The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2014
HBcAb+ or non-HBcAb+ donors. At 5 years, mean(SD) survival for the HBcAb+ group was 187(14) weeks as compared to 184(3.8) weeks for the non-HBcAb group (p= 0.2). The HBcAb+ group had similar mean(SD) time to diagnosis of chronic rejection as compared to the non-HBcAb group (1130 +/- 537 compared to 916 +/- 451 days, respectively). Conclusion: Lung transplant recipients from HBcAb + donors have low risk (5/32; 16%) of seroconversion to HBcAb positivity without evidence of increased risk of viremia which does not impact short or long term survival. This supports HepB vaccination of recepients pre-transplantation in order for HbcAb+ organs to continue to be utilized safely.
Prolonged Ischemia Does Not Affect Survival Following Lung Transplantation J.C. Grimm ,1 V. Valero III,1 A. Kilic,1 J.V. Conte,1 P.D. Shah,2 C.A. Merlo,2 A. Shah.1 1Surgery, The Johns Hopkins Medical Institution, Baltimore, MD; 2Medicine, The Johns Hopkins Medical Institution, Baltimore, MD. Purpose: The impact of prolonged ischemia (> 8 hours) on outcomes following orthotopic lung transplantation (OLT) is controversial. Organ utilization and allocation could be profoundly affected by further investigation into the influence of ischemic time on clinical outcomes. We, therefore, sought to evaluate the impact of prolonged cold ischemia times on long-term survival following lung transplantation. Methods: The United Network for Organ Sharing (UNOS) data for adult (> 18 years) patients undergoing OLT between 2001-2013 was examined. Primary stratification by the presence of prolonged ischemia was performed. Preoperative recipient characteristics, donor information, intraoperative variables, and postoperative outcomes were compared between those with and without prolonged ischemia. A Kaplan Meier estimate at 5-years was utilized to compare survival in the two cohorts. Covariates which were significantly associated with 1- and 5-year mortality were then included in a multivariable Cox-Regression model. Results: In the designated study period, 2,043 (12.0%) of the 16,996 patients who underwent OLT had allografts exposed to prolonged ischemia. The mean age was 53.3±13.2 years and 56.6% were male. There was no difference in survival at 5-years (p= 0.35) between those with and without ischemia greater than 8 hours. Furthermore, ischemia was not an independent predictor of 1- (p= 0.25) or 5-year (p= 0.27) mortality. Male gender, advanced age (> 65 years), history of a previous thoracic transplant, intensive care status prior to OLT, lung allocation score> 80, postoperative stroke, new onset dialysis and primary graft failure were, however, all predictors of both 1- and 5-year mortality; while age less than 50 years was protective. Conclusion: This is the largest known study investigating the impact of protracted cold time on survival following OLT. Prolonged graft ischemia did not result in a significant difference in 5-year survival and it was not an independent predictor of subsequent mortality. Given the scarcity of organs and the paucity of suitable recipients, prolonged cold ischemia time should not preclude transplantation. It is therefore reasonable to consider extending the accepted period of ischemia to longer than 8 hours in certain patient populations to improve organ utilization. 1( 19) Outcomes of Lung Transplant Recipients of Hepatitis B core Antibody Positive Donors H.K. Rokadia , C. Koval, S. Mistak, O. Akindipe, P. Garcha, C. Lane, W. Tsuang, M. Budev. Cleveland Clinic, Cleveland, OH. Purpose: Utilizing allografts from Hepatitis B core antibody (HBcAb) donors has been an acceptable practice with low viral transmission occurring in vaccinated recipients. We aim to study clinical outcomes of lung transplant recipients (LTxR) who received organs from HbcAb donors including incidence of seroconversion, short and long term mortality, and freedom from BOS. Methods: A retrospective study was performed of LTxR who received HBcAb+ organs between 1/2006-10/2013 at a large volume transplant center. We analyzed demographic and serologic data, freedom from bronchiolitis obliterans, and survival data from the Cleveland Clinic Lung Transplant EDIT database. Results: 759 transplant operations were performed of which 32 individuals (mean age 59+/-7.6 years, male 50%) received transplants from HbcAb+ donors (12 donors HBsAb+ also, all donors HepB viral load negative) with mean follow up of 3.5 years. 22 of 32 LTxR underwent double lung transplants, of which 2 of 32 were re-transplantations. Of the 32 LTxR, 10 were immunized prior to transplant, 8 with incomplete vaccine with unknown immunity at transplant, and 3 LTxR had HBcAb+ serology at time of transplant. Five (4 of which non-immunized) individuals demonstrated seroconversion from HBcAb negativity to HBcAb positivity after transplant with no evidence of HepB viremia. Of these five seroconversions, 2 individuals received post-transplant lamivudine with no sequela. No LTxR of HBcAb+ donor died of viral hepatitis. At 1, 3, and 5 years post transplant, there was no significant difference in mortality of LTxR between those that received
1( 20) Donor Diabetes and Lung Transplant: Does It Matter? J.C. Haney , A.M. Ganapathi, B.R. Englum, P.J. Speicher, B.C. Gulack, A.A. Osho, A.W. Castleberry, R.D. Davis, M.G. Hartwig. Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC. Purpose: Diabetes mellitus (DM) is a risk factor for patients undergoing some surgical procedures, but it is unclear if donor DM (DDM) impacts organ recipient outcomes following lung transplantation (LTx). We hypothesize that both insulin (IDDM) and non-insulin DDM (NIDDM) would adversely affect survival and airway complications following LTx. Methods: The United Network for Organ Sharing database identified all lung recipients from 1994-2011 where DDM status was known, excluding pediatric, multi-organ, and re-transplants. Donor, recipient, and procedural characteristics were compared between LTx recipients with DDM and nonDDM organs. Kaplan Meier analysis with the log-rank test and a Cox proportional hazard model were used to determine the effect of DDM on long-term survival and anastomotic healing. Results: 18,906 LTx recipients were included in the analysis. 871 patients (4.7%) received a DDM organ. Donors with DM were older, had increased body mass index, and had a lower PaO2 compared to non-DM donors (all p< 0.01). 411, or 47.7%, of DM donors were insulin dependent at donation. Long-term survival differed between DDM and non-DDM organs (Figure 1). The Cox model demonstrated both IDDM and NIDDM to be independent risk factors of long-term mortality (HR: 1.20; p= 0.04 and HR: 1.32; p< 0.01 respectively). NIDDM was also a risk factor of post-operative airway dehiscence (OR: 2.58; p< 0.01). Transplantation from 2005-2011 (OR: 2.14; p< 0.01) was identified as a predictor of getting a DDM lung. An interaction term between IDDM/NIDDM and BMI was not significant (p= 0.44/0.08 respectively). Conclusion: Both IDDM and NIDDM are risk factors for decreased cumulative survival following LTx. NIDDM is also associated with airway dehiscence. Further study of the mechanistic effect of DDM on LTx recipients is warranted.