Prevalence of Acute and Chronic Renal Failure After Lung Transplantation

Abstracts S261 objective is to demonstrate superiority of EVR on GFR 12 months post randomization. Key secondary objectives include demonstration of non-inferior immunosuppressive efficacy (BPAR, graft loss, death), BOS; safety (infections, hypertension, hyperlipidemia, new-onset diabetes) and patients’ quality of life (QoL, SF36). Results: As of September 2014 there have been 129 patients enrolled and 91 randomized in the 4EVERLUNG study at 7 German Transplant centers. Continuation of the study was well supported by a neutral data safety monitoring board. Conclusion: The Results of the 4EVERLUNG study might help to evaluate the benefit of an innovative “quadruple low” immunosuppressive regimen in LTxR by preserving RF and/or limiting progression of BOS, while simultaneously ensuring sufficient immunosuppression. 7( 08) Prevalence of Acute and Chronic Renal Failure After Lung Transplantation A. Monnier,1 T. Krummel,1 O. Collange,2 G. Haffner,2 S. Hirschi,3 T. Dégot,3 T. Hannedouche,1 R. Kessler .3  1Nephrology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; 2Intensive Care Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; 3Pneumology, Lung Transplantation Group, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. Purpose: Both acute and chronic renal failure are common after lung transplantation.We aimed to determine the prevalence of acute renal failure during the postoperative ICU stay and stage IV chronic renal failure at 1 year post transplantation. Methods: We realised a single-centre retrospective cohort study of 160 patients transplanted between 1st January 2009 and 31th December 2013 and followed patients for one year. The occurrence of renal failure during the postoperative ICU stay was defined by the AKIN score. Stage IV chronic kidney disease at one year was defined by an eGFR according to CKD-EPI < 30 mL / min / 1.73m2. Results: . In our cohort, the prevalence of acute renal failure during the postoperative ICU stay was 74.5%. Furthermore, 10% of patients were dialyzed. One year post surgery, 2.3% were still on dialysis. The prevalence of chronic kidney disease stage IV or more was 7.75% at 1 year after transplantation. The mean eGFR at 1 year postop was 67 ± 30 mL/min/1.73 m2, which corresponds to a medium loss of glomerular filtration of 45%. Acute renal failure defined as a AKIN score ≥  2 during initial ICU stay and a higher level of exposure to anticalcineurin inhibitors during the first year were associated with the occurrence of stage IV chronic renal failure at one year after lung transplantation. Conclusion: The significant impairment of renal function during the first year post lung transplantation validates the need for new strategies to improve the prevention and management of renal failure without compromising lung allograft function. 7( 09) Mast Cell Phenotypes in the Allograft After Lung Transplantation. A. Banga ,1 M.M. Budev,2 X. Wang,2 F. Hsieh.2  1Lung Transplant Program, Division of Pulmonary & Critical Care Medicine, UT Southwestern Medical Center, Dallas, TX; 2Cleveland Clinic, Cleveland, OH. Purpose: Chronic lung allograft dysfunction (CLAD) remains the most important cause of limited long term survival after lung transplantation (LT). The precise role of mast cells (MC) and their phenotypes, MC-tryptase (MCT) and MC-tryptase/chymase (MCTC), in causing allograft dysfunction is not known. Methods: We identified 20 trans-bronchial lung biopsies (TBLB) done among patients with early (less than 6 months post LT,group I,n= 5) & late normal allograft function (more than 6 months post LT,group II,n= 5), A2 or worse acute cellular rejection (ACR) (group III,n= 5) and CLAD (group IV,n= 5). Immunohistochemical staining was done with tryptase (Promega, G3361) and chymase (Abcam, clone CC1) antibodies. The total number of MCT, MCTC and ratio of MCTC:MCT were compared between the 4 groups using a generalized linear mixed model. Data for groups were presented as least square means with standard error and inter-group comparisons were analysed using the Tukey-Kramer method.

Results: The overall difference in total MCT cells was significant among the four groups (p= 0.0358) with inter-group difference being significant between group I and II (2.14±0.21 vs 2.93±0.21,p=  0.0394). Total MCTC cells among the 4 groups were also different (p= 0.0024) with group IV having significantly higher number of MCTC cells (1.99±0.33) as compared to the other three groups (group I:0.29±0.35,p= 0.0026;group II:0.76±0.34,p= 0.048;group III:0.62±0.34,p=  0.021). Finally, ratio of MCTC:MCT cells was significantly higher among group IV (43.79±2.1) as compared to the other three groups (group I:14.89±2.35; group II:12.78±2.17; group III:16.0±1.99, p< 0.001 for all comparisons, see Figure). Conclusion: The burden of MC increases over time after LT although it does not seem to change significantly with development of ACR or CLAD. Given the significant increase in the absolute number and proportion of MCTC cells, there appears to be a phenotypic switch from MCT to MCTC cells among patients with CLAD. Role of MCTC cells in development of CLAD should be evaluated further. 

7( 10) Do We Really Need to Rush? Early and Mid Term Results of Lung Transplantation (Ltx) of Organs With Total Ischemic Time (TIT) Over 8 Hours - A Propensity Score Matched, Single-Center Analysis B. Zych , D. Garcia-Saez, A. Sabashnikov, P. Mohite, N. Patil, M. Zeriouh, A. Popov, F. De Robertis, M. Amrani, T. Bahrami, A. Reed, M. Carby, A.R. Simon.  Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital. Royal Brompton and Harefield NHS Foundation Trust, Harefield, United Kingdom. Purpose: Over the years significant progress have been achieved in donor lung protection. Despite of that, influence of duration of ischemic time on LTx outcome remains unclear. In this study we evaluated the Results of LTx with graft TIT over 8 hours. Methods: 321 patients underwent first time LTx in our institution between 01.2007 and 06.2014. 59 recipients receiving the lungs with TIT <  8 hrs. (group I) were matched using a propensity score with 59 recipients received organs with TIT ≥  8 hrs (group II). Recipient and donor demographics and preoperative variables as well as postoperative outcome were compared between the groups. Results: TIT in group II was longer (median (interquartile range) 578(509;648) vs. 320(253;387) min. (p< 0.01). Other donor parameters: age, gender, cause of death, the last pre-retrieval PaO2/FiO2 ratio, duration of mechanical ventilation (MV), bronchoscopy Results, history of smoking, abnormal chest radiogram, percentage of donors from donation after circulatory death (DCD) and use of ex-vivo evaluation tools were comparable as well as: recipient age, gender, diagnosis, percentage of bridged to LTx with extracorporeal life support (ECLS), operated on pump and received double LTx. Any significant differences were observed in: post-transplant PaO2/FiO2 ratio and prevalence of grade 3 primary graft dysfunction (PGD) over the first 72 hrs. after LTx. Also the duration of MV, ICU and hospital length of stay and prevalence of acute rejection (AR) did not differ. 1 and 3 years Kaplan-Maier survival and freedom from bronchiolitis obliterans syndrome