Change in Body Mass Index over Time after Continuous Flow Left Ventricular Assist Device Implantation

Abstracts S49 1( 09) BOS Is Associated with Increased Cytotoxic Pro-Inflammatory CD8 T and NKT-Like and NK Cells in the Distal Airways G. Hodge , S. Hodge, A. Yeo, P. Nguyen, E. Hopkins, C. Holmes-Liew, P.N. Reynolds, M. Holmes.  Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia. Purpose: Immunosuppression therapy following lung transplantation fails to prevent bronchiolitis obliterans syndrome (BOS), primarily a disease of the small airways, which we have shown is associated with lack of suppression of cytotoxic mediators, perforin and granzyme B, and pro-inflammatory cytokines IFNγ  and TNFα  in peripheral blood T, NKT-like (particularly CD8+) and NK cells. We have also recently shown loss of glucocorticoid receptor (GCR) and up-regulation of histone deacetylase 2 (HDAC2) in these pro-inflammatory lymphocytes following transplant. We hypothesize that these lymphocytes target the small airways during BOS. Methods: Blood, bronchoalveolar lavage, proximal and distal airway bronchial brushings were collected from patients with BOS (n= 5), stable lung transplant patients (n= 18) and healthy aged-matched controls (n= 10). Intracellular cytotoxic mediators, pro-inflammatory cytokines and expression of GCR and HDAC2 were measured in lymphocytes subsets following culture using flow cytometry. Results: BOS was associated with an increase in CD8 T and NKT-like and NK cells in the distal airways compared with stable patients and controls. There was an increase in perforin, granzyme b, IFNγ , TNFα  and a loss of GCR and HDAC2 from these lymphocyte subsets in patients with BOS compared with stable patients and controls. There was a correlation between the percentage of CD8+T cells expressing HDAC2 and GCR from distal brushings with FEV1 (HDAC2:R= .676, p= .031; GCR: R= .632, p= .039). Conclusion: BOS is associated with increased cytotoxic/pro-inflammatory CD8+ T and NKT-like and NK cells in the distal airways. Treatments that increase HDAC2 and GCR in these lymphocyte subsets may improve graft survival. 1( 10) Change in Body Mass Index over Time after Continuous Flow Left Ventricular Assist Device Implantation J.M. Tatum ,1 S. Abdoli,1 F.S. Schenkel,1 T. Possemato,1 M.L. Barr,1 P. Crookes,2 M.E. Bowdish.1  1Cardiothoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA; 2Upper GI and Bariatric Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA. Purpose: Change in body mass index (BMI) after continuous flow left ventricular assist device (CF-LVAD) implantation remain poorly described. The purpose of this study was to examine % change in BMI over time in those patients implanted with a CF-LVAD who survived to discharge. Methods: Between 10/2009-11/2015, 83 pts underwent CF-LVAD implantation and were discharged from the hospital. Mean age was 60 +/-12 years, 64 (77%) were males. INTERMACS (IM) class: 19% IM 1, 49% IM 2, 21% IM 3, and 10% IM 4. 47% implanted as bridge-to-candidacy and 43% as destination therapy. 94% underwent isolated CF-LVAD, 5 requiring temporary CF-RVAD. Mean BMI was 29.9+/-8.1 kg/m2. Pre-implant BMIs were: 49 BMI < 30.0 (GROUP 1), 15 BMI 30.0-34.9 (GROUP 2, obese), and 19 BMI ≥ 35.0 (GROUP 3, morbidly obese). Post implant weights were divided into 30-day intervals to compare data. Results: Overall 1, 2, and 3 year survival was 82, 66, and 58%. Analysis of BMI groups showed age was significantly different (p= 0.001). Group 1 pts were significantly older than group 3 (63.9 +/- 11.4 vs. 50 +/- 12.5 years, p< 0.001). There were no differences in gender or IM classification. There were twice as many BTC implants in Group 3 than the other two groups (p= 0.011). K-M and Cox-proportional hazard estimates of survival were similar between BMI groups (p= 0.18). Multivariate analysis showed IM class and gender were predictive of death. Overall % change in BMI was 2.1+/13 at 12 months. Logistic regression shows that %change in BMI neither increased nor decreased with time (r2= 0.3) in either the overall group (SEE FIGURE) or within each subgroup. Conclusion: Conditional 3-year survival is equivalent across BMI groups and associated with no change in BMI over time. Unfortunately, the younger, morbidly obese group did not have a statistically significant reduction in weight, which is often an intended goal in these BTC recipients.

1( 11) Pre-Lung Transplant Body Composition and Associations with Post Transplant Outcomes E.M. Capel ,1 M. O’Driscoll,1 A. Tierney,1 G. Snell.2  1Nutrition Services, The Alfred Hospital, Melbourne, Australia; 2Lung Transplantation Services, The Alfred Hospital, Melbourne, Australia. Purpose: Both progressive or severe malnutrition and Body Mass Index (BMI) ≥ 30 kg/m2 are contraindications to lung transplant (LTx). BMI is not a good indicator of body composition (fat mass vs. fat-free mass) in the transplant population and there is limited data available on body composition pre LTx and its impact on post LTx morbidity. This retrospective analysis examines pre LTx body composition and its impact on post LTx clinical outcomes for patients undergoing bilateral sequential LTx in an Australian transplant centre. Methods: Body composition was measured pre LTx using bioelectrical impedance analysis (BIA) (SECA 515 scales). Post LTx outcome data examined included length of acute hospital stay, ICU readmissions, lung function (FEV1) and BMI at 3 and 6 months post LTx. Excess fat mass percentage (%FM) and deplete fat free mass index (FFMI) were defined using gender cut offs (men: ≥ 25% FM, FFMI < 16 kg/m2; women: ≥ 35% FM, FFMI < 15kg/m2). Results: 20 patients had pre LTx BIA results available. Based on pre LTx BMI, 1 patient was underweight (5%), 10 (50%) were a healthy weight, 9 (45%) were overweight and none were obese. Using BIA, however, 11 patients (55%) had deplete fat free mass and 17(85%) were obese based on fat mass. FFMI depletion did not significantly impact on acute length of hospitalisation (p= 0.670) or post LTx FEV1 at 3 (p= 0.370) or 6 months (p= 0.347). However, 3 FFMI deplete patients were readmitted to ICU post LTx, compared to just 1 patient in the non FFMI deplete group. Over half of patients (n= 11, 55%) had both low FFMI and high %FM. Two patients with this ‘sarcopaenic obesity’ profile had acute hospital admissions post LTx of ≥ 65 days. Conclusion: This observational study supports a disparity between BMI and body composition in the LTx population. BIA can identify those with deranged body composition pre LTx and may help target appropriate clinical interventions. Sarcopaenic obesity in pre LTx patients may lead to a longer hospital stay. Further research in larger patient numbers is needed to determine the impact of body composition on post LTx morbidity and mortality outcomes. 1( 12) Single Centre Observational Study on Adequacy and Tolerance of Nutrition Support on the First 7 Days of ECMO as Bridge to Lung Transplant R. Patel , P. Mohite, S. Soresi, M. Carby, A. Simon, A. Reed.  Royal Brompton and Harefield Hospital, Middlesex, United Kingdom.