(254) - De Novo DQ Donor-Specific Antibodies Are Associated With Chronic Lung Allograft Dysfunction

Abstract

s S99 Device related complications (DRC) raise acuity of illness allowing patients to be listed as status 1A. We sought to study HTx outcomes of status 1A patients supported with CF LVADs with (DRC+) or without (DRC-) device related complications. Methods: UNOS data (2006 to 2012), on adult HTx patients listed as status 1A with CF LVADs at HTx was analyzed. Outcomes were compared between DRC+ and DRCgroups. Data on DRC+ group was further analyzed under five UNOS categories (B1 = Thromboembolism, B2 = Device related infections, B3 = Mechanical failure, B4 = Ventricular arrhythmia, B5 = other). Results: During the study period 6799 patients received HTx under 1A listing, of which 2113 (31%) were supported with CF LVADs (Fig). Substantially more patients are supported with CF LVADs under 1A listing, 11.4% in 2006 to 41.5% in 2012. Alarming number of CF LVAD patients are added to 1A listing for DRC, 20% in 2006 to 55% in 2012, p = 0.0001. Majority of DRC are in B2 category54% followed by B117.4%. Demographics and perioperative variables between DRC+ and DRCwere comparable except DRC+ had longer wait times (330 ± 323 days vs 168 ± 298 days), more blood group O (57% v 40%) and higher BMI (29 ± 5.5 vs 27± 5). Post HTx survival for DRC+ was significantly inferior compared to DRCgroup both at 1 yr (85.6% vs 89.4%, p = 0.01) and 3 yrs (78% vs 82.7%, p = 0.01). Among DRC+ subgroups, 1 and 3 yr survival was inferior only for B2 category (85% and 77%, p = 0.01). Conclusion: Increasing number of patients receiving HTx under 1A listing are supported with CF LVADs. DRC are steadily increasing, majority of them from B2 category. Longer wait times, blood group O and higher BMI are associated with DRC. Post HTx survival in the DRC+ group is inferior, primarily for B2 category. Benefits of CF LVADs for patients awaiting HTx need to be weighed against the development of DRC and inferior post HTx survival.