(349) - Peripheral Blood Gene Expression Identifies Damage-Associated Innate Immune Pathways in Patients With Primary Graft Dysfunction After Lung Transplantation

Abstract

s S135 exist, mostly with a restrictive pulmonary function. Those patients have been denominated as having restrictive CLAD and in general show poor survival. It is unknown which factors may predict survival at diagnosis of rCLAD. Methods: All patients diagnosed with rCLAD between 2007 and 08/2014 have been assessed in retrospect and parameters have been collected at the moment of diagnosis and the impact of the collected parameters has been assessed on survival using both unadjusted and adjusted analysis (SAS 9.1). Results: During the study period, 33 patients have been diagnosed with rCLAD with a median survival of 324 days. Unadjusted analysis showed that infiltrates in lower lobe or diffuse infiltrates (p= 0.0052), elevated CRP (p= 0.0012), acute onset (p= 0.0019), lymphocytic bronchiolitis on concomittant transbronchial biopsy (TBB) (p= 0.014), BAL eosinophils ≥ 2% (p= 0.0009) and elevated BAL neutrophils (p= 0.012) were associated with a worse survival after diagnosis, while native lung disease, gender, age at diagnosis, previous BOS, type of transplant, post-operative day of CLAD diagnosis, presence of anti-HLA antibodies, Aspergillus growth, CLAD stage at diagnosis, FVC/FVC best at diagnosis, acute rejection on concommitant TBB did not influence survival after diagnosis. Adjusted analysis showed that acute onset (p= 0.038), BAL eosinophils ≥ 2% (p= 0.020) and BAL neutrophilia (p= 0.033) were the determinants with the strongest association with survival after rCLAD diagnosis. Conclusion: This analysis demonstrates that BAL differential cell count and an acute onset of rCLAD were associated with a shorter survival time after rCLAD diagnosis.