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80: Quality of Life and Predictors of Medication Adherence in Pediatric Heart Transplant Recipients
S32
The Journal of Heart and Lung Transplantation, Vol 29, No 2S, February 2010
Conclusions: Our study identifies renal insufficiency as a significant risk factor for higher LTx mortality in preoperatively ventilated patients. Future guidelines on LTx under these circumstances should include this information. 77 The Impact of Recipient Body Mass Index on Outcomes Following Lung Transplantation J.G. Allen,1 G.J. Arnaoutakis,1 E.S. Weiss,1 C.A. Merlo,2 J.V. Conte,1 A.S. Shah.1 1Johns Hopkins Medical Institutions, Baltimore, MD; 2Johns Hopkins Medical Institutions, Baltimore, MD. Purpose: Lung transplant(LTx) candidates are frequently over or underweight. Few studies have examined the effect of recipient weight on outcomes following LTx. The United Network for Organ Sharing(UNOS) database provides an opportunity to examine outcomes related to body mass index(BMI) in a large modern cohort of LTx patients. Methods and Materials: We retrospectively reviewed the UNOS dataset for 10,057 adult primary LTx patients(1998-2007). Patients were stratified by recipient BMI strata:⬍18.5(underweight), 18.5-24.9(normal), 25.029.9(overweight), ⬎30(obese). All cause mortality was examined with Cox proportional hazard regression incorporating 15 variables. Mortality was examined using the Kaplan-Meier method(30d, 90d, 1yr, and 5yr). Results: Of 10,057, 12.3% (n⫽1237) were underweight, 44.3% (n⫽4453) were normal weight, 31.6% (n⫽3182) were overweight, and 11.8% (n⫽1185) were obese. 4034 (40%) died during the study. Mortality was significantly different between the strata at each time point examined, with incremental increases in mortality for each BMI strata above or below normal. On multivariable analysis, BMI strata predicted mortality compared to normal; underweight (Hazard ratio (HR) 1.13[1.02-1.26], p⫽0.02), overweight (HR 1.10[1.02-1.19], p⫽0.01), and obese (HR 1.14[1.02-1.27], p⫽0.02) recipients had increased risk of death. KaplanMeier modeling showed a significant effect of BMI on survival (Figure1). However, this effect was no longer significant when 1st yr deaths were excluded. Conclusions: Our study represents the largest modern cohort evaluating recipient weight in LTx. Underweight, overweight, and obese patients have higher mortality when compared to normal weight controls. However, this effect appears to be mediated by mortality in the 1st yr after LTx.[figure1]
78 WITHDRAWN 79 Insurance Status and Education Level Are Independent Predictors of Survival after Lung Transplantation J.G. Allen,1 G.J. Arnaoutakis,1 J.F. McDyer,2 J.B. Orens,2 A.S. Shah,1 C.A. Merlo.2,3 1Johns Hopkins University School of Medicine, Baltimore, MD; 2Johns Hopkins University School of Medicine, Baltimore, MD; 3 Johns Hopkins School of Public Health, Baltimore, MD.
Purpose: Socioeconomic factors such as education, race, income, and insurance status have been shown to affect health outcomes and are known to play a role in survival after heart, kidney, and liver transplantation. Despite this, little is known about the role of socioeconomic factors as predictors of survival after lung transplantation. Methods and Materials: All patients over the age of 18 years in the UNOS Registry undergoing lung transplantation during the period Jan 2000 through May 2009 were included in the study. Time-to-event analyses for risk of death after transplantation were performed using Kaplan-Meier survival and Cox proportional hazards models. Results: During the study period, there were 11,213 patients who underwent lung transplantation. The median (IQR) follow-up time was 713 (218-1448) days. The mean (SD) age was 52.0 (12.7) years, mean (SD) FEV1% predicted was 35.9 (20.9) and 45.4% were female. Of the cohort, 22.2% had a college degree or greater level of education. During the study period, 60.8% reported having private insurance, 27.5% reported having Medicare, and 7% reported having Medicaid. In bivariable analyses, recipients with higher education level had significantly improved survival (HR: 0.90, 95% CI: 0.83-0.97) when compared to recipients with lower education level. Likewise, recipients with private insurance had improved survival (HR: 0.82, 95% CI: 0.73-0.92) when compared to recipients with Medicaid. In multivariable analyses, the effect of higher education level (HR: 0.87, 95% CI: 0.80-0.95) and private insurance (HR: 0.79, 95% CI: 0.70-0.90) persisted even after adjusting for age, sex, race, diagnosis,markers of disease severity, and known predictors of survival after lung transplantation. Conclusions: Socioeconomic factors are significant predictors of survival after lung transplantation. Lung transplant recipients with higher education levels and private insurance appear to have increased survival when compared to recipients with lower education and Medicaid beneficiaries independent of racial differences. 80 Quality of Life and Predictors of Medication Adherence in Pediatric Heart Transplant Recipients K. Uzark,1 M. Zamberlan,2 P. Murphy,3 C. Nasman,4 R. Rodriguez,5 J. Dupuis,6 S. Rodgers,6 Y. Wang,1 R. Ittenbach.1 1Cincinnati Children’s Hospital Medical Ctr, Cincinnati, OH; 2University of Michigan Medical Ctr, Ann Arbor, MI; 3St Louis Children’s Hospital, St. Louis, MO; 4 Cleveland Clinic Foundation, Cleveland, OH; 5Columbia Univeristy Medical Ctr, New York, NY; 6Children’s Hospital of Michigan, Detroit, MI; 7Children’s Memorial Hospital, Chicago, IL. Purpose: While heart transplantation (HTx) has improved survival and quality of life (QOL) in children with terminal heart disease, consistent and lifelong medication (med) adherence is required to sustain these outcomes. In this multicenter study, our aim was to examine the prevalence and correlates of medication non-adherence in pediatric HTx recipients including QOL factors as perceived by patients and parents and demographic/ medical variables. Methods and Materials: The pediatric quality of life inventory core and cardiac module scales were administered to 75 children/parents (mean age 13.6 ⫾ 3.1yrs) including 33 males and 42 females, 1 to 17 yrs (mean 6.85) following HTx. Mean age at HTx was 6.73 yrs, range 10 days to 17.6 yrs. Clinicians rated medication adherence on a 4-point scale based on drug level history. Results: Adherence was rated as excellent in 57 (76%) of patients, less than excellent or incomplete adherence in 18 (24%). Lower adherence was significantly correlated with lower self-reported psychosocial QOL scores (p⫽.05) and lower self-reported treatment (barriers) scores (i.e. more perceived problems related to taking meds), r⫽.32, p⫽.006, including difficulty remembering to take meds (p⫽.03). Parental perceptions of the child’s QOL and treatment barrier scores however, were not significantly correlated with adherence. Adherence was not correlated with the child’s gender, SES, time since transplant, or number of meds taken. Patients with incomplete adherence tend to be older, p⫽.06. In a logistic regression analysis, only self-reported treatment barriers was a significant predictor of med adherence (p⫽.01).
Abstracts Conclusions: One in 4 pediatric HTx recipients have incomplete medication adherence. The child’s report of perceived barriers to med adherence was predictive of their adherence behavior associated with diminished psychosocial QOL. Routine assessment of barriers to adherence identified by the child/adolescent with strategies to incorporate meds into their lifestyle may promote improved QOL and survival in pediatric HTx recipients. 81 Timing of Transplant Following Mechanical Circulatory Support in 375 Patients: Lessons from a Single Center Experience K.J. Hoercher, N.G. Smedira, D. Yoon, J. Rajeswaran, E.H. Blackstone. Cleveland Clinic, Cleveland, OH. Purpose: Determining optimal timing of transplantation (Tx) for pts bridged on mechanical circulatory support (MCS) is difficult. Previous reports have shown early Tx (⬍ 30 days) is thought to increase mortality, however, the benefit of awaiting full functional recovery must be counterbalanced with risk of adverse events that increase with each day on MCS. Our purpose was to investigate the complex relationship of duration of MCS and pt and device factors impacting survival after Tx. Methods and Materials: From 12/91 to 7/2006, 375 transplant candidates were bridged with MCS at a single center and of these, 262 were transplanted. Implantable pulsatile devices were used in 321, continous flow in 11, total artificial heart in 5, external pulsatile in 34, and extracorporeal membrane oxygenation in 68. Two time related models were developed: 1) a competing risk multivariable model of death on MCS and 2) a model of death after Tx in which patient factors, events on MCS, and duration of support were investigated as risk factors. Results: Risk– unadjusted survival on MCS before Tx was 84%, 73%, 62%, and 45% at 1,3, 6, and 12 months. Of 262 surviving to Tx, 94%, 74%, and 58% survived at 30 days, 5 and 10 yrs after Tx. Risk factors for death post Tx included longer, but not shorter, duration of MCS (p⫽⬍.0001), use of multiple devices, global sensitization, cardiac reoperation, and poor renal function. Conclusions: Longer MCS duration did not improve and may have worsened survival to and after Tx. Importantly, Tx early (⬍30days) after MCS did not increase mortality. This suggests that the cumulative burden of MCS complications diminishes survival after Tx thereby increasing risk for each day on MCS. Awaiting full functional recovery must be balanced with awareness that the longer the duration of support, the potentially worse pre and post Tx survival. 82 Patient-Reported Outcomes after the Minimally Invasive Approach to Lung Transplantation A. DeVito Dabbs,1 M.A. Dew,2 D. Zaldonis,3 J. Aubrecht,1 M.M. Crespo,4 J.M. Pilewski,4 J.K. Bhama,3 S. Gilbert,3 C. Bermudez,3 Y. Toyoda.3 1University of Pittsburgh, Pittsburgh, PA; 2University of Pittsburgh, Pittsburgh, PA; 3University of Pittsburgh, Pittsburgh, PA; 4 University of Pittsburgh, Pittsburgh, PA. Purpose: The antero-axillary, minimally invasive (MI) approach for lung transplant is a safe alternative to conventional surgical approaches for most recipients. We hypothesized that MI recipients will also have more favorable patient-reported recovery outcomes than conventional approach recipients. Methods and Materials: A comparative cohort design was used to detect differences in patient-reported recovery at 2 months post-discharge between a prospective cohort of 25 recipients who underwent the MI approach compared to a retrospective cohort of 58 recipients who underwent conventional approaches, either clamshell (n⫽31) or single thoractomy (n⫽27), but would have been eligible for the MI approach had it been available. We examined between-group differences in baseline characteristics and patient-reported recovery outcomes at 2 months, including physical performance (using Karnofsky index), psychological distress (using
S33 the Symptom Checklist-90 anxiety and depression subscales) and healthrelated quality of life (SF-36 physical-mental dimension scores). Results: Baseline characteristics (gender, race, income, marital status, employment status and type of pre-transplant pulmonary disease) were equivalent between groups. Recipients in the MI group underwent double versus single transplant procedures at a higher rate (p⫽.003), were older (mean age 60 versus 52 years, p⫽.023), and at 2 months reported better physical performance (p⫽.021) and lower anxiety (p⫽.016). No statistically significant between-group differences were found in levels of depression or health-related quality of life dimension scores. Conclusions: Although recipients in the MI group were all recipients of double lung procedures and older, they reported higher levels of physical functioning and lower levels of anxiety at 2 months compared to recipients in the conventional approach group. These data suggest that the MI approach to lung transplantation is associated with superior patient-reported recovery outcomes compared to conventional surgical approaches. 83 Transition of Pediatric Heart Transplant Patients to the Adult Heart Transplant Program: Are They Doomed To Be Rejected? C. Burch, A. Amegatcher, J. Patel, M. Kittleson, M. Kawano, S. Davis, Z. Goldstein, J. Moriguchi, A. Ardehali, J. Kobashigawa. David Geffen School of Medicine at UCLA/Cedars Sinai Heart Institute, Los Angeles, CA. Purpose: Pediatric renal transplant patients that transition to adult transplant programs have been reported to have increased episodes of rejection. This may be due to a lapse of continuity of care or due to the psychological stress of the transition. The purpose of the current study was to determine if this phenomenon exists in heart transplant recipients in a large single center. Methods and Materials: Between 1987 and 2005, 1499 patients, adult (n⫽1266) and pediatric (n⫽233), were transplanted at our institution. Of those, 33 pediatric heart transplant patients transitioned to our adult heart transplant program when they reached their 21st birthday. We compared outcomes of these 33 patients to an adult heart transplant population (n⫽66) matched in a 2:1 fashion for gender and time from transplant, where outcomes included rejection and survival. Results: There was only one rejection episode in the pediatric transplant group that occurred within 1 year after transitioning to the adult program. Therefore, freedom from subsequent first year rejection was similar in both groups (97% vs 100% adult group, p⫽0.18). Subsequent 5-Year actuarial survival was also similar in both groups (79% vs 82% adult group, p⫽0.63). Conclusions: Pediatric heart transplant patients who transition to the adult heart transplant program do not appear to have increased number of rejection episodes following the transition and have comparable survival to the adult group. This offers further support to the policy of safely transitioning pediatric heart transplant recipients to the adult program once they have reached their 21st birthday. 84 Effect of High Frequency Chest Wall Oscillation Versus Chest Physiotherapy on Lung Function Post-Lung Transplant: A Pilot Study T. Marcarian, M. Ilagan, A.J. Lee, A. Esguerra, J. Porter, B. Rodman, F. Villamor, C. Tamonang, K. Mayol-Ngo, A. Madsen, A. Parker, Z. Shameem, A. Richman, M. Mekpongsatorn, S. Madrona, C. Burchette, S. Sommer, P. Miller, P. Kehoe, S. Takayanagi, S. Lackey, J. Onga, S. Weigt, D. Ross, A. Gawlinski. UCLA Health System, Los Angeles. Purpose: Chest physiotherapy (CPT) and high frequency chest wall oscillation (HFCWO) are routinely employed post-lung transplant (LT) to attenuate dyspnea, increase expiratory flow, and improve secretion clearance. To date, no studies are published on treatment (Tx) efficacy post-LT. We examined differences between HFCWO and CPT on lung function (dyspnea, peak expiratory flow [PEF], and SpO2/FiO2 ratio) in LT recipients.
The Journal of Heart and Lung Transplantation, Vol 29, No 2S, February 2010
Conclusions: Our study identifies renal insufficiency as a significant risk factor for higher LTx mortality in preoperatively ventilated patients. Future guidelines on LTx under these circumstances should include this information. 77 The Impact of Recipient Body Mass Index on Outcomes Following Lung Transplantation J.G. Allen,1 G.J. Arnaoutakis,1 E.S. Weiss,1 C.A. Merlo,2 J.V. Conte,1 A.S. Shah.1 1Johns Hopkins Medical Institutions, Baltimore, MD; 2Johns Hopkins Medical Institutions, Baltimore, MD. Purpose: Lung transplant(LTx) candidates are frequently over or underweight. Few studies have examined the effect of recipient weight on outcomes following LTx. The United Network for Organ Sharing(UNOS) database provides an opportunity to examine outcomes related to body mass index(BMI) in a large modern cohort of LTx patients. Methods and Materials: We retrospectively reviewed the UNOS dataset for 10,057 adult primary LTx patients(1998-2007). Patients were stratified by recipient BMI strata:⬍18.5(underweight), 18.5-24.9(normal), 25.029.9(overweight), ⬎30(obese). All cause mortality was examined with Cox proportional hazard regression incorporating 15 variables. Mortality was examined using the Kaplan-Meier method(30d, 90d, 1yr, and 5yr). Results: Of 10,057, 12.3% (n⫽1237) were underweight, 44.3% (n⫽4453) were normal weight, 31.6% (n⫽3182) were overweight, and 11.8% (n⫽1185) were obese. 4034 (40%) died during the study. Mortality was significantly different between the strata at each time point examined, with incremental increases in mortality for each BMI strata above or below normal. On multivariable analysis, BMI strata predicted mortality compared to normal; underweight (Hazard ratio (HR) 1.13[1.02-1.26], p⫽0.02), overweight (HR 1.10[1.02-1.19], p⫽0.01), and obese (HR 1.14[1.02-1.27], p⫽0.02) recipients had increased risk of death. KaplanMeier modeling showed a significant effect of BMI on survival (Figure1). However, this effect was no longer significant when 1st yr deaths were excluded. Conclusions: Our study represents the largest modern cohort evaluating recipient weight in LTx. Underweight, overweight, and obese patients have higher mortality when compared to normal weight controls. However, this effect appears to be mediated by mortality in the 1st yr after LTx.[figure1]
78 WITHDRAWN 79 Insurance Status and Education Level Are Independent Predictors of Survival after Lung Transplantation J.G. Allen,1 G.J. Arnaoutakis,1 J.F. McDyer,2 J.B. Orens,2 A.S. Shah,1 C.A. Merlo.2,3 1Johns Hopkins University School of Medicine, Baltimore, MD; 2Johns Hopkins University School of Medicine, Baltimore, MD; 3 Johns Hopkins School of Public Health, Baltimore, MD.
Purpose: Socioeconomic factors such as education, race, income, and insurance status have been shown to affect health outcomes and are known to play a role in survival after heart, kidney, and liver transplantation. Despite this, little is known about the role of socioeconomic factors as predictors of survival after lung transplantation. Methods and Materials: All patients over the age of 18 years in the UNOS Registry undergoing lung transplantation during the period Jan 2000 through May 2009 were included in the study. Time-to-event analyses for risk of death after transplantation were performed using Kaplan-Meier survival and Cox proportional hazards models. Results: During the study period, there were 11,213 patients who underwent lung transplantation. The median (IQR) follow-up time was 713 (218-1448) days. The mean (SD) age was 52.0 (12.7) years, mean (SD) FEV1% predicted was 35.9 (20.9) and 45.4% were female. Of the cohort, 22.2% had a college degree or greater level of education. During the study period, 60.8% reported having private insurance, 27.5% reported having Medicare, and 7% reported having Medicaid. In bivariable analyses, recipients with higher education level had significantly improved survival (HR: 0.90, 95% CI: 0.83-0.97) when compared to recipients with lower education level. Likewise, recipients with private insurance had improved survival (HR: 0.82, 95% CI: 0.73-0.92) when compared to recipients with Medicaid. In multivariable analyses, the effect of higher education level (HR: 0.87, 95% CI: 0.80-0.95) and private insurance (HR: 0.79, 95% CI: 0.70-0.90) persisted even after adjusting for age, sex, race, diagnosis,markers of disease severity, and known predictors of survival after lung transplantation. Conclusions: Socioeconomic factors are significant predictors of survival after lung transplantation. Lung transplant recipients with higher education levels and private insurance appear to have increased survival when compared to recipients with lower education and Medicaid beneficiaries independent of racial differences. 80 Quality of Life and Predictors of Medication Adherence in Pediatric Heart Transplant Recipients K. Uzark,1 M. Zamberlan,2 P. Murphy,3 C. Nasman,4 R. Rodriguez,5 J. Dupuis,6 S. Rodgers,6 Y. Wang,1 R. Ittenbach.1 1Cincinnati Children’s Hospital Medical Ctr, Cincinnati, OH; 2University of Michigan Medical Ctr, Ann Arbor, MI; 3St Louis Children’s Hospital, St. Louis, MO; 4 Cleveland Clinic Foundation, Cleveland, OH; 5Columbia Univeristy Medical Ctr, New York, NY; 6Children’s Hospital of Michigan, Detroit, MI; 7Children’s Memorial Hospital, Chicago, IL. Purpose: While heart transplantation (HTx) has improved survival and quality of life (QOL) in children with terminal heart disease, consistent and lifelong medication (med) adherence is required to sustain these outcomes. In this multicenter study, our aim was to examine the prevalence and correlates of medication non-adherence in pediatric HTx recipients including QOL factors as perceived by patients and parents and demographic/ medical variables. Methods and Materials: The pediatric quality of life inventory core and cardiac module scales were administered to 75 children/parents (mean age 13.6 ⫾ 3.1yrs) including 33 males and 42 females, 1 to 17 yrs (mean 6.85) following HTx. Mean age at HTx was 6.73 yrs, range 10 days to 17.6 yrs. Clinicians rated medication adherence on a 4-point scale based on drug level history. Results: Adherence was rated as excellent in 57 (76%) of patients, less than excellent or incomplete adherence in 18 (24%). Lower adherence was significantly correlated with lower self-reported psychosocial QOL scores (p⫽.05) and lower self-reported treatment (barriers) scores (i.e. more perceived problems related to taking meds), r⫽.32, p⫽.006, including difficulty remembering to take meds (p⫽.03). Parental perceptions of the child’s QOL and treatment barrier scores however, were not significantly correlated with adherence. Adherence was not correlated with the child’s gender, SES, time since transplant, or number of meds taken. Patients with incomplete adherence tend to be older, p⫽.06. In a logistic regression analysis, only self-reported treatment barriers was a significant predictor of med adherence (p⫽.01).
Abstracts Conclusions: One in 4 pediatric HTx recipients have incomplete medication adherence. The child’s report of perceived barriers to med adherence was predictive of their adherence behavior associated with diminished psychosocial QOL. Routine assessment of barriers to adherence identified by the child/adolescent with strategies to incorporate meds into their lifestyle may promote improved QOL and survival in pediatric HTx recipients. 81 Timing of Transplant Following Mechanical Circulatory Support in 375 Patients: Lessons from a Single Center Experience K.J. Hoercher, N.G. Smedira, D. Yoon, J. Rajeswaran, E.H. Blackstone. Cleveland Clinic, Cleveland, OH. Purpose: Determining optimal timing of transplantation (Tx) for pts bridged on mechanical circulatory support (MCS) is difficult. Previous reports have shown early Tx (⬍ 30 days) is thought to increase mortality, however, the benefit of awaiting full functional recovery must be counterbalanced with risk of adverse events that increase with each day on MCS. Our purpose was to investigate the complex relationship of duration of MCS and pt and device factors impacting survival after Tx. Methods and Materials: From 12/91 to 7/2006, 375 transplant candidates were bridged with MCS at a single center and of these, 262 were transplanted. Implantable pulsatile devices were used in 321, continous flow in 11, total artificial heart in 5, external pulsatile in 34, and extracorporeal membrane oxygenation in 68. Two time related models were developed: 1) a competing risk multivariable model of death on MCS and 2) a model of death after Tx in which patient factors, events on MCS, and duration of support were investigated as risk factors. Results: Risk– unadjusted survival on MCS before Tx was 84%, 73%, 62%, and 45% at 1,3, 6, and 12 months. Of 262 surviving to Tx, 94%, 74%, and 58% survived at 30 days, 5 and 10 yrs after Tx. Risk factors for death post Tx included longer, but not shorter, duration of MCS (p⫽⬍.0001), use of multiple devices, global sensitization, cardiac reoperation, and poor renal function. Conclusions: Longer MCS duration did not improve and may have worsened survival to and after Tx. Importantly, Tx early (⬍30days) after MCS did not increase mortality. This suggests that the cumulative burden of MCS complications diminishes survival after Tx thereby increasing risk for each day on MCS. Awaiting full functional recovery must be balanced with awareness that the longer the duration of support, the potentially worse pre and post Tx survival. 82 Patient-Reported Outcomes after the Minimally Invasive Approach to Lung Transplantation A. DeVito Dabbs,1 M.A. Dew,2 D. Zaldonis,3 J. Aubrecht,1 M.M. Crespo,4 J.M. Pilewski,4 J.K. Bhama,3 S. Gilbert,3 C. Bermudez,3 Y. Toyoda.3 1University of Pittsburgh, Pittsburgh, PA; 2University of Pittsburgh, Pittsburgh, PA; 3University of Pittsburgh, Pittsburgh, PA; 4 University of Pittsburgh, Pittsburgh, PA. Purpose: The antero-axillary, minimally invasive (MI) approach for lung transplant is a safe alternative to conventional surgical approaches for most recipients. We hypothesized that MI recipients will also have more favorable patient-reported recovery outcomes than conventional approach recipients. Methods and Materials: A comparative cohort design was used to detect differences in patient-reported recovery at 2 months post-discharge between a prospective cohort of 25 recipients who underwent the MI approach compared to a retrospective cohort of 58 recipients who underwent conventional approaches, either clamshell (n⫽31) or single thoractomy (n⫽27), but would have been eligible for the MI approach had it been available. We examined between-group differences in baseline characteristics and patient-reported recovery outcomes at 2 months, including physical performance (using Karnofsky index), psychological distress (using
S33 the Symptom Checklist-90 anxiety and depression subscales) and healthrelated quality of life (SF-36 physical-mental dimension scores). Results: Baseline characteristics (gender, race, income, marital status, employment status and type of pre-transplant pulmonary disease) were equivalent between groups. Recipients in the MI group underwent double versus single transplant procedures at a higher rate (p⫽.003), were older (mean age 60 versus 52 years, p⫽.023), and at 2 months reported better physical performance (p⫽.021) and lower anxiety (p⫽.016). No statistically significant between-group differences were found in levels of depression or health-related quality of life dimension scores. Conclusions: Although recipients in the MI group were all recipients of double lung procedures and older, they reported higher levels of physical functioning and lower levels of anxiety at 2 months compared to recipients in the conventional approach group. These data suggest that the MI approach to lung transplantation is associated with superior patient-reported recovery outcomes compared to conventional surgical approaches. 83 Transition of Pediatric Heart Transplant Patients to the Adult Heart Transplant Program: Are They Doomed To Be Rejected? C. Burch, A. Amegatcher, J. Patel, M. Kittleson, M. Kawano, S. Davis, Z. Goldstein, J. Moriguchi, A. Ardehali, J. Kobashigawa. David Geffen School of Medicine at UCLA/Cedars Sinai Heart Institute, Los Angeles, CA. Purpose: Pediatric renal transplant patients that transition to adult transplant programs have been reported to have increased episodes of rejection. This may be due to a lapse of continuity of care or due to the psychological stress of the transition. The purpose of the current study was to determine if this phenomenon exists in heart transplant recipients in a large single center. Methods and Materials: Between 1987 and 2005, 1499 patients, adult (n⫽1266) and pediatric (n⫽233), were transplanted at our institution. Of those, 33 pediatric heart transplant patients transitioned to our adult heart transplant program when they reached their 21st birthday. We compared outcomes of these 33 patients to an adult heart transplant population (n⫽66) matched in a 2:1 fashion for gender and time from transplant, where outcomes included rejection and survival. Results: There was only one rejection episode in the pediatric transplant group that occurred within 1 year after transitioning to the adult program. Therefore, freedom from subsequent first year rejection was similar in both groups (97% vs 100% adult group, p⫽0.18). Subsequent 5-Year actuarial survival was also similar in both groups (79% vs 82% adult group, p⫽0.63). Conclusions: Pediatric heart transplant patients who transition to the adult heart transplant program do not appear to have increased number of rejection episodes following the transition and have comparable survival to the adult group. This offers further support to the policy of safely transitioning pediatric heart transplant recipients to the adult program once they have reached their 21st birthday. 84 Effect of High Frequency Chest Wall Oscillation Versus Chest Physiotherapy on Lung Function Post-Lung Transplant: A Pilot Study T. Marcarian, M. Ilagan, A.J. Lee, A. Esguerra, J. Porter, B. Rodman, F. Villamor, C. Tamonang, K. Mayol-Ngo, A. Madsen, A. Parker, Z. Shameem, A. Richman, M. Mekpongsatorn, S. Madrona, C. Burchette, S. Sommer, P. Miller, P. Kehoe, S. Takayanagi, S. Lackey, J. Onga, S. Weigt, D. Ross, A. Gawlinski. UCLA Health System, Los Angeles. Purpose: Chest physiotherapy (CPT) and high frequency chest wall oscillation (HFCWO) are routinely employed post-lung transplant (LT) to attenuate dyspnea, increase expiratory flow, and improve secretion clearance. To date, no studies are published on treatment (Tx) efficacy post-LT. We examined differences between HFCWO and CPT on lung function (dyspnea, peak expiratory flow [PEF], and SpO2/FiO2 ratio) in LT recipients.