolletii, collectively referred to as the M. abscessus complex. Outcomes according to M. abscessus complex classification are unclear. Methods and Materials: Retrospective case review of 59 lung or heartlung transplants occurring between 2003-2010 at Great Ormond Street Hospital. Isolates were initially identified to M. abscessus complex level and then later differentiated to separate species within the complex. Microbiological classification was related to post-transplant outcome, minimum follow-up was 12 months. Results: Five CF patients infected with M. abscessus complex underwent lung or heart-lung transplantation between 2003-2010. All received amikacin pleural cavity wash prior to donor organ implantation, and prolonged intravenous and then oral antibiotic regimens post-operatively. One patient with M. abscessus (sensu stricto) died in 2nd month post transplantation from unidentified sepsis. One patient with M. abscessus (sensu stricto) had recurrence of infection post transplantation, with significant associated morbidity, which was successfully treated, and was still alive 39 months later. The remaining 3 patients, one each with M. abscessus (sensu stricto), M. massiliense and M. bolletii had excellent outcome and were still alive without infection at 22-93 months. Conclusions: Acceptable post-transplant outcomes can be achieved with intensive multidrug antibiotic regimens in children infected with M. abscessus complex. Increased morbidity and mortality seems to be associated with M. abscessus (sensu stricto), and not with other species within the M. abscessus complex. Future multicentre studies are required to confirm this apparent risk stratification. 319 Acidic Gastroesophageal Reflux May Not Predict Earlier Bronchiolitis Obliterans in Pediatric Lung Transplant C. Towe, S. Sweet, R. Rothbaum, P. Michelson, A. Faro. Pediatrics, Washington University, St. Louis, MO. Purpose: Bronchiolitis Obliterans (BO) is the leading cause of late morbidity and mortality post lung transplant (LTx). Gastroesophageal reflux (GER) associated lung injury is hypothesized to be a risk factor for BO. We are reporting the preliminary data of this ongoing study to determine if acidic GER is associated with decreased time to BO in pediatric LTx. Methods and Materials: We performed a chart review of the 38 LTx recipients from our center, aged 5 months to 21 years, who successfully completed 24 hour esophageal pH probe studies from 2006 to August 2011. 39 studies were reviewed with 1 patient studied after both primary and secondary LTx. Studies were performed using standard techniques and a dual channel pediatric probe. Data collected included date of LTx, age at LTx, gender, underlying pulmonary disease, whether this was a primary or secondary lung transplant, presence of a fundoplication, episodes of acute rejection (A2 or greater), time to BO, date of study, and the proximal and distal results in the form of DeMeester scores. Significance of associations were determined by Chi-Square analysis (p ⬍ 0.05), and Kaplan-Meyer survival analysis was used to determine what characteristics were predictive of time to BO (p ⬍ 0.05). Results: 24 (61.5%) pH probe studies had abnormal proximal and/or distal DeMeester scores. Pre-transplant fundoplication (n ⫽ 8) was associated with normal proximal and distal scores. Having 1 or more episodes of acute rejection (n ⫽ 18) predicted a decreased time to BO. Neither the presence of a fundoplication pre-transplant nor undergoing fundoplication posttransplant (n ⫽ 8) predicted time to BO. Neither an abnormal proximal nor abnormal distal score predicted time to BO. Conclusions: We found that the majority of our patients had abnormal DeMeester scores. However, in the current analysis neither an abnormal score nor the fundoplication status of the patient had a significant effect on time to BO. Longer term follow-up with greater patient numbers is required before making conclusive treatment recommendations.
320 Quality of Life in Pediatric Lung Transplantation: Comparing Recipients to Population Mean Values M. Mann,1 D. Czyzewski,2 J.K. Jonhson,1 J. Schnuck,2 M. Mignogna,2 G.B. Mallory,1 M.G. Schecter.1 1Department of Pediatric Pulmonary Medicine, Baylor College of Medicine, Houston, TX; 2Department of Psychology, Baylor College of Medicine, Houston, TX. Purpose: Outcomes for pediatric lung transplantation traditionally have been defined by patient or graft survival. Quality of life (QOL) is also an important outcome when examining overall benefit of lung transplantation.There is limited data regarding QOL in pediatric lung transplant recipients. We hypothesize that QOL in pediatric lung transplant is higher in children after transplant when compared to children actively listed for lung transplant and that QOL after transplant is comparable with normative reference values in the population. Methods and Materials: The PedsQL™ is a measurement model to assess health related and psychosocial QOL in healthy children and those with chronic or acute disease. Patients followed by our lung transplant center over the age of two years, pre or post-transplant, were eligible for enrollment. Enrolled families completed the PedsQLtransplant™ and the PedsQL™ generic modules at scheduled follow up. Mean total scores for PedsQL™ generic and PedsQLtransplant™ were calculated for parent and child reports. Our patients were also compared to healthy control and patients with chronic disease data. Independent samples t-tests and one sample t-tests were used for analysis. Results: Table 1
●
Module Type
Mean SD (pre/ (pre/post) post)
mean pre/post p value mean for compared to between healthy healthy pre/post controls controls
mean pre/post mean for compared to chronic chronic condition condition
PedsQL™ parent
56.2/71.6
14.4/16.6
p⫽0.02
0.001/0.003
73.1
0.01/0.643
PedsQL™child
56.0/75.1
14.9/16.2
p⫽0.006 83.9
0.001/0.01
74.2
0.01/0.789
PedsQLtransplant™ 73.9/75.2 parent
73.9/12.6
p⫽0.80
PedsQLtransplant™ 71.2/81.4 child
14.7/11.1
p⫽0.047
82.3
Conclusions: QOL in children lung transplant recipients is greater compared to that of children listed for transplant. Patients listed for transplant have lower QOL scores compared to children with chronic diseases. While transplant recipients do not achieve QOL scores similar to healthy controls, they achieve scores comparable to child with chronic diseases. 321 Impact of Age on Health-Related Quality of Life Benefit of Lung Transplantation L.G. Singer,1,2 N. Chowdhury,1 C. Chaparro,1,2 S. Keshavjee.1,3 1 Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada; 2Medicine, University of Toronto, Toronto, ON, Canada; 3Thoracic Surgery, University of Toronto, Toronto, ON, Canada. Purpose: There is controversy about the survival and health-related quality of life (HRQL) benefit in of lung transplantation in older patients. The objective of this study was to determine whether the changes in HRQL conferred by lung transplantation are associated with recipient age at the time of transplant. Methods and Materials: Multiple HRQL measures including SF-36, St. George’s Respiratory Questionnaire (SGRQ), and EQ-5D were prospectively assessed in stable outpatients at multiple time points pre- and post-lung transplant (tx). We included patients who had at least one pre-tx HRQL assessment and who had HRQL assessed at one and/or two years post tx. We calculated changes in selected HRQL measures (SF-36 physical component summary (PCS), SRGQ total score, EQ-5D)) between the last pre-tx assessment and the 1- and 2-year post-tx assessments. We used linear regression to study associations between age at tx and post-tx change in HRQL. We categorized HRQL benefit from tx as improvement in HRQL greater than a clinically important difference for each measure. We used
The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012
Purpose: Mycobacterium abscessus (M. abscessus) is an emerging respiratory pathogen in cystic fibrosis (CF) patients, but consensus regarding post-lung transplant outcome is unclear. Once classified as a single species M. abscessus is now defined as three closely related species: M. abscessus (sensu stricto); M. massiliense; and M. bolletii, collectively referred to as the M. abscessus complex. Outcomes according to M. abscessus complex classification are unclear. Methods and Materials: Retrospective case review of 59 lung or heartlung transplants occurring between 2003-2010 at Great Ormond Street Hospital. Isolates were initially identified to M. abscessus complex level and then later differentiated to separate species within the complex. Microbiological classification was related to post-transplant outcome, minimum follow-up was 12 months. Results: Five CF patients infected with M. abscessus complex underwent lung or heart-lung transplantation between 2003-2010. All received amikacin pleural cavity wash prior to donor organ implantation, and prolonged intravenous and then oral antibiotic regimens post-operatively. One patient with M. abscessus (sensu stricto) died in 2nd month post transplantation from unidentified sepsis. One patient with M. abscessus (sensu stricto) had recurrence of infection post transplantation, with significant associated morbidity, which was successfully treated, and was still alive 39 months later. The remaining 3 patients, one each with M. abscessus (sensu stricto), M. massiliense and M. bolletii had excellent outcome and were still alive without infection at 22-93 months. Conclusions: Acceptable post-transplant outcomes can be achieved with intensive multidrug antibiotic regimens in children infected with M. abscessus complex. Increased morbidity and mortality seems to be associated with M. abscessus (sensu stricto), and not with other species within the M. abscessus complex. Future multicentre studies are required to confirm this apparent risk stratification. 319 Acidic Gastroesophageal Reflux May Not Predict Earlier Bronchiolitis Obliterans in Pediatric Lung Transplant C. Towe, S. Sweet, R. Rothbaum, P. Michelson, A. Faro. Pediatrics, Washington University, St. Louis, MO. Purpose: Bronchiolitis Obliterans (BO) is the leading cause of late morbidity and mortality post lung transplant (LTx). Gastroesophageal reflux (GER) associated lung injury is hypothesized to be a risk factor for BO. We are reporting the preliminary data of this ongoing study to determine if acidic GER is associated with decreased time to BO in pediatric LTx. Methods and Materials: We performed a chart review of the 38 LTx recipients from our center, aged 5 months to 21 years, who successfully completed 24 hour esophageal pH probe studies from 2006 to August 2011. 39 studies were reviewed with 1 patient studied after both primary and secondary LTx. Studies were performed using standard techniques and a dual channel pediatric probe. Data collected included date of LTx, age at LTx, gender, underlying pulmonary disease, whether this was a primary or secondary lung transplant, presence of a fundoplication, episodes of acute rejection (A2 or greater), time to BO, date of study, and the proximal and distal results in the form of DeMeester scores. Significance of associations were determined by Chi-Square analysis (p ⬍ 0.05), and Kaplan-Meyer survival analysis was used to determine what characteristics were predictive of time to BO (p ⬍ 0.05). Results: 24 (61.5%) pH probe studies had abnormal proximal and/or distal DeMeester scores. Pre-transplant fundoplication (n ⫽ 8) was associated with normal proximal and distal scores. Having 1 or more episodes of acute rejection (n ⫽ 18) predicted a decreased time to BO. Neither the presence of a fundoplication pre-transplant nor undergoing fundoplication posttransplant (n ⫽ 8) predicted time to BO. Neither an abnormal proximal nor abnormal distal score predicted time to BO. Conclusions: We found that the majority of our patients had abnormal DeMeester scores. However, in the current analysis neither an abnormal score nor the fundoplication status of the patient had a significant effect on time to BO. Longer term follow-up with greater patient numbers is required before making conclusive treatment recommendations.
320 Quality of Life in Pediatric Lung Transplantation: Comparing Recipients to Population Mean Values M. Mann,1 D. Czyzewski,2 J.K. Jonhson,1 J. Schnuck,2 M. Mignogna,2 G.B. Mallory,1 M.G. Schecter.1 1Department of Pediatric Pulmonary Medicine, Baylor College of Medicine, Houston, TX; 2Department of Psychology, Baylor College of Medicine, Houston, TX. Purpose: Outcomes for pediatric lung transplantation traditionally have been defined by patient or graft survival. Quality of life (QOL) is also an important outcome when examining overall benefit of lung transplantation.There is limited data regarding QOL in pediatric lung transplant recipients. We hypothesize that QOL in pediatric lung transplant is higher in children after transplant when compared to children actively listed for lung transplant and that QOL after transplant is comparable with normative reference values in the population. Methods and Materials: The PedsQL™ is a measurement model to assess health related and psychosocial QOL in healthy children and those with chronic or acute disease. Patients followed by our lung transplant center over the age of two years, pre or post-transplant, were eligible for enrollment. Enrolled families completed the PedsQLtransplant™ and the PedsQL™ generic modules at scheduled follow up. Mean total scores for PedsQL™ generic and PedsQLtransplant™ were calculated for parent and child reports. Our patients were also compared to healthy control and patients with chronic disease data. Independent samples t-tests and one sample t-tests were used for analysis. Results: Table 1
●
Module Type
Mean SD (pre/ (pre/post) post)
mean pre/post p value mean for compared to between healthy healthy pre/post controls controls
mean pre/post mean for compared to chronic chronic condition condition
PedsQL™ parent
56.2/71.6
14.4/16.6
p⫽0.02
0.001/0.003
73.1
0.01/0.643
PedsQL™child
56.0/75.1
14.9/16.2
p⫽0.006 83.9
0.001/0.01
74.2
0.01/0.789
PedsQLtransplant™ 73.9/75.2 parent
73.9/12.6
p⫽0.80
PedsQLtransplant™ 71.2/81.4 child
14.7/11.1
p⫽0.047
82.3
Conclusions: QOL in children lung transplant recipients is greater compared to that of children listed for transplant. Patients listed for transplant have lower QOL scores compared to children with chronic diseases. While transplant recipients do not achieve QOL scores similar to healthy controls, they achieve scores comparable to child with chronic diseases. 321 Impact of Age on Health-Related Quality of Life Benefit of Lung Transplantation L.G. Singer,1,2 N. Chowdhury,1 C. Chaparro,1,2 S. Keshavjee.1,3 1 Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada; 2Medicine, University of Toronto, Toronto, ON, Canada; 3Thoracic Surgery, University of Toronto, Toronto, ON, Canada. Purpose: There is controversy about the survival and health-related quality of life (HRQL) benefit in of lung transplantation in older patients. The objective of this study was to determine whether the changes in HRQL conferred by lung transplantation are associated with recipient age at the time of transplant. Methods and Materials: Multiple HRQL measures including SF-36, St. George’s Respiratory Questionnaire (SGRQ), and EQ-5D were prospectively assessed in stable outpatients at multiple time points pre- and post-lung transplant (tx). We included patients who had at least one pre-tx HRQL assessment and who had HRQL assessed at one and/or two years post tx. We calculated changes in selected HRQL measures (SF-36 physical component summary (PCS), SRGQ total score, EQ-5D)) between the last pre-tx assessment and the 1- and 2-year post-tx assessments. We used linear regression to study associations between age at tx and post-tx change in HRQL. We categorized HRQL benefit from tx as improvement in HRQL greater than a clinically important difference for each measure. We used