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Prevalence of Malnutrition and Growth in Children after Lung Transplantation
Abstracts S349 no significant correlations seen in any of the outcome measures, although number of days on positive pressure ventilation showed a trend toward significance (p= 0.08). Similarly, there was no difference in survival/freedom from BOS when comparing weight/length> 50% versus weight/length< 50% at time of transplant (p= 0.34) (figure 1). Conclusion: Malnutrition is a common finding in infants awaiting lung transplant. Severity of malnutrition does not appear to correlate with outcomes post-transplant, and its impact on graft survival is unclear.
9( 69) Evaluation of Epstein-Barr Viral Loads as a Predictor of Development of Post-Transplant Lymphoproliferative Disorder A. Parrish ,1 M. Fenchel,1 G. Storch,2 R. Buller,2 S. Mason,2 S. Mason,2 N. Williams,3 D. Ikle,4 S. Sweet,2 L. Danziger-Isakov.1 1Cincinnati Children’s Hosp Med Ctr, Cincinnati, OH; 2Washington University, St. Louis, MO; 3National Institutes of Health, Bethesda, MD; 4Rho, Inc., Chapel Hill, NC. Purpose: Prediction of post-transplant lymphoproliferative disorder (PTLD) after pediatric lung transplant remains difficult. Use of Epstein-Barr virus (EBV) viral loads (VL) in whole blood (WB) has been poorly predictive, while use of bronchoalveolar lavage (BAL) fluid has been suggested to have enhanced utility. Methods: The NIH-sponsored Clinical Trials in Organ Transplantation in Children (CTOTC-03) obtained serial quantitative measurements of EBV viral load in both WB and BAL fluid after pediatric lung transplantation. Samples were collected at scheduled intervals and with symptomatic events for two years post-transplant. Donor and recipient EBV serostatus (D/R) was recorded. Descriptive statistics, contingency analyses, and Kaplan-Meier analyses interrogated for a relationship between EBV VL and the development of PTLD. Results: Of 61 patients, 34 (56%) had a detectable EBV VL (at least once in either WB or BAL). EBV D+ patients more often had a positive VL (D+/R-: 13/18; D+/R+: 14/25) compared to EBV D- patients (D-/R+:1/5). However, this was only statistically significant difference was for WB (p= 0.025) and not BAL (p= 0.08).Interestingly, 5/12 D-/R- patients developed EBV during the study period indicating potential community acquisition or inaccurate serostatus assignment. No D-/R- with EBV VL developed PTLD. All 4 who developed PTLD were a subset of the 13 D+/R- EBV patients with a positive VL. In D+/R-, EBV BAL VL in those with PTLD was a mean of 904 copies/mL (range 16-3226) compared to those without PTLD (2292; range 13-14624). Neither the time to first EBV VL nor the VL quantity in BAL or WB was statistically different between those with and without PTLD. Conclusion: Donor EBV seropositivity was associated with increased risk of positive WB EBV VL. Neither WB nor BAL EBV VL was predictive of the development of PTLD, regardless of EBV serostatus in this prospective pediatric lung transplant cohort. This minimizes the impact of comprehensive monitoring of WB and BAL to predict PTLD. 9( 70) Prevalence of Malnutrition and Growth in Children after Lung Transplantation M.C. Gazzaneo , G. Mackey, U. Kyle, S. Culhane, E. Melicoff-Portillo, S. Das, N. Crews, G. Mallory, L. Shekerdemian, J. Cossbu. Pediatrics, Texas Children’s Hospital, Houston, TX.
Purpose: Lung transplantation is the final therapeutic option for children with end-stage lung disease and malnutrition increases risk of mortality post operatively. The purpose of this study was to evaluate nutritional status in children admitted to the intensive care unit (ICU) at the time of lung transplantation (LTx) and somatic growth during the first year thereafter. Methods: Retrospective chart review of patients who underwent lung transplant (1/11-8/14). Nutritional status on admission to the ICU and for the first year after lung transplant were assessed by height for age (HFA: stunting) z-scores according to the WHO/CDC growth charts. Hospital and ICU length of stay (LOS), readmissions, rejection episodes and duration of mechanical ventilation were obtained. Results: Fifty-three children (19 males) were included: age 10.9 years (3.816; median (IQR)); Hospital LOS, 21(12-71) days; ICU LOS: 4.2 (3-5) days; duration of mechanical ventilation, 1 (1-2) days. The prevalence of stunting at time of LTx was 69.8%. Patients with cystic fibrosis (CF) (n= 25) had on admission a HFA z-scores of -1.98±1.10 vs -1.03±1.56 (p < 0.05) for non CF patients, respectively. CF patients had higher admission rates and higher incidence of rejection (55% and 67% respectively) compare to non CF patients (44% and 33%). Weight, height, and HFA z-score at LTX and at 12 months were: 29±18, 34±19 kg;122±34,127±32 cm;-1.46±1.46,-2.04±1.40, respectively, all comparisons p < 0.05. There was no association between stunting and longer hospital and ICU LOS and duration of mechanical ventilation. Two patients died during the first year after LTx. Conclusion: Patients with cystic fibrosis had a higher prevalence of stunting compared to non cystic fibrosis patients, higher rates of readmissions, and more episodes of rejection. Patients had an improvement on anthropometric variables with increased height after LTX, but at a lower than expected rate for age leading to worsening stunting. 9( 71) Improving Health Management: The Development of an Adolescent Specific Education Program M. Paraskeva , R. Martin, K. Attard, B. Levvey, J. Marshall, B. Tarrant, S. Ivulich, G.P. Westall. Lung Transplant Service, Alfred Hospital, Melbourne, Australia. Purpose: There is consensus regarding the importance of a coordinated and sensitive transition process to support adolescents after transplant as they take responsibility for their healthcare and become adults. We describe the development of an adolescent specific education program aimed at optimizing transition into adulthood and improving transplant related education, psychosocial and transplant outcomes. Methods: The Pediatric and Adolescent team is an interdisciplinary group who manage the care of 22 children and adolescents within an adult lung transplant service. With evidence of inferior long-term outcomes, higher rates of non-adherence and poorer health literacy in this age group an education program was developed with input from the patient cohort. A questionnaire exploring individual knowledge around health management, psychosocial function and adherence was completed by 80% of the cohort. Based on the results a program was developed delivering education at 3 stages: pre-transplant; early post-transplant (12 weeks) and late transplant. Results: Pre-transplant sessions occur individually focusing on general transplant education and the need for post-transplant adherence. The early transplant program consists of weekly sessions of topics such as: Why did I have a transplant; Medications and why they are important and Preventing Infection. Ongoing education occurs 6 monthly in a group format over 4 hours and covers issues identified by the cohort as important to them. They have included: Travelling with a transplant; Piercings and tattoos; Drugs and Alcohol; Dealing with Rejection. 25% of sessions have been patient-led and each day has included a moderated discussion around the transplant experience All transplant recipients aged 13-25 yo are invited to participate. Attendance has been > 90% at all sessions. Feedback has suggested: all participants found the sessions helpful, 70% felt the opportunity to speak to others with a transplant helped normalize their experience and 65% indicated that the sessions had helped them manage their transplant better. Conclusion: The development of an education program in conjunction with the patient cohort has been well received and deemed to be beneficial by most adolescents attending. The impact of the program on long-term outcomes and health literacy is yet to be determined but may provide a way to improve adolescent outcomes.
9( 69) Evaluation of Epstein-Barr Viral Loads as a Predictor of Development of Post-Transplant Lymphoproliferative Disorder A. Parrish ,1 M. Fenchel,1 G. Storch,2 R. Buller,2 S. Mason,2 S. Mason,2 N. Williams,3 D. Ikle,4 S. Sweet,2 L. Danziger-Isakov.1 1Cincinnati Children’s Hosp Med Ctr, Cincinnati, OH; 2Washington University, St. Louis, MO; 3National Institutes of Health, Bethesda, MD; 4Rho, Inc., Chapel Hill, NC. Purpose: Prediction of post-transplant lymphoproliferative disorder (PTLD) after pediatric lung transplant remains difficult. Use of Epstein-Barr virus (EBV) viral loads (VL) in whole blood (WB) has been poorly predictive, while use of bronchoalveolar lavage (BAL) fluid has been suggested to have enhanced utility. Methods: The NIH-sponsored Clinical Trials in Organ Transplantation in Children (CTOTC-03) obtained serial quantitative measurements of EBV viral load in both WB and BAL fluid after pediatric lung transplantation. Samples were collected at scheduled intervals and with symptomatic events for two years post-transplant. Donor and recipient EBV serostatus (D/R) was recorded. Descriptive statistics, contingency analyses, and Kaplan-Meier analyses interrogated for a relationship between EBV VL and the development of PTLD. Results: Of 61 patients, 34 (56%) had a detectable EBV VL (at least once in either WB or BAL). EBV D+ patients more often had a positive VL (D+/R-: 13/18; D+/R+: 14/25) compared to EBV D- patients (D-/R+:1/5). However, this was only statistically significant difference was for WB (p= 0.025) and not BAL (p= 0.08).Interestingly, 5/12 D-/R- patients developed EBV during the study period indicating potential community acquisition or inaccurate serostatus assignment. No D-/R- with EBV VL developed PTLD. All 4 who developed PTLD were a subset of the 13 D+/R- EBV patients with a positive VL. In D+/R-, EBV BAL VL in those with PTLD was a mean of 904 copies/mL (range 16-3226) compared to those without PTLD (2292; range 13-14624). Neither the time to first EBV VL nor the VL quantity in BAL or WB was statistically different between those with and without PTLD. Conclusion: Donor EBV seropositivity was associated with increased risk of positive WB EBV VL. Neither WB nor BAL EBV VL was predictive of the development of PTLD, regardless of EBV serostatus in this prospective pediatric lung transplant cohort. This minimizes the impact of comprehensive monitoring of WB and BAL to predict PTLD. 9( 70) Prevalence of Malnutrition and Growth in Children after Lung Transplantation M.C. Gazzaneo , G. Mackey, U. Kyle, S. Culhane, E. Melicoff-Portillo, S. Das, N. Crews, G. Mallory, L. Shekerdemian, J. Cossbu. Pediatrics, Texas Children’s Hospital, Houston, TX.
Purpose: Lung transplantation is the final therapeutic option for children with end-stage lung disease and malnutrition increases risk of mortality post operatively. The purpose of this study was to evaluate nutritional status in children admitted to the intensive care unit (ICU) at the time of lung transplantation (LTx) and somatic growth during the first year thereafter. Methods: Retrospective chart review of patients who underwent lung transplant (1/11-8/14). Nutritional status on admission to the ICU and for the first year after lung transplant were assessed by height for age (HFA: stunting) z-scores according to the WHO/CDC growth charts. Hospital and ICU length of stay (LOS), readmissions, rejection episodes and duration of mechanical ventilation were obtained. Results: Fifty-three children (19 males) were included: age 10.9 years (3.816; median (IQR)); Hospital LOS, 21(12-71) days; ICU LOS: 4.2 (3-5) days; duration of mechanical ventilation, 1 (1-2) days. The prevalence of stunting at time of LTx was 69.8%. Patients with cystic fibrosis (CF) (n= 25) had on admission a HFA z-scores of -1.98±1.10 vs -1.03±1.56 (p < 0.05) for non CF patients, respectively. CF patients had higher admission rates and higher incidence of rejection (55% and 67% respectively) compare to non CF patients (44% and 33%). Weight, height, and HFA z-score at LTX and at 12 months were: 29±18, 34±19 kg;122±34,127±32 cm;-1.46±1.46,-2.04±1.40, respectively, all comparisons p < 0.05. There was no association between stunting and longer hospital and ICU LOS and duration of mechanical ventilation. Two patients died during the first year after LTx. Conclusion: Patients with cystic fibrosis had a higher prevalence of stunting compared to non cystic fibrosis patients, higher rates of readmissions, and more episodes of rejection. Patients had an improvement on anthropometric variables with increased height after LTX, but at a lower than expected rate for age leading to worsening stunting. 9( 71) Improving Health Management: The Development of an Adolescent Specific Education Program M. Paraskeva , R. Martin, K. Attard, B. Levvey, J. Marshall, B. Tarrant, S. Ivulich, G.P. Westall. Lung Transplant Service, Alfred Hospital, Melbourne, Australia. Purpose: There is consensus regarding the importance of a coordinated and sensitive transition process to support adolescents after transplant as they take responsibility for their healthcare and become adults. We describe the development of an adolescent specific education program aimed at optimizing transition into adulthood and improving transplant related education, psychosocial and transplant outcomes. Methods: The Pediatric and Adolescent team is an interdisciplinary group who manage the care of 22 children and adolescents within an adult lung transplant service. With evidence of inferior long-term outcomes, higher rates of non-adherence and poorer health literacy in this age group an education program was developed with input from the patient cohort. A questionnaire exploring individual knowledge around health management, psychosocial function and adherence was completed by 80% of the cohort. Based on the results a program was developed delivering education at 3 stages: pre-transplant; early post-transplant (12 weeks) and late transplant. Results: Pre-transplant sessions occur individually focusing on general transplant education and the need for post-transplant adherence. The early transplant program consists of weekly sessions of topics such as: Why did I have a transplant; Medications and why they are important and Preventing Infection. Ongoing education occurs 6 monthly in a group format over 4 hours and covers issues identified by the cohort as important to them. They have included: Travelling with a transplant; Piercings and tattoos; Drugs and Alcohol; Dealing with Rejection. 25% of sessions have been patient-led and each day has included a moderated discussion around the transplant experience All transplant recipients aged 13-25 yo are invited to participate. Attendance has been > 90% at all sessions. Feedback has suggested: all participants found the sessions helpful, 70% felt the opportunity to speak to others with a transplant helped normalize their experience and 65% indicated that the sessions had helped them manage their transplant better. Conclusion: The development of an education program in conjunction with the patient cohort has been well received and deemed to be beneficial by most adolescents attending. The impact of the program on long-term outcomes and health literacy is yet to be determined but may provide a way to improve adolescent outcomes.