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686 Early Detection and Resection of Lung Cancer in Heart Transplant Recipients Yields Similar Survival to Recipients without Lung Cancer
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The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012 found at an appropriate stage for resection (p ⫽ 0.008). Patients receiving surgery had a similar survival to those heart recipients who did not develop cancer whereas those receiving only medical treatment have a worse prognosis (p⫽0.002). The product-limit-survival estimates at 1, 2, and 5 years for those in the CXR group are 57.1%, 28.9%, and 14.3% and in the CT group are 76.2%, 50.8%, and 25.4%. Conclusions: Cardiac transplant recipients with a significant smoking history have a significant risk of developing bronchogenic carcinoma. Routine chest CT screening in high-risk patients enables clinicians to identify disease at an earlier stage appropriate for resection as compared to chest xray alone. Patients receiving early surgical intervention have similar survivability to those heart recipients who do not develop lung cancer. 687
Conclusions: Only high-titer HLA DQ antibodies appear to be associated with subsequent greater development in TCAD. Low-titer HLA DQ antibodies may suggest an acquired tolerance. Further studies will be needed to assess the importance of antibody titer to outcome and whether treatment of these high-titer HLA DQ antibodies would result in less TCAD. 686 Early Detection and Resection of Lung Cancer in Heart Transplant Recipients Yields Similar Survival to Recipients without Lung Cancer W.A. Teeter,1 C. Ayers,2 D. Rosenbaum,1 M. Drazner,2 M. Peltz,1 M. Wait,1 D. Meyer,1 M. DiMaio.1 1Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, TX; 2Division of Cardiology, University of Texas Southwestern Medical Center at Dallas, TX. Purpose: Heart transplant recipients with a history of significant tobacco use have an increased incidence of lung cancer. In 2002 we began annual computed tomography (CT) surveillance of our heart transplant recipients with greater than a 10-pack year history of tobacco use to detect the early development of bronchogenic carcinoma. Methods and Materials: We performed a review of our cardiac transplantation experience (n ⫽ 390) with respect to clinical characteristics, mortality, and the imaging modalities used to diagnose lung cancer in this population.
Incidence of Azole Resistance in Aspergillus Fumigatus among Lung Transplant Recipients (LTRs) M.-L. Luong,1 S. Howard,2 S.E. Richardson,3 L.G. Singer,1 C. Chaparro,1 S. Keshavjee,1 Y. Akinlolu,1 S. Azad,1 C. Rotstein,1 T. Mazzulli,4 S. Husain.1 1The Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada; 2School of Translational Medicine, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom; 3Central Provincial Health Laboratory, Ontario Agency for Health Protection and Promotion, Toronto, ON, Canada; 4Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. Purpose: The prevalence of azole resistance and cyp51A mutations (most common mechanism of azole resistance) in A. fumigatus among LTRs is unknown. We performed a prospective single-center study to determine the frequency of resistance cyp51A alterations in this understudied patient group. Methods and Materials: 91 LTRs from Jan 2008 to Oct 2011 were prospectively followed. Aspergillus was isolated from 38% (35/91) of LTRs after transplantation, 71% (25/35) of which were A. fumigatus. 60% (15/25) of A. fumigatus were studied further; comprising of 1) sequencing the cyp51A gene and 2) antifungal susceptibility testing by CLSI method. Results: A single point mutation in the cyp51A gene was identified in 20% (3/15) of A. fumigatus isolates, with the following amino acid substitutions: A9T, I242V and N248K. Susceptibility testing to itraconazole and voriconazole demonstrated minimal inhibitory concentration (MIC) of 0.25 and 0.25 for all three mutant isolates, while susceptibility testing to posaconazole demonstrated an MIC of 0.06 for N248K mutant and 0.12 for both I242V and A9T mutants. MIC to itraconazole, voriconazole and posaconazole among 12 wild type strains varied between 0.12-1.0 (median 0.12), 0.12-2.0 (median 0.12) and 0.03-0.5 (median 0.06), respectively. Prior voriconazole exposure was noted in 33% (4/12) of LTRs with wild type strains and 66% (2/3) of LTRs with mutant strains (2 colonization, 1 invasive disease) (OR 4.0; 0.3-58.6). All cases of colonization resolved at the end of voriconazole therapy. No patient with mutant strains died at one year of follow-up. Conclusions: There was no azole resistance detected in this study. Three A. fumigatus isolates revealed a cyp51A point mutation. However, it remains unconfirmed whether any of these alterations contribute to in vitro azole resistance. No deleterious outcome with mutant strains was noted in this study. 688 Effect of Hypogammaglobulinemia after Lung Transplantation on the Incidence of Community Acquired Respiratory Viral Infections B.C. Noell, K.L. Dawson, H. Seethamraju. The Methodist Hospital, Houston, TX.
Results: Twenty three patients developed 27 cases of primary lung carcinoma (6.92%), of which 15 cases were treated surgically. All 7 patients diagnosed by CT had a negative CXR within 6 months of diagnosis and all were treated surgically. Only 40% of patients diagnosed by chest xray were
Purpose: This study aims to determine if lung transplant recipients with hypogammaglobulinemia (HGG) are at an increased risk of developing community acquired respiratory viral infections (CARV). Secondary endpoints include the effect of HGG on the incidence of biopsy proven acute rejection (BPAR) and mortality. Methods and Materials: A review was performed on all lung transplant recipients from 2008 to present at a single center. Patients without IgG
The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012 found at an appropriate stage for resection (p ⫽ 0.008). Patients receiving surgery had a similar survival to those heart recipients who did not develop cancer whereas those receiving only medical treatment have a worse prognosis (p⫽0.002). The product-limit-survival estimates at 1, 2, and 5 years for those in the CXR group are 57.1%, 28.9%, and 14.3% and in the CT group are 76.2%, 50.8%, and 25.4%. Conclusions: Cardiac transplant recipients with a significant smoking history have a significant risk of developing bronchogenic carcinoma. Routine chest CT screening in high-risk patients enables clinicians to identify disease at an earlier stage appropriate for resection as compared to chest xray alone. Patients receiving early surgical intervention have similar survivability to those heart recipients who do not develop lung cancer. 687
Conclusions: Only high-titer HLA DQ antibodies appear to be associated with subsequent greater development in TCAD. Low-titer HLA DQ antibodies may suggest an acquired tolerance. Further studies will be needed to assess the importance of antibody titer to outcome and whether treatment of these high-titer HLA DQ antibodies would result in less TCAD. 686 Early Detection and Resection of Lung Cancer in Heart Transplant Recipients Yields Similar Survival to Recipients without Lung Cancer W.A. Teeter,1 C. Ayers,2 D. Rosenbaum,1 M. Drazner,2 M. Peltz,1 M. Wait,1 D. Meyer,1 M. DiMaio.1 1Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, TX; 2Division of Cardiology, University of Texas Southwestern Medical Center at Dallas, TX. Purpose: Heart transplant recipients with a history of significant tobacco use have an increased incidence of lung cancer. In 2002 we began annual computed tomography (CT) surveillance of our heart transplant recipients with greater than a 10-pack year history of tobacco use to detect the early development of bronchogenic carcinoma. Methods and Materials: We performed a review of our cardiac transplantation experience (n ⫽ 390) with respect to clinical characteristics, mortality, and the imaging modalities used to diagnose lung cancer in this population.
Incidence of Azole Resistance in Aspergillus Fumigatus among Lung Transplant Recipients (LTRs) M.-L. Luong,1 S. Howard,2 S.E. Richardson,3 L.G. Singer,1 C. Chaparro,1 S. Keshavjee,1 Y. Akinlolu,1 S. Azad,1 C. Rotstein,1 T. Mazzulli,4 S. Husain.1 1The Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada; 2School of Translational Medicine, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom; 3Central Provincial Health Laboratory, Ontario Agency for Health Protection and Promotion, Toronto, ON, Canada; 4Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. Purpose: The prevalence of azole resistance and cyp51A mutations (most common mechanism of azole resistance) in A. fumigatus among LTRs is unknown. We performed a prospective single-center study to determine the frequency of resistance cyp51A alterations in this understudied patient group. Methods and Materials: 91 LTRs from Jan 2008 to Oct 2011 were prospectively followed. Aspergillus was isolated from 38% (35/91) of LTRs after transplantation, 71% (25/35) of which were A. fumigatus. 60% (15/25) of A. fumigatus were studied further; comprising of 1) sequencing the cyp51A gene and 2) antifungal susceptibility testing by CLSI method. Results: A single point mutation in the cyp51A gene was identified in 20% (3/15) of A. fumigatus isolates, with the following amino acid substitutions: A9T, I242V and N248K. Susceptibility testing to itraconazole and voriconazole demonstrated minimal inhibitory concentration (MIC) of 0.25 and 0.25 for all three mutant isolates, while susceptibility testing to posaconazole demonstrated an MIC of 0.06 for N248K mutant and 0.12 for both I242V and A9T mutants. MIC to itraconazole, voriconazole and posaconazole among 12 wild type strains varied between 0.12-1.0 (median 0.12), 0.12-2.0 (median 0.12) and 0.03-0.5 (median 0.06), respectively. Prior voriconazole exposure was noted in 33% (4/12) of LTRs with wild type strains and 66% (2/3) of LTRs with mutant strains (2 colonization, 1 invasive disease) (OR 4.0; 0.3-58.6). All cases of colonization resolved at the end of voriconazole therapy. No patient with mutant strains died at one year of follow-up. Conclusions: There was no azole resistance detected in this study. Three A. fumigatus isolates revealed a cyp51A point mutation. However, it remains unconfirmed whether any of these alterations contribute to in vitro azole resistance. No deleterious outcome with mutant strains was noted in this study. 688 Effect of Hypogammaglobulinemia after Lung Transplantation on the Incidence of Community Acquired Respiratory Viral Infections B.C. Noell, K.L. Dawson, H. Seethamraju. The Methodist Hospital, Houston, TX.
Results: Twenty three patients developed 27 cases of primary lung carcinoma (6.92%), of which 15 cases were treated surgically. All 7 patients diagnosed by CT had a negative CXR within 6 months of diagnosis and all were treated surgically. Only 40% of patients diagnosed by chest xray were
Purpose: This study aims to determine if lung transplant recipients with hypogammaglobulinemia (HGG) are at an increased risk of developing community acquired respiratory viral infections (CARV). Secondary endpoints include the effect of HGG on the incidence of biopsy proven acute rejection (BPAR) and mortality. Methods and Materials: A review was performed on all lung transplant recipients from 2008 to present at a single center. Patients without IgG