Lung transplantation : studies in candidates and recipients P 1476 Results of a phase 2 b multi-center trial of ALN-RSV 01 in respiratory syncytial virus ( RSV )-infected lung transplant patients

printing supported by . Visit Chiesi at Stand B2.10 SUNDAY, SEPTEMBER 2ND 2012 vival after lung transplantation and reduces health related quality of life (HRQOL). Aims: The study was performed to find parameters correlating with low exercise capacity of patients with advanced CLAD. Methods: In this single-center prospective study, all patients with advanced CLAD (FEV1 <50% baseline) in our out-patient clinic were screened between 1.7.2011 and 15.11.2011 by exercise capacity, HRQOL (using SF 36, St. George, HADS), body composition, blood gas analysis, pulmonary function testing, respiratory muscle function and chest x –ray. The patients with low exercise capacity (LEC-CLAD) were defined as 6MWT < 50% predicted or use of oxygen or wheelchair/rollator. Results: 319 of 785 patients, had CLAD and 53 had the diagnosis of advanced CLAD. A single patient refused consent to this study, 52 patients were included. 19 needed oxygen or had a 6 min walk test (6 MWT) fewer than 50% predicted (LEC-CLAD). Patients with LEC-CLAD demonstrated lower forced vital capacity (1820ml vs 2380ml, p = 0.001), pathologic respiratory muscle function (P0.1/Pimax index: 0.14 vs. 0.06, p < 0.001), decreased inspiratory capacity (IC; 1190ml vs. 1620ml, p = 0.001). We were able to show a positive correlation between 6 MWT and IC (r = 0,367, p < 0.001). Patients with LEC-CLAD demonstrated a decrease in activity and social function. Conclusion: Advanced CLAD is an inhomogeneity cohort of patients showing different exercise tolerance of reduced lung function. We were able to demonstrated pronounced hyperinflation in patients with worse toleration and pathologic respiratory muscle function. P1481 Low BMI in emphysema patients: A contraindication for lung transplantation? David Ruttens, Stijn Verleden, Robin Vos, Elly Vandermeulen, Annemie Vaneylen, Dirk Vanraemdonck, Bart Vanaudenaerde, Geert Verleden. Lung Transplant Unit, KU Leuven and UZ Gasthuisberg, Leuven, Belgium Lung transplantation (LTx) is an accepted therapeutic option for patient with endstage emphysema. These emphysema patients can be subdivided in blue bloaters and pink puffers,although most patients have characteristics of both groups. BMI is an important tool in distinguishing these subgroups. A low BMI is associated with a poor nutritional status which may predict a poor outcome after LTx. We aimed to investigate the outcome of emphysema patients with a low pre-transplant BMI (<20) in terms of acute rejection (AR), lymphocytic bronchiolitis (LB), infections, BOS and survival. All 193 patients transplanted for emphysema between 1991-2011 and surviving more than 60 days post transplant, were included (53 SLTx(single) and 140 SSLTx(double)). AR, LB and BOS are diagnosed according to the ISHLT criteria. Multivariate analyzes were done using SAS software. Patients with a lower BMI (<20) had a significant better 10-years survival compared with those with a BMI>20 for the total population (p=0.01) (figure). Prevalence of BOS was significantly lower within the lower BMI group, independent from other covariates (table). There is a statistical association between the prevalence of BOS, infection and LB (table). We conclude from this single centre observation that emphysema patients with a BMI below 20 have a better outcome in terms of BOS and mortality and this should therefore no longer be regarded as contraindication for LTx. P1482 Systemic oxygenation affects post-transplantation edema formation and pulmonary artery hypertension in an ex vivo animal model Sara Klein, Stefan Dhein, Luisa Bauer, Franziska Schlegel, Sven Lehmann, Markus Barten, Friedrich-Wilhelm Mohr, Hartmuth Bittner. Heart Center Leipzig, Clinic for Cardiac Surgery, Leipzig, Germany Introduction: By using an ex vivo model of isolated perfused and ventilated rabbit lungs we investigated the influence of systemic oxygenation on pulmonary function during simulated transplantation. Methods: Lungs of New Zealand White rabbits were flush-perfused with Perfadex® Solution, followed by an ischemic storage for 4h on ice. Thereafter ventilation and reperfusion for 2h were continued to simulate a transplantation situation (oxygenated group, pulmonary artery pO2=120mmHg). In another series the perfusate inflow was gassed with nitrogen to simulate the typical situation with deoxygenated pulmonary artery blood and not reanastomized private vessels(deoxygenated group, pulmonary artery pO2=50mmHg). Hemodynamic and ventilatory parameters were continuously detected. Results: After 2h reperfusion time the oxygenated group showed a significant lower PAP and lung weight compared to the deoxygenated group (p<0.05). PAP and lung weight steadily increased after reestablishment of lung perfusion (PAP 8.78±0.89 to 11.5±1.06cmH2O; lung weight 22.1±1.32 to 35.4±4.23g). This development was significantly influenced by the intravascular pO2 (PAP 9.65±0.43 to 8.02±0.63cmH2O; lung weight 17.9±1.54 to 21.5±2.29g, p<0.05). Conclusions: Oxygenation of the lung perfusate during simulated transplantation attenuates post transplant edema formation and decreases pulmonal arterial hypertension. Transfering this to the surgical situation, revascularisation of bronchial arteries after lung transplantation might initiate positive effects in the early phase after lung transplantation. P1483 Extracorporeal life support (ECLS) as a bridge to lung transplantation (LTx) Bartlomiej Zych1, Toufan Bahrami1, Anna Reed2, Mohamed Amrani1, Prashant Mohite1, Ajay Moza1, Heike Krueger1, Martin Carby2, Andre Simon1. 1Department or Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, United Kingdom; 2Department of Respiratory Medicine, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, United Kingdom Purpose: Death on the waiting list remains high in patients awaiting LTx. ECLS as a bridge may increase patient’s survival. We present our initial experience. Materials and methods: Between Feb. 2010 and Dec. 2011 100 patients underwent LTx at our institution. 7 (7%) recipients were supported with ECLS prior to LTx. Outcome, donor and recipient parameters were analysed. Results: Donor age was 21(20;47) (median (interquartile range)) y.; gender – F/M: 5/2, cause of death: intracranial haemorrhage 3, hypoxic brain injury 2, bacterial meningitis 2; duration of donor mechanical ventilation was 2(2;2.5) days; PaO2/FiO2 ratio: 63.4(58.15;69.45) kPa. One patient died during the support. Table 1. Recipients’ demographics and perioperative data Recipient 1 2 3 4 5 6 7 Age (years) 25 46 21 23 40 29 50 Gender M F F F F F M Diagnosis CF HP CF CF PH E-D PF Type of ECLS v-v ILA v-v ILA/v-v v-a v-v v-v ECMO ECMO ECMO ECMO ECMO ECMO Duration of ECLS (days) 8 1 6 7/8 33 7 9 Duration of postoperative MV (hours) 624 384 72 46 304 398 301 ICU LOS (days) 26 26 10 11 18 19 17 Hospital LOS (days) 70 45 30 41 169# 48 69 FEV1/FVC (%pred.) current 73.6/78.5 79.1/101 85.1/95 59.1/62.2 55.3/70.2 69.6/62 49.3/47 Follow up 739 416 221 182 169 86 67 CF, cystic fibrosis; HP, hypersensivity pneumonitis; PH, pulmonary hypertension; PF, pulmonary fibrosis; E-D, Elerhs-Danlos syndrome related emphysema; ECMO, Extracorporeal Mebrane Oxygenation; ILA, Interventional Lung Assist; LOS, length of stay. #Still in hospital. Conclusion: ECLS as a bridge to LTx is a feasible option of treatment providing good early results. Longer weaning from mechanical ventilation, hospital and ICU LOS after transplantation should be expected. P1484 Superior lung preservation with a polyethylene glycol based solution in a porcine lung transplant model Anne Olland1, Arne Neyrinck1,6, Malika Benhamed2, Thomas Boogmans6, Alessia Stanzi1, Karim Elbayed2, Shana Wauters1, Geert Verleden3, Izzie Namer4, Dirk Van Raemdonck1,5. 1Laboratory for Experimental Thoracic Surgery, Catholic University Leuven, Leuven, Belgium; 2CNRS UMR 7237, UMR 7177, Strasbourg University, Strasbourg, France; 3Laboratory for Pneumology, University Hospital Gasthuisberg, Leuven, Belgium; 4Biophysics and Nuclear Medicine Department, University Hospital, Strasbourg, France; 5Thoracic Surgery Department, University Hospital Gasthuisberg, Leuven, Belgium; 6Anesthesiology Department, University Hospital Gasthuisberg, Leuven, Belgium Objectives: Scot15® is a low-K+ preservation solution including polyethylene glycol (PEG) as a colloid for protection of vascular endothelium during cold ischemia. PEG was previously demonstrated to have “immunocamouflage” properties. The aim of this study was to assess whether these properties would be beneficial in a pig lung transplant model. Material: Domestic pig donor lungs were flushed either with Scot15®[S;n=6] or Perfadex®[P;n=6] and stored on ice for 22 hours. The left lung was transplanted in a recipient animal observed during 6 hours after reperfusion. Pulmonary vascular resistance (PVR) and partial arterial oxygen tension (PaO2) were measured hourly. Lung biopsies were taken for HRMAS detection of the respective colloid in the lungs. Bronchoalveolar lavage (BAL) was taken to assess neutrophilic alveolar recruitment. At the end of reperfusion, wet to dry weight ratio (W/D) was measured as a marker of lung edema. Results: HRMAS showed presence of PEG in the lungs in [S] before and during the reperfusion. Dextran was not detected in [P]. After 6 hours of reperfusion, PaO2 was significantly better in [S] (310±51mmHg versus 198±71mmHg in [P]; p=0.03). PVR remained lower in [S] but the difference did not reach signifi268s Poster Discussion Room C7 14:45 16:45 Abstract printing supported by . Visit Chiesi at Stand B2.10printing supported by . Visit Chiesi at Stand B2.10 SUNDAY, SEPTEMBER 2ND 2012 cance. Differential cell count of BAL showed lower neutrophilic cell count in [S] (89±67neutrophils in [S] versus 139±53 neutrophils in [P]; p=0.001). There was no difference in W/D weight ratio (p=0.9). Con