532: Donor Scoring Does Not Predict Early Outcome

The Journal of Heart and Lung Transplantation Volume 27, Number 2S

Abstracts

intend to validate this set prospectively to assess the diagnostic and predictive value. The identity of the self antigens that the 13 autoantibodies bind to elucidates the nature of the immunological response resulting in BOS. 531 Longitudinal Analysis of Exhaled Breath Condensate Biomarkers after Lung Transplantation A. Krishnan,1 S. Chow,2 P.S. Thomas,2 A.R. Glanville,1 D.H. Yates,1 1 Thoracic Medicine and Lung Transplantation, St.Vincents Hospital, Sydney, NSW, Australia; 2Thoracic Medicine, University of New South Wales, Sydney, NSW, Australia Purpose: Improved outcomes post lung transplantation (LTx) depend on close surveillance for rejection and infections. Exhaled breath condensate (EBC) collection is a novel, non-invasive method of sampling the airway. Several markers of inflammation and oxidative imbalance are measurable in EBC and may be early markers of graft dysfunction. We have previously reported significant differences between various post LTx diagnoses in a cross sectional study. This study aimed to investigate the utility of longitudinal exhaled breath biomarker measurements in the follow-up of LTx patients. Methods and Materials: We studied 68 LTx patients prospectively, at 6 monthly intervals and analysed 148 samples. EBC was collected using a refrigerator circuit (Ecoscreen V1.1, Jaeger, Germany). Between-group comparisons done using ANOVA. Results: Table 1: Values expressed as mean (SEM) Conclusions: This is the first study of longitudinal EBC biomarker measurements in LTx patients. Patients with BOS have a significant increase in markers of oxidative stress and neutrophilic inflammation as well as low pH. There is also evidence of marked oxidative stress in ACR and viral infections. EBC biomarker analysis is an easily repeatable test which has the potential to delineate both the processes and time course of complications after lung transplantation. Further studies are required to validate its use in clinical practice.

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Methods and Materials: From January 2005 to July 2007, 185 sequential bilateral lung transplants were performed in our center.Of these,148(80%) had complete donor information required for the retrospective donor score calculation: age, smoking history, chest x-ray, secretions on bronchoscopy and ABGs.Logistic regression relating the score to various post-transplant outcomes such as PaO2/FiO2⬎24h after transplantation, length of intubation (log-transf.) and ICU stay were used in order to study the predictive value of the score. Results: The median and IQR donor score in the lungs used for transplantation were 4(1.7-6.2) in 2005, 4(2.7-6) in 2006 and 5(3-7) in 2007.The number of donors at each donor score is shown in Fig.1.In univariate analyses the score was not significantly correlated with post-transplant PaO2/FiO2(Fig.2).There was also no significant correlation between the score and recipient length of intubation (r2⫽0.019 p⫽0.23) or ICU stay (r2⫽0.018 p⫽0.2). Conclusions: The proposed scoring system based solely on donor clinical variables did not predict early recipient outcomes in our center.

Table 1 Biomarker

Viral 6 weeks p value infection post (nⴝ11)

Biomarker

BOS 0 BOS>1

p value

pH

5.8 (0.35) 6.2 (0.56) 0.04

NOx (␮M)

0.002

Iso (pg/ml)

729.2 (185.1) ACR (n⫽9) 29.91 (9.14)

0.05

Iso (pg/ml)

p value

LTB4

27.82 (7.5) 531.6 (158.6) 584.2 (188.1)

Biomarker H2O2 (pg/ml)

323.1 (64.3) 6 weeks post 21.89 (14.3)

58.79 (6.5) 2091.1 (613.7) 1068.2 (125.1)

0.008 0.02

0.009

NOx: nitrogen oxides, Iso: isoprostane, LTB4: leukotriene B4, H2O2: Hydrogen peroxide

532 Donor Scoring Does Not Predict Early Outcome M. Cypel,1 E. Yildirim,1 C. Boasquevisque,1 M. Anraku,1 V.T. Sales,1 D.E. Rodrigues,1 C. Payne,1 A. Pierre,1 M. de Perrot,1 S. Keshavjee,1 T.K. Waddell,1 1Thoracic Surgery, Toronto Lung Transplant Group, University of Toronto, Toronto, ON, Canada Purpose: A donor lung scoring system might prove useful to improve decision making in donor selection and for data comparison among different centers.A new donor lung score using 5 traditional clinical donor variables was recently reported to correlate with early results after transplantation.We aimed to determine whether this specific score predicted early recipient outcomes in our center.

533 Risk Factors for Death in High LAS Patients after Lung Transplantation C.A. Merlo,1 J.B. Orens,1 J.V. Conte,2 A.S. Shah,2 1Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; 2Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD