Simultaneous or Sequential Lung-Kidney Transplantation Confer Superior Survival in Renal-Failure Patients Undergoing Lung Transplantation: A National Analysis

Abstracts S95 2( 28) Simultaneous or Sequential Lung-Kidney Transplantation Confer Superior Survival in Renal-Failure Patients Undergoing Lung Transplantation: A National Analysis B.A. Yerokun ,1 M.S. Mulvihill,1 A.A. Osho,2 M.G. Hartwig.1  1Duke University Medical Center, Durahm, NC; 2Massachusetts General Hospital, Boston, MA. Purpose: Lung transplantation outcomes are impaired in those candidates with renal dysfunction at the time of listing. We tested the hypothesis that simultaneous lung and kidney transplantation confers a survival advantage to those requiring dialysis after listing in comparison to those requiring dialysis after listing but only receiving a pulmonary allograft. Methods: The UNOS registry was queried for all adult lung transplant recipients requiring dialysis after listing but prior to transplant through June 2016 (N-117). Candidates were subsequently partitioned into those that underwent simultaneous Lung-Kidney transplantation (SLK) (N= 12), lung transplant alone but continued to require dialysis (KAL) (N= 68), and lung transplant alone but subsequently underwent kidney transplantation (LTA) (N= 6). Descriptive statistics and Kaplan-Meier analysis with log-rank test was performed. Results: Recipients undergoing SLK, KAL, and LTA were similar with respect to age, gender, % Predicted FEV1 at transplant, % Predicted FVC at transplant, need for ventilator at transplant, and LAS at match (all p> 0.05). Recipients undergoing SLK had a higher creatinine at transplant (4.4, 2.3, and 1.0, respectively, p= 0.01). Recipients undergoing LTA were more likely to require ECMO at the time of transplantation (0%, 25%, and 41.2%, respectively, p= 0.01). LTA was associated with decreased survival relative to SLK or KAL (p= 0.02). Conclusion: Of candidates requiring dialysis before transplantation, those that go on to receive simultaneous pulmonary and renal allografts have a survival advantage over those that receive a pulmonary allograft alone but subsequently continue to require dialysis after transplant. Simultaneous lung-kidney transplantation should be considered in the candidate recipient requiring dialysis after listing who is not projected to recover renal function following lung transplantation.

2( 29) De Novo Solid Organ Malignancies After Lung Transplantation: A 25Year Single Center Experience R. Waseda ,1 M. Hoda,2 A. Benazzo,2 P. Jaksch,2 T. Klikovits,2 G. Lang,2 S. Taghavi,2 W. Klepetko.2  1Fukuoka University, Fukuoka, Japan; 2Medical University of Vienna, Vienna, Austria. Purpose: De novo malignancy is a life-limiting factor in long-term survival after lung transplantation. The overall incidence of maligancy is increased 2-3 fold in solid organ transplant recipients compared to the general population. We reviewed our 25-year experience to investigate the incidence, clinical characteristics, risk factors, and clinical course of de novo solid organ malignancies (SOM) after lung transplantation (LuTX). Methods: A retrospective analysis of all patients who underwent LuTX in the division of thoracic surgery, medical university of Vienna, between 1989 and 2014 was performed. All relevant data were retrieved from the institutional database. Survival analysis was calculated using Kaplan-Meier curves.

Risk for incidence of SOM was calculated using logistic regression test, and expressed with Odds ratio (OR). Results: A total of 1491 LuTX (Double 1230 including 19 combined Heartlung transplantation, Single 261) were performed in the period. 55 SOM in 54 patients (3.6%) were observed. Patient characteristics were as follows: age at LuTX was 49.4±14.1, age at SOM diagnosis was 53.9±14.1, sex (male/ female) was 32/22, underlying disease for LuTX (COPD/IP/cystic fibrosis/ pulmonary hypertension/others) was 28(52%)/14(26%)/3/2/5. Type of LuTX (double/single) was 32/22. Data of SOM were as follows: type of SOM was bronchogenic 18 (lung 17, mediastinum 1), digestive 22 (esophagus 2, stomach 4, colorectal 9, liver 1, pancreas 6), others 15 (kidney 2, bladder 1, testis 2, prostate 2, cervix 2, ovary 1, breast 3, head&neck 2). Mean time to SOM diagnosis was 1795±1410 days. 29 of SOM (53%) were diagnosed as stage IV. Overall survival in the patients with SOM (n= 54) was 61.5% at 5-year, 31.5% at 10-year, respectively. Survival from SOM diagnosis was 41.5% at 1-year, 21.6% at 3-year, respectively. Bronchogenic SOM had a significant poor prognosis with 1-year survival of 29.4% and 3-year survival of 5.9%. Single LuTX was a significant risk for SOM (OR= 16.3), especially for bronchogenic SOM (OR= 26.1). Conclusion: Prognosis in patients with posttransplant SOM was very poor. To diagnose SOM in early stage might be able to improve the prognosis. Therefore, intensive screening for patients with high-risk factors for SOM after LuTX would be important. 2( 30) Post-Transplant Lymphoproliferative Disorder After Lung Transplantation: 10-Year Experience at Duke University L. Zaffiri ,1 C. Frankel,1 E.N. Pavlisko,2 S.M. Palmer,1 L.D. Snyder.1  1Pulmonary and Critical Care, Duke University, Durham, NC; 2Pathology, Duke University, Durham, NC. Purpose: Post-transplant lymphoproliferative disorder (PTLD) represents a serious complication of lung transplantation. In the present study, we describe a retrospective analysis of 35 patients with PTLD after lung transplantation at Duke University Medical Center. Methods: Patients with PTLD were retrospectively identified through electronic medical record review of all transplants between 2004 and 2015. Manual chart review confirmed details of the diagnosis, treatment and survival. Descriptive statistics were used to characterize the cohort. Log rank tests were used to assess clinical variables in a survival model. Results: The median age of the patients at time of transplantation was 50.3 years-old (range 12-75 yo). 23 patients (77%) underwent bilateral lung transplantation. The median interval after transplantation to the diagnosis of PTLD was 436 (183-1264) days. Fifteen patients (50%) were diagnosed within one year of transplantation. PTLD affected primarily the lungs (53%). Histologically, monomorphic PTLD was diagnosed in 60% of cases, followed by polymorphic PTLD (23%). Treatment of PTLD was initiated in 28 of the 30 patients and R-CHOP was the treatment of choice in 60% of cases. Eighteen patients (60%) have died, demonstrating a 50% survival of 5 months. No difference in survival was noted between morphologic subtypes of PTLD, and diagnosis within one year of transplantation or later. Similarly, transplant types, immunosuppressive regimens, PTLD locations, EBV status and histological presence of EBV were not predictive of survival. Conclusion: PTLD remains a rare but challenging complication to diagnose and successfully treat after lung transplantation. Further studies are necessary to identify predisposing factors, patient characteristics and treatment strategies to accelerate the diagnosis and improve survival. 2( 31) NonTuberculous Mycobacteria Infection and Lung Transplantation in Cystic Fibrosis: A Worldwide Survey of Clinical Practice M. Brodlie ,1 A. Tissot,2 M.F. Thomas,1 P.A. Corris.3  1Paediatric Respiratory Medicine, Freeman Hospital/Great North Children's Hospital/Newcastle University, Newcastle upon Tyne, United Kingdom; 2Respiratory Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France; 3Respiratory Medicine, Freeman Hospital/Newcastle University, Newcastle upon Tyne, United Kingdom. Purpose: NonTuberculous Mycobacteria (NTM) infection in cystic fibrosis (CF) is of increasing concern. Optimal treatment requires multiple drugs