- Email: [email protected]
Peripheral Blood Gene Expression Identifies Damage-Associated Innate Immune Pathways in Patients With Primary Graft Dysfunction After Lung Transplantation
Abstracts S135 antero-lateral or clamshell incisions using intraoperative ECMO support. In 5 cases, we transplanted a right upper (RUL) + right middle lobe (RML) and a left upper lobe (LUL). The remaining patients received RUL and LUL (n= 2), RLL and LLL (n= 2 ), and complete right lung and LUL (n= 2). There were no postoperative air leaks requiring further intervention. The 30-day survival was 90.9%. Two patients died during the first year from graft failure (at day 11) and SIRS (at day 77), respectively. All other patients are still alive at 44.4±14.3 months. One patient developed BOS stage III and 7 recipients were hospitalized for infections at some point. All survivors are followed as outpatients and have little activity limitations. Their FVC and FEV1 is 52.2±20.2% and 51.6±18.8%, respectively. Conclusion: Although lobar lung transplantation has been used as a bailout strategy in cases of unexpected size mismatches or in very urgent patients, we show here that elective lobar lung transplantation can be performed safely with similar overall results as regular lung transplants. It is a valuable option for patients, mainly female with small thoraces. 3( 47) Early Donor Specific Antibodies After Lung Transplantation Lead to an Increase of CD56+CD16+ NK Cells in Peripheral Blood J. Salman ,1 F. Ius,1 A. Knoefel,1 W. Sommer,1 C. Kuehn,1 I. Tudorache,1 M. Avsar,1 J. Gottlieb,2 T. Welte,2 C. Falk,3 A. Haverich,1 G. Warnecke.1 1Department for Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany; 2Department of Pneumology, Hannover Medical School, Hannover, Germany; 3Transplant Immunology, Institute of Transplant Immunology, Integrated Research and Treatment Center, Hannover Medical School, Hannover, Germany. Purpose: Natural killer (NK) cells play a key role in host defense due to their ability to release cytokines and to mediate cytolytic activity against tumor cells and virus-infected cells. The role of NK cells after lung transplantation (LTX) has not yet been thoroughly investigated. However, NK cells might be involved in immune recognition after kidney transplantation due to their capability to bind donor-specific anti-HLA-antibodies (DSA) by their Fcγ RIII (CD16). Therefore we hypothesized, that development of early DSA in lung transplant recipients leads to an upregulation of CD56+CD16+ NK Cells in peripheral blood. Methods: In 72 patients undergoing bilateral LTX, flow cytometry analysis of NK cells in peripheral blood according to their CD56 and CD16 expression was performed at 3 weeks after LTX and correlated to the existence of DSA within the first three weeks after LTX. Results: Mean age of the recipients was 49.6±13.0 yrs and 51.2% were male. Fifty-five patients (76.4%) developed DSA within the first three weeks after LTX. Three weeks after LTX, DSA+ patients showed a trend towards higher expression of CD56 dimCD16 + NK cells (88.9±2.0 vs 83.5±3.2%; p= 0 .08), whereas DSA- recipients revealed significantly lower expression of CD56brightCD16- NK cells (18.6±4.0 vs. 11.0±2.1%; p= 0.05). Conclusion: At 3 weeks after LTX, presence of DSA is associated with an increase of CD56+CD16+ NK cells, indicating an expansion of this cytotoxic NK subset. The significant reduction of the potentially regulatory CD56brightCD16- NK subset in DSA+ lung recipients suggests that this subset may act as an important counter regulator of the cytotoxic CD16+ NK subset.In order to further characterize the effect of DSA on the NK cell repertoire, mid to long term follow up is necessary also for a potential role of NK cells in development of chronic rejection (BOS) or immunological tolerance after Ltx. 3( 48) Predictors of Survival in Patients Diagnosed With Restrictive CLAD S.E. Verleden , D. Ruttens, E. Vandermeulen, H. Bellon, D.E. Van Raemdonck, B.M. Vanaudenaerde, G.M. Verleden, R. Vos. Department of Clinical and Experimental Medicine, Laboratory of Pulmonology, Lung Transplant Unit, KU Leuven, Leuven, Belgium. Purpose: Chronic lung allograft dysfunction remains one of the main factors limiting long-term survival. Recent evidence demonstrated that besides bronchiolitis obliterans syndrome, other phenotypes of CLAD
exist, mostly with a restrictive pulmonary function. Those patients have been denominated as having restrictive CLAD and in general show poor survival. It is unknown which factors may predict survival at diagnosis of rCLAD. Methods: All patients diagnosed with rCLAD between 2007 and 08/2014 have been assessed in retrospect and parameters have been collected at the moment of diagnosis and the impact of the collected parameters has been assessed on survival using both unadjusted and adjusted analysis (SAS 9.1). Results: During the study period, 33 patients have been diagnosed with rCLAD with a median survival of 324 days. Unadjusted analysis showed that infiltrates in lower lobe or diffuse infiltrates (p= 0.0052), elevated CRP (p= 0.0012), acute onset (p= 0.0019), lymphocytic bronchiolitis on concomittant transbronchial biopsy (TBB) (p= 0.014), BAL eosinophils ≥ 2% (p= 0.0009) and elevated BAL neutrophils (p= 0.012) were associated with a worse survival after diagnosis, while native lung disease, gender, age at diagnosis, previous BOS, type of transplant, post-operative day of CLAD diagnosis, presence of anti-HLA antibodies, Aspergillus growth, CLAD stage at diagnosis, FVC/FVC best at diagnosis, acute rejection on concommitant TBB did not influence survival after diagnosis. Adjusted analysis showed that acute onset (p= 0.038), BAL eosinophils ≥ 2% (p= 0.020) and BAL neutrophilia (p= 0.033) were the determinants with the strongest association with survival after rCLAD diagnosis. Conclusion: This analysis demonstrates that BAL differential cell count and an acute onset of rCLAD were associated with a shorter survival time after rCLAD diagnosis. 3( 49) Peripheral Blood Gene Expression Identifies Damage-Associated Innate Immune Pathways in Patients With Primary Graft Dysfunction After Lung Transplantation E. Cantu ,1 J.M. Diamond,2 Y. Suzuki,1 J. Tiwari,1 B. Beduhn,1 J. Nellen,1 C. Borders,1 J. Ellis,1 D.J. Lederer,3 K. Meyer,4 R.J. Shah,2 N.J. Meyer,2 K. Milewski,1 J.W. Tobias,2 D.A. Baldwin,2 V.M. Van Deerlin,5 K.M. Olthoff,1 A. Shaked,1 J.D. Christie.2 1Surgery, University of Pennsylvania, Philadelphia, PA; 2Medicine, University of Pennsylvania, Philadelphia, PA; 3Medicine, Columbia University, New York, NY; 4Medicine, University of Wisconsin, Madison, WI; 5Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA. Purpose: Evidence from bronchial alveolar lavage gene expression suggests primary graft dysfunction (PGD) after lung transplantation is characterized by early inflammasome and innate immune pathway up-regulation in the lung. We sought to determine early systemic gene expression responses in recipient blood. Methods: Peripheral blood mononuclear cells were sampled from 102 lung transplant recipients within one hour of reperfusion as part of the NIAID Clinical Trials in Organ Transplantation Study (CTOT-03). A custom panel of 100 hypothesis-driven mediators was measured using the Panomics platform. Gene expression data were normalized following the manufacturer’s protocol. Two outliers with clear expression cluster departure were excluded. We used a linear model to test the differences in the expression after transplant between the patients with and without PGD, adjusting for age. To avoid inflated false positive rates due to multiple statistical comparisons, we used the Benjamini-Hochberg false discovery rate approach and reported the adjusted p-values. Results: 100 samples were analyzed. Genes with skewed distributions were log-transformed before the analysis. 24 gene products met the FDR significance cutoff for PGD association (Table). Among the top 3 most significantly dysregulated genes were FASLG, CD27 and PTX3 important in cell apoptosis, T cell and innate immunity (0.0036, 0.0105, and 0.0107, respectively). GATHER analysis of significantly associated genes highlighted 4 pathways (Cytokine-cytokine receptor interaction; Jak-STAT signaling; Toll-like receptor signaling and Apoptosis) with significant dysregulation. Conclusion: In the early phases of PGD in the lung, dysregulation of inflammasome and innate immune pathways is evident in circulating mononuclear cells suggesting effects are not just a local phenomenon. The Toll-like receptor pathway may be critical to both local and systemic responses in clinical PGD.
S136
The Journal of Heart and Lung Transplantation, Vol 34, No 4S, April 2015
Results: The one- and 5 year survival rates in Group 1 were significantly better than Group 2 (87% and 69% vs. 80% and 34%, respectively, p< 0.001, log rank test). In multivariate analysis, a ZRS consisting of ≥ 3 comorbidities and ZDS of ≥ 3 points were found to be significant risk factors for mortality in Group 2 (N= 14 HR 2.79; 95%CI 1.29-6.02 and N= 37 HR 2.30; 95%CI 1.31-4.04, respectively). In Group 1, ZRS of ≥ 3 was also found to be a risk factor for mortality using the same multivariate model (N= 21, HR 2.50; 95%CI 1.37-4.58). In Group 1, ZDS ≥ 3 was not found to be a risk factor. Conclusion: The accumulation of three ore more comorbidities was a risk factor for mortality in both young and old lung transplant recipients. The negative impact of extended donor lungs seems stronger in older recipients. In order to maximize posttransplant outcome, careful candidate selection and risk calculation weighing comorbidities is crucial. 3( 52) Contemporary Survival and Outcomes Following Airway Dehiscence Post Lung Transplantation: A Significant Price to Pay A.J. Hayanga ,1 J. Aboagye,2 H.K. Hayanga,3 E. Murphy,1 D. Meldrum,1 J. D’Cunha,4 A. Khaghani.1 1Cardiothoracic Surgery, Spectrum Health Michigan State University, Grand Rapids, MI; 2Cardiothoracic Surgery, Johns Hopkins Medical Institutions, Baltimore, MD; 3Cardiac Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, MD; 4Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
3( 50) Detection of Genetic Variants to Predict Chronic Lung Allograft Dysfunction M. Schmitt ,1 B. Marsland.2 1GATC Biotech AG, Konstanz, Germany; 2Centre Hospitalier Universitaire Vaudois, Epalinges, Switzerland. Purpose: SysCLAD, an European union-funded project under the FP-7, aims at identifying biomarkers and personalized signatures for Chronic Lung Allograft Dysfunction (CLAD) and its subtypes Bronchiolitis Obliterans Syndrome (BOS) and Restrictive Allograft Syndrome (RAS). Methods: DNA was extracted from 64 stable transplant recipients and 56 patients with diagnosed BOS (n= 35) and RAS (n= 21). Libraries were prepared with fragment sizes ensuring the best sequencing output possible following an improved SureSelect All Exon V5 protocol. All libraries were sequenced on HiSeq sequencers using 100 bp paired-end sequencing with approximately 70 - 100 million reads. Results: The average coverage was 90 - 120x per sample. Genetic variants were determined by GATC inhouse pipelines and comparative analyses were performed by Ingenuity (Qiagen). Conclusion: Final data and conclusions will be presented. 3( 51) Lung Transplantation in the Elderly: Influence of Multiple Comorbidities and Extended Criteria Donor Lungs I. Inci , J. Ehrsam, K. Slankamenac, S. Hillinger, W. Jungraithmayr, I. Schmitt Opitz, D. Schneiter, C. Benden, W. Weder. University Hospital, Zurich, Switzerland. Purpose: Increased risk for recipients ≥ 60 years old have been reported although single centers report favorable outcomes for carefully selected older recipients. The purpose of the study was to determine the influence of recipient and donor comorbidities as a risk factor for survival in two predefined age groups. Methods: In recipients < 60 (N= 232, Group 1) and ≥ 60 years (N= 83, Group 2) old, the impact of comorbidities was determined by the Zurich Recipient Score (ZRS), including BMI, systemic arterial hypertension, osteoporosis, cardiac disease, insulin dependent diabetes mellitus, chronic renal dysfunction, diverticulosis and critical situation (such as ECMO, mechanical ventilation). Donor lung quality was assessed by the Zurich Donor Score (ZDS) consisting of 6 extended donor criteria and 5 comorbidities including systemic arterial hypertension, cardiac disease, insulin dependent diabetes mellitus, chronic renal and liver disease.
Purpose: Airway dehiscence is a rare complication that carries increased morbidity and mortality post lung transplantation. We sought to examine risk factors associated with this complication and impact on survival. Methods: We performed a retrospective evaluation of the United Network for Organ Sharing (UNOS) data from 2000 to 2012. A backward stepwise logistic regression was performed on recipient, donor and transplant related variables to select independent risk factors associated with airway dehiscence, mortality with survival evaluated using Kaplan Meier method. Results: We evaluated a total of 16,156 consecutive adult lung transplant recipients with 233 (1.4%) who developed airway dehiscence. Predictors of increased risk of airway dehiscence included male gender (OR 1.61, p= 0.001), advancing recipient age (OR 1.02, p< 0.001) and admission to intensive care unit (ICU) pre- transplantation (OR 2.13, p< 0.001). The 30-day (89.6% vs 96.2%, p-0.001), 1-year (54.6% vs 84.4%, p< 0.001), 3-year (38.7% vs 67.4%, p< 0.001) and 5-year (33.2% vs 54.2%, p< 0.001) actuarial survival(s) were each significantly reduced in recipients with airway dehiscence. Factors associated with an increased risk of mortality included the use of extracorporeal mechanical support (ECMO) (OR 1.4, p= 0.02) and impaired renal function (1.26, p< 0.01). Double lung (DL) transplantation (OR 0.8 p< 0.001) was associated with a decreased risk of death. Infection (37.7%), pulmonary complications (22.1%) and graft failure (12.3%) were the two most common causes of death and patients with airway dehiscence were 2.5 times more likely to die within 5 years (HR 2.54 95% CI 2.12-3.02). Conclusion: Airway dehiscence is a rare and damaging complication associated with a significant mortality burden most dramatic within the first 90 days and mainly attributable to infectious and pulmonary complications. 3( 53) Sparing Native Upper Lobe or Segment in Living-Donor Lobar Lung Transplantation Due to Small-for-Size Grafts A. Aoyama ,1 F. Chen,1 S. Tanaka,1 E. Miyamoto,1 M. Takahashi,1 K. Ohata,1 T. Kondo,1 H. Motoyama,1 K. Hijiya,1 M. Isomi,1 K. Minakata,2 T. Yamada,1 M. Sato,1 H. Date.1 1Thoracic Surgery, Kyoto University, Kyoto, Japan; 2Cardiovascular Surgery, Kyoto University, Kyoto, Japan. Purpose: Living-donor lobar lung transplantation (LDLLT) is indicated for rapidly deteriorating patients, and the total volume of the 2 lower lobe grafts must be sufficient for the recipient. To rescue patients with small lobar grafts, we performed 5 LDLLTs with the native upper lobes spared from 2011, and evaluated the short- and mid- term outcomes. Methods: Between August 2008 and October 2014, 49 patients underwent 51 LDLLTs at our institution, including 11 single lobar transplantations. Among 40 bilateral lobar transplantations, native upper lobe or segment were spared
exist, mostly with a restrictive pulmonary function. Those patients have been denominated as having restrictive CLAD and in general show poor survival. It is unknown which factors may predict survival at diagnosis of rCLAD. Methods: All patients diagnosed with rCLAD between 2007 and 08/2014 have been assessed in retrospect and parameters have been collected at the moment of diagnosis and the impact of the collected parameters has been assessed on survival using both unadjusted and adjusted analysis (SAS 9.1). Results: During the study period, 33 patients have been diagnosed with rCLAD with a median survival of 324 days. Unadjusted analysis showed that infiltrates in lower lobe or diffuse infiltrates (p= 0.0052), elevated CRP (p= 0.0012), acute onset (p= 0.0019), lymphocytic bronchiolitis on concomittant transbronchial biopsy (TBB) (p= 0.014), BAL eosinophils ≥ 2% (p= 0.0009) and elevated BAL neutrophils (p= 0.012) were associated with a worse survival after diagnosis, while native lung disease, gender, age at diagnosis, previous BOS, type of transplant, post-operative day of CLAD diagnosis, presence of anti-HLA antibodies, Aspergillus growth, CLAD stage at diagnosis, FVC/FVC best at diagnosis, acute rejection on concommitant TBB did not influence survival after diagnosis. Adjusted analysis showed that acute onset (p= 0.038), BAL eosinophils ≥ 2% (p= 0.020) and BAL neutrophilia (p= 0.033) were the determinants with the strongest association with survival after rCLAD diagnosis. Conclusion: This analysis demonstrates that BAL differential cell count and an acute onset of rCLAD were associated with a shorter survival time after rCLAD diagnosis. 3( 49) Peripheral Blood Gene Expression Identifies Damage-Associated Innate Immune Pathways in Patients With Primary Graft Dysfunction After Lung Transplantation E. Cantu ,1 J.M. Diamond,2 Y. Suzuki,1 J. Tiwari,1 B. Beduhn,1 J. Nellen,1 C. Borders,1 J. Ellis,1 D.J. Lederer,3 K. Meyer,4 R.J. Shah,2 N.J. Meyer,2 K. Milewski,1 J.W. Tobias,2 D.A. Baldwin,2 V.M. Van Deerlin,5 K.M. Olthoff,1 A. Shaked,1 J.D. Christie.2 1Surgery, University of Pennsylvania, Philadelphia, PA; 2Medicine, University of Pennsylvania, Philadelphia, PA; 3Medicine, Columbia University, New York, NY; 4Medicine, University of Wisconsin, Madison, WI; 5Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA. Purpose: Evidence from bronchial alveolar lavage gene expression suggests primary graft dysfunction (PGD) after lung transplantation is characterized by early inflammasome and innate immune pathway up-regulation in the lung. We sought to determine early systemic gene expression responses in recipient blood. Methods: Peripheral blood mononuclear cells were sampled from 102 lung transplant recipients within one hour of reperfusion as part of the NIAID Clinical Trials in Organ Transplantation Study (CTOT-03). A custom panel of 100 hypothesis-driven mediators was measured using the Panomics platform. Gene expression data were normalized following the manufacturer’s protocol. Two outliers with clear expression cluster departure were excluded. We used a linear model to test the differences in the expression after transplant between the patients with and without PGD, adjusting for age. To avoid inflated false positive rates due to multiple statistical comparisons, we used the Benjamini-Hochberg false discovery rate approach and reported the adjusted p-values. Results: 100 samples were analyzed. Genes with skewed distributions were log-transformed before the analysis. 24 gene products met the FDR significance cutoff for PGD association (Table). Among the top 3 most significantly dysregulated genes were FASLG, CD27 and PTX3 important in cell apoptosis, T cell and innate immunity (0.0036, 0.0105, and 0.0107, respectively). GATHER analysis of significantly associated genes highlighted 4 pathways (Cytokine-cytokine receptor interaction; Jak-STAT signaling; Toll-like receptor signaling and Apoptosis) with significant dysregulation. Conclusion: In the early phases of PGD in the lung, dysregulation of inflammasome and innate immune pathways is evident in circulating mononuclear cells suggesting effects are not just a local phenomenon. The Toll-like receptor pathway may be critical to both local and systemic responses in clinical PGD.
S136
The Journal of Heart and Lung Transplantation, Vol 34, No 4S, April 2015
Results: The one- and 5 year survival rates in Group 1 were significantly better than Group 2 (87% and 69% vs. 80% and 34%, respectively, p< 0.001, log rank test). In multivariate analysis, a ZRS consisting of ≥ 3 comorbidities and ZDS of ≥ 3 points were found to be significant risk factors for mortality in Group 2 (N= 14 HR 2.79; 95%CI 1.29-6.02 and N= 37 HR 2.30; 95%CI 1.31-4.04, respectively). In Group 1, ZRS of ≥ 3 was also found to be a risk factor for mortality using the same multivariate model (N= 21, HR 2.50; 95%CI 1.37-4.58). In Group 1, ZDS ≥ 3 was not found to be a risk factor. Conclusion: The accumulation of three ore more comorbidities was a risk factor for mortality in both young and old lung transplant recipients. The negative impact of extended donor lungs seems stronger in older recipients. In order to maximize posttransplant outcome, careful candidate selection and risk calculation weighing comorbidities is crucial. 3( 52) Contemporary Survival and Outcomes Following Airway Dehiscence Post Lung Transplantation: A Significant Price to Pay A.J. Hayanga ,1 J. Aboagye,2 H.K. Hayanga,3 E. Murphy,1 D. Meldrum,1 J. D’Cunha,4 A. Khaghani.1 1Cardiothoracic Surgery, Spectrum Health Michigan State University, Grand Rapids, MI; 2Cardiothoracic Surgery, Johns Hopkins Medical Institutions, Baltimore, MD; 3Cardiac Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, MD; 4Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
3( 50) Detection of Genetic Variants to Predict Chronic Lung Allograft Dysfunction M. Schmitt ,1 B. Marsland.2 1GATC Biotech AG, Konstanz, Germany; 2Centre Hospitalier Universitaire Vaudois, Epalinges, Switzerland. Purpose: SysCLAD, an European union-funded project under the FP-7, aims at identifying biomarkers and personalized signatures for Chronic Lung Allograft Dysfunction (CLAD) and its subtypes Bronchiolitis Obliterans Syndrome (BOS) and Restrictive Allograft Syndrome (RAS). Methods: DNA was extracted from 64 stable transplant recipients and 56 patients with diagnosed BOS (n= 35) and RAS (n= 21). Libraries were prepared with fragment sizes ensuring the best sequencing output possible following an improved SureSelect All Exon V5 protocol. All libraries were sequenced on HiSeq sequencers using 100 bp paired-end sequencing with approximately 70 - 100 million reads. Results: The average coverage was 90 - 120x per sample. Genetic variants were determined by GATC inhouse pipelines and comparative analyses were performed by Ingenuity (Qiagen). Conclusion: Final data and conclusions will be presented. 3( 51) Lung Transplantation in the Elderly: Influence of Multiple Comorbidities and Extended Criteria Donor Lungs I. Inci , J. Ehrsam, K. Slankamenac, S. Hillinger, W. Jungraithmayr, I. Schmitt Opitz, D. Schneiter, C. Benden, W. Weder. University Hospital, Zurich, Switzerland. Purpose: Increased risk for recipients ≥ 60 years old have been reported although single centers report favorable outcomes for carefully selected older recipients. The purpose of the study was to determine the influence of recipient and donor comorbidities as a risk factor for survival in two predefined age groups. Methods: In recipients < 60 (N= 232, Group 1) and ≥ 60 years (N= 83, Group 2) old, the impact of comorbidities was determined by the Zurich Recipient Score (ZRS), including BMI, systemic arterial hypertension, osteoporosis, cardiac disease, insulin dependent diabetes mellitus, chronic renal dysfunction, diverticulosis and critical situation (such as ECMO, mechanical ventilation). Donor lung quality was assessed by the Zurich Donor Score (ZDS) consisting of 6 extended donor criteria and 5 comorbidities including systemic arterial hypertension, cardiac disease, insulin dependent diabetes mellitus, chronic renal and liver disease.
Purpose: Airway dehiscence is a rare complication that carries increased morbidity and mortality post lung transplantation. We sought to examine risk factors associated with this complication and impact on survival. Methods: We performed a retrospective evaluation of the United Network for Organ Sharing (UNOS) data from 2000 to 2012. A backward stepwise logistic regression was performed on recipient, donor and transplant related variables to select independent risk factors associated with airway dehiscence, mortality with survival evaluated using Kaplan Meier method. Results: We evaluated a total of 16,156 consecutive adult lung transplant recipients with 233 (1.4%) who developed airway dehiscence. Predictors of increased risk of airway dehiscence included male gender (OR 1.61, p= 0.001), advancing recipient age (OR 1.02, p< 0.001) and admission to intensive care unit (ICU) pre- transplantation (OR 2.13, p< 0.001). The 30-day (89.6% vs 96.2%, p-0.001), 1-year (54.6% vs 84.4%, p< 0.001), 3-year (38.7% vs 67.4%, p< 0.001) and 5-year (33.2% vs 54.2%, p< 0.001) actuarial survival(s) were each significantly reduced in recipients with airway dehiscence. Factors associated with an increased risk of mortality included the use of extracorporeal mechanical support (ECMO) (OR 1.4, p= 0.02) and impaired renal function (1.26, p< 0.01). Double lung (DL) transplantation (OR 0.8 p< 0.001) was associated with a decreased risk of death. Infection (37.7%), pulmonary complications (22.1%) and graft failure (12.3%) were the two most common causes of death and patients with airway dehiscence were 2.5 times more likely to die within 5 years (HR 2.54 95% CI 2.12-3.02). Conclusion: Airway dehiscence is a rare and damaging complication associated with a significant mortality burden most dramatic within the first 90 days and mainly attributable to infectious and pulmonary complications. 3( 53) Sparing Native Upper Lobe or Segment in Living-Donor Lobar Lung Transplantation Due to Small-for-Size Grafts A. Aoyama ,1 F. Chen,1 S. Tanaka,1 E. Miyamoto,1 M. Takahashi,1 K. Ohata,1 T. Kondo,1 H. Motoyama,1 K. Hijiya,1 M. Isomi,1 K. Minakata,2 T. Yamada,1 M. Sato,1 H. Date.1 1Thoracic Surgery, Kyoto University, Kyoto, Japan; 2Cardiovascular Surgery, Kyoto University, Kyoto, Japan. Purpose: Living-donor lobar lung transplantation (LDLLT) is indicated for rapidly deteriorating patients, and the total volume of the 2 lower lobe grafts must be sufficient for the recipient. To rescue patients with small lobar grafts, we performed 5 LDLLTs with the native upper lobes spared from 2011, and evaluated the short- and mid- term outcomes. Methods: Between August 2008 and October 2014, 49 patients underwent 51 LDLLTs at our institution, including 11 single lobar transplantations. Among 40 bilateral lobar transplantations, native upper lobe or segment were spared