Common Indication For Transplantation Research Articles

The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease.

The high prevalence of obesity in the United States drives the burden of NASH, recently renamed as metabolic dysfunction-associated steatohepatitis (MASH). We assessed the most recent trends in liver transplantation in the United States. The Scientific Registry of Transplant Recipients (SRTR 2013-2022) was used to select adult (18 years or above) candidates who underwent liver transplant. There were 116,292 candidates who underwent liver transplant with known etiology of chronic liver disease. In candidates without HCC, the most common etiology was alcohol-associated liver disease (ALD), increasing from 23% (2013) to 48% (2022), followed by NASH/MASH, which increased from 19% to 27%; the rates of viral hepatitis decreased (chronic hepatitis C: 28%-4%; chronic hepatitis B: 1.8%-1.1%) (all trend p<0.01). The proportion of HCC decreased from 25% (2013-2016) to 17% (2021-2022). Among HCC cohort, the proportion of chronic hepatitis C decreased from 60% (2013) to 27% (2022), NASH/MASH increased from 10% to 31%, alcohol-associated liver disease increased from 9% to 24% (trend p<0.0001), and chronic hepatitis B remained stable between 5% and 7% (trend p=0.62). The rapid increase in the proportion of NASH/MASH in HCC continued during the most recent study years [20% (2018), 28% (2020), 31% (2022)]; the trend remained significant after adjustment for age, sex, ethnicity, obesity, and type 2 diabetes. Liver transplant etiologies in the United States have changed over the last decade. Alcohol-associated liver disease and NASH/MASH remain the 2 most common indications for transplantation among those without HCC, and NASH/MASH is the most common in patients with HCC.

Liver transplantation program at the Burnasyan Federal Biophysical Center: experience in 500 procedures

To analyze the features and outcomes of 500 liver transplantations in adults over a 12-year period. The study included data on 500 liver transplantations between May 2010 and April 2023. We analyzed 483 adults who underwent transplantation and 438 candidates for this procedure. All data were obtained from local liver transplantation registry. Clinical outcomes were recorded as of June 1, 2023. Statistical analysis was performed using the Statistica 12 (StatSoft Inc., USA) and Jamovi version 2.3.21.0 software (Jamovi project). Among 438 patients in the waiting list between January 2012 and May 2023, liver transplantation was performed in 198 (45%) cases including 27 (6%) transplantations from living-related donors and 37 (8%) procedures in other centers. There were 109 (25%) deaths. The 1- and 3-year survival rates were 81% (95% CI 76-85%) and 50% (95% CI 42-59%), respectively. Organs from deceased donors (n=134, 27%) and living-related donors (n=366, 73%) were used for transplantations. Redo transplantations were necessary in 21 (4%) cases. The median age of recipients was 45 years (range 18-72), median MELD-Na score - 16 (range 6-43). The most common indications for transplantation were viral cirrhosis (37%), cholestatic liver disease (16%), and hepatocellular carcinoma (14%). Monotherapy with calcineurin inhibitors was performed in 39% of cases, combination of calcineurin inhibitors and glucocorticoids, antimetabolites or mTOR inhibitors - 52%, three-component schemes - 8% of cases. Annual, 5- and 7-year survival rates of recipients after primary transplantation were 87% (95% CI: 84-90%), 79% (95% CI: 75-83%) and 75% (95% CI: 70-80%), respectively. In case of liver transplantation from living-related donors, these values were 89% (95% CI: 86-92%), 84% (95% CI: 80-88%) and 80% (95% CI: 75-85%), after transplantation from deceased donors - 81% (95% CI: 74-88%), 66% (95% CI: 57-76%) and 58% (95% CI: 45-72%), respectively. Liver transplantation is highly effective for patients with diffuse and focal liver diseases. Living donors not only significantly improve availability of this technology, but also provide substantial advantages in outcomes compared to liver transplantation from deceased donors, reducing the likelihood of recipient mortality by 10% after one post-transplantation year and by more than 20% after five years.

Corneal Transplantation for Infectious Keratitis: A Prospective Dutch Registry Study.

The aim of this study was to analyze real-world practice patterns and graft survival after corneal transplantation for infectious keratitis in the Netherlands. All consecutive keratoplasties for infectious keratitis registered in the Netherlands Organ Transplant Registry were included. Graft survival was analyzed using Kaplan-Meier survival curves with Cox regression to compare the 3 most common pathogens with subgroup analysis for type and reason of transplantation, sex, and graft size. Multivariable analysis was performed using the same explanatory factors. Between 2007 and 2017, 1111 keratoplasties for infectious keratitis were registered in the Netherlands Organ Transplant Registry. The most common pathogens were viruses (n = 437), bacteria (n = 271), and Acanthamoeba (n = 121). Human leukocyte antigen (HLA) matching did not provide a significant survival benefit, whereas emergency procedures showed worse graft survival [hazard ratio (HR) = 0.40, P = 0.120; HR = 2.73, P < 0.001, respectively]. Graft size >8.5 mm was significantly worse than graft size 8.5 mm (HR = 2.062, P = 0.010). In therapeutic keratoplasty, graft survival was significantly worse for Acanthamoeba than viral keratitis (HR = 2.36, P = 0.008). In the multivariable model, adjusting for graft size, type, and reason for transplantation, viral and bacterial keratitis did not differ significantly in graft survival, and Acanthamoeba showed a significantly worse prognosis (vs. viral keratitis, HR = 2.30, P < 0.001; bacterial keratitis, HR = 2.65, P < 0.001). Viral keratitis was the most common indication for transplantation, followed by bacterial and Acanthamoeba keratitis. HLA matching did not offer protection over elective non-HLA-matched procedures, whereas emergency procedures and grafts sized >8.5 mm showed poor survival. In optical keratoplasty, survival is high for all pathogens, whereas in therapeutic keratoplasty Acanthamoeba shows poor outcome.

212. Outcomes of Weekly Fluconazole Antifungal Prophylaxis in Pancreas Transplant Recipients

Abstract Background Fungal infections following pancreas transplantation carry significant morbidity and mortality with an estimated incidence of 3 to 28%. The American Society of Transplantation (AST) suggests considering fluconazole prophylaxis in pancreas transplant recipients (PTR) at high-risk of invasive candidiasis (IC). However, optimal dosage and duration of prophylaxis is unclear. Weekly fluconazole for prevention of IC has been previously reported in liver and bone marrow transplant recipients. We analyzed outcomes of once weekly fluconazole prophylaxis in PTR. Methods We retrospectively reviewed all pancreas transplants performed at our institution from January 2017 through September 2021. PTR at high-risk for IC were defined per AST criteria as those with enteric drainage, vascular thrombosis, and post-perfusion pancreatitis. Patients received once weekly oral fluconazole 200 mg for 12 weeks post-transplant for IC prophylaxis. We analyzed incidence of breakthrough IC within the first 6 months post-transplant. Results We identified a total of 22 PTR, all of whom received simultaneous kidney transplantation from deceased donors. Of these, 12/22 (55%) were male and 11/22 (50%) were African American. Median age at the time of transplantation was 39 years (IQR 34-46). The most common indication for transplantation was type 1 diabetes mellitus (17/22, 21%) with associated nephropathy. No donor organ cultures were positive for fungi and all pancreas transplants were performed using enteric drainage. Notably, one patient developed pancreas allograft thrombosis while another developed pancreatitis. No patients required early discontinuation of fluconazole due to intolerance or side effects and none developed breakthrough IC within 6 months post-transplant (Table 1). Table 1. Conclusion Weekly fluconazole prophylaxis has not been previously studied in PTR. In our cohort, this approach was well tolerated, with no cases of IC at 6 months post-transplantation in patients at high-risk. Randomized controlled clinical trials are needed to define the optimal strategy in this population. Disclosures M. Rizwan Sohail, MD, Aziyo Biologics: Honoraria|Boston Scientific Corporation: Honoraria|Medtronic: Grant/Research Support|TRYX: Grant/Research Support.

CT-275 Incidence and Characteristics of Chronic GVHD in Haploidentical Stem-Cell Transplantation With Post-Transplantation Cyclophosfamide: Experience of the Spanish Group of Hematopoietic Transplantation and Cell Therapy (GETH-TC)

Chronic graft-versus-host-disease (cGVHD) is a relevant cause of late morbidity and mortality related to allogenic-stem-cell transplantation in long-term survivors. GVHD prophylaxis using post-transplantation cyclophosphamide (PTCy) has improved haploidentical stem-cell transplantation (haplo-HSCT) outcomes; however, data related to characteristics, risk factors, or cGVHD outcomes are limited. In this study, we analyze the incidence, risk factors and disability related to cGVHD in patients undergoing haplo-HSCT PTCy. Retrospective multicenter analysis of 389 consecutive patients that underwent haplo-HSCT-PTCy at 7 Spanish transplant centers from 2007 to 2020. cGVHD diagnosis was made following the NIH criteria and Disability related to cGVHD was defined as Fatobene et al criteria. Median age was 48 years (5-74), and 62% were males. AML and HL were the most common indications for transplantation (37%, 22%). 36% received a previous transplant. The median follow-up was 35 months (3-102). Cumulative incidence of aGVHD and aGVHD III-IV at day +180 was 66% and 20%. The 2-year OS was 59%, 2-year PFS 54%, 2 year-GRFS was 45%. 95 patients developed cGVHD, cumulative incidence of cGVHD and cGVHD moderate-severe was 34% and 10% at 3 years. 42 patients required systemic treatment. In the univariate analysis of risk factors for cGVHD in patients alive on day +100, female donor (p=0.034), female donor and male recipient (p=0.041), DRI low (p=0.026), myeloablative conditioning (p=0-047), previous aGVHD (p=0.014), and the use of radiotherapy in conditioning (p=0.004) were identified. Busulfan conditioning was identified as a protective factor (p=0.036). In multivariate analysis, the presence of previous GVHD (p=0.031) and the protective power of conditioning with busulfan (p=0.036) remains statistically significant. cGVHD according to NIH at 3 years, moderate cGVHD showed a higher OS (p=0.054), higher PFS (p=0.004) and lower relapse than the rest of the groups (p=0.035). Receiving one line of treatment (p=0.043) and use of bone marrow were the only risk factors identified for these patients. Haplo-HPT with Cy-post shows a low, but not negligible incidence of cGVHD, and its use represents an alternative for some patients. The development of moderate cGVHD is a protective factor in this transplant modality. The characterization of predictive factors of this subgroup is relevant given the results.

The role of bariatric surgery in liver transplantation: timing and type

IntroductionThe rise in obesity worldwide has shifted the indications for liver transplantation (LT), with non-alcoholic steatohepatitis (NASH) being the second most common indication for transplantation. There remains an underestimation of cirrhosis being attributed to NASH. Bariatric surgery (BS) is a reliable solution to overcome obesity and its associated comorbidities. The role of BS in LT has been investigated by different studies; however, the type of BS and timing of LT need further investigation.MethodsA systemic review examining the role of BS in LT patients was performed. After selection of the studies based on inclusion and exclusion criteria, data extraction was performed by two independent reviewers. Primary outcomes included patient and graft survival.ResultsFrom a total of 2374 articles, five met the prefined criteria. One hundred sixty-two patients had both BS + LT and 1426 underwent LT alone. The percentage of female patients in the BS + LT and LT cohorts was 75% and 35% respectively. The average age in BS + LT and LT cohorts was 43.05 vs. 56.22 years respectively. Patients undergoing BS had comparable outcomes in terms of overall patient survival, graft survival and post-operative morbidity compared to LT alone. When comparing BMI change in patients with prior versus simultaneous BS + LT, no significant difference was found.ConclusionBS and LT patients achieve comparable outcomes to general LT populations. Further studies examining simultaneous BS + LT are needed to answer questions concerning patient selection and timing of surgery.

The Evolution of the MELD Score and Its Implications in Liver Transplant Allocation: A Beginner's Guide for Trainees.

The Evolution of the MELD Score and Its Implications in Liver Transplant Allocation: A Beginner's Guide for Trainees.

Improvement in Outcomes of Autologous Stem Cell Transplant in Patients with Lymphoma Older Than 70 Years: The Significance of Age in 2020s?

Backgrounds: Autologous stem cell transplant (ASCT) has been the standard treatment approach for patients with relapsed or high-risk lymphoma for several decades. Despite the improvement in supportive care, age has remained one of the critical factors that determines transplant eligibility and outcomes. Herein, we explored the transplant-related outcomes of patients with lymphoma aged 70 years or older at our institution and compared to those with younger ages.Methods: In this retrospective single center study, we include all patients with diagnosis of lymphoma who underwent ASCT between January 2000 and February 2021 at Mayo Clinic, Rochester, Minnesota. In addition to data obtained from the transplant database, we abstracted data from electronic medical record. We described relevant clinical characteristics and transplant associated outcomes including engraftment, transplant related mortality, relapse incidence, and survival outcomes. We compared the key transplant related outcomes with patients at the younger age group between 65 and 70 years old.Results: A total of 196 patients with lymphoma aged 70 years or older underwent ASCT between January 2000 and February 2021. The median age of patients at the time of ASCT was 72.4 (70.0-78.7) years with 24 patients (12.2%) being older than 75 years old. Of 196 patients, 76 (38.8%) had Charlson comorbidity index of 3 or higher and 10 (5.1%) had performance status of 2 or higher at the time of ASCT. Table 1 summarizes the relevant baseline clinical characteristics of 196 patients in this cohort including the comparison with younger patients (age 65-70 years old, n=296). The most common transplant indication in this cohort was relapsed diffuse large B cell lymphoma. The majority of patients (91.3%) received peripheral blood graft with a median CD34+ cell dose of 5.14x10 6 cells/kg which was significantly lower than younger patients (P=0.01). The rate of neutrophil and platelet engraftment was 99.0% and 98.8% with corresponding median time to engraftment of 13 days for both cell lineages. The 30- and 100-day non-relapse mortality (NRM) of the entire cohort was 1.5% (95%CI 0-3.2%) and 4.6% (95%CI 1.6-7.5%) not statistically different between 70-75 years old and 75 years or older cohorts. With the median follow-up duration of 48 months, the 2-year event free survival (EFS) and overall survival (OS) was 55.9% (95%CI 49.2-63.5%) and 67.4% (95%CI 61.0-74.5%), respectively. Patients from the 70 years old or older cohort had similar EFS but inferior OS compared to the 65-70 years old cohort. However, there was no difference in EFS and OS between 70-75 and >75 years old cohorts. There was overall an improved trend of 30-day NRM, 2-year EFS and 2-year OS over the 3 different transplant periods (Figures). Although not statistically significant, patients who underwent ASCT between 2000 and 2006 had a trend towards higher 30-day NRM compared to patients who were transplanted at later time points (7.3% vs 0%, P=0.06). The major causes of death included progressive lymphoma, infection, and conditioning regimen related organ toxicities.Conclusion: Outcomes of ASCT in older patients with lymphoma have improved over time with an excellent 30-day NRM (0%) in the past recent years. The major cause of treatment failure after ASCT was progressive disease. With appropriate patient selection, ASCT in older patients is feasible and provides acceptable outcomes comparable to the patients from younger age group. [Display omitted] DisclosuresPaludo: Karyopharm: Research Funding. Ansell: Bristol Myers Squibb, ADC Therapeutics, Seattle Genetics, Regeneron, Affimed, AI Therapeutics, Pfizer, Trillium and Takeda: Research Funding.

PD-L1 (Programmed Death Ligand 1) as a Marker of Acute Cellular Rejection After Heart Transplantation.

PD-L1 (Programmed Death Ligand 1) as a Marker of Acute Cellular Rejection After Heart Transplantation.

The European Group for Blood and Marrow Transplantation Risk Score Predicts Outcome of Elderly Patients with Allogeneic Stem Cell Transplantation for Acute Leukemia and Myelodysplastic Syndrome

Introduction:Hematological malignancies are more and more common in elderly patients. Acute myeloid leukemia (AML) in elderly patients would have more unfavorable cytogenetics, frequently express drug resistance, respond less well to chemotherapy and more likely to be preceded by the myelodysplastic syndrome (MDS), while MDS is a predominantly malignant disease of elderly patients, with a median age of approximately 75 years old at diagnosis and more than 80% are noted to be older than 60 years. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the curative therapy for refractory AML or high risk MDS, old age had been a limitation to access the eligibility for allo-HSCT and seldom prospective trial evaluates the outcomes for elderly patients with allo-HSCT. Here, we conducted a retrospective study to analyze the prognostic factors predicting outcome of elderly patients with allo-HSCT for acute leukemia and MDS at our institution during a 10-year period.MethodWe reviewed patients with diagnosis of acute leukemia or MDS, who underwent allo-HSCT at age older than 50 years old from January 2003 to December 2014. Clinical characteristics including age, sex, underlying disease, type of allogeneic transplant, conditioning regimens, European Group for Blood and Bone marrow Transplantation (EBMT) risk score, and presence of acute graft-versus-host disease (aGVHD) or chronic GVHD (cGVHD) were collected and analyzed. Cox proportional hazard model was adopted to explore the independent prognostic factors for overall survival (OS), disease-free survival (DFS) and non-relapse mortality (NRM).ResultsA total of 85 elderly patients were included during study period and the medial age at allo-HSCT was 55 years old. There were 63 (74%) patients receiving allo-HSCT for AML, which was the most common indication for transplantation in this cohort. 47 (55%) recipients' stem cell source were unrelated donors, while 46 (54%) patients underwent myeloablative conditioning regimens. 14 (17%) cases developed grade III-IV aGVHD, while 22 (26%) had moderate to severe cGVHD. The significant prognostic factors for worse OS after transplantation (Table 1) were EBMT risk score > 3 (hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.14-13.88; P=0.01), and grade III-IV aGVHD (HR 4.36, 95% CI 2.13-9.93; P < 0.01), while patients with moderate to severe cGVHD would have better OS (HR 0.45, 95% CI 0.20-0.99; P=0.04). Similar finding was noted in DFS analysis: EBMT risk score > 3 (HR 2.27, 95% CI 1.31-3.94; P < 0.01), aGVHD (HR 4.70, 95% CI 2.41-9.17; P < 0.01), and moderate to severe cGVHD (HR 0.46, 95% CI 0.23-0.90; P = 0.02). In addition, EBMT risk score > 3 (HR 2.41, 95% CI 0.99-4.63; P = 0.05) and grade III-IV aGVHD (HR 5.87, 95% CI 2.43-14.13; P < 0.01) significantly correlated with non-relapse mortality (Table 2). The OS of patents with EBMT risk score < 3 was significant better than those with EBMT risk score >3 (log-rank p= 0.01), and Kaplan-Meier curve of OS divided by EBMT risk score were illustrated in figure 1.ConclusionWe identify EBMT risk score > 3 and grade III-IV aGVHD as adversely prognostic factors for OS, DFS and NRM in elderly patients underwent allo-HSCT. Development of moderate to severe cGVHD allows elderly patients to have better OS as well as DFS, and interestingly, it would not increase NRM significantly. It indicates graft-versus-leukemia may be essential important in survival and disease control for elderly patients experiencing allo-HSCT. This cohort study suggests that EBMT risk score > 3 predicts poor outcomes and careful management of GVHD may lead to better survival for elderly patients experiencing allo-HSCT.Key words: acute leukemia, myelodysplastic syndrome, elderly, allogeneic hematopoietic stem cell transplantation, European Group for Blood and Bone marrow Transplantation (EBMT) risk score, graft-versus-host disease [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Outcomes after cardiac transplantation: a new tertiary centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Our hospital is one of the most remote transplant centres in the world. We evaluated the short- and long-term outcomes after cardiac transplantation at a new Tertiary Centre hospital in Western Australia. Methods A retrospective study of all patients undergoing cardiac transplantation since February 2015 until November 2020 was conducted. De-identified data was collected using hospital medical records and the ANZSCTS database. Primary outcome measure was mortality at any time point and acute rejection. Secondary outcome measures included new renal failure, post-operative blood product use and readmission rate. Results A total of 59 cardiac transplantations were conducted, with the mean age of recipients being 52 (±15) years and the majority being male (64.4%). Ischaemic cardiomyopathy and dilated cardiomyopathy were the most common indications for transplantation, accounting for 71.2% of all transplants. The mean age of donors was 35.29 (±11.11) years with the majority being male (69.5%). There were no mortalities and acute rejection within 3 months of transplant occurred in 16 (27.1%) patients. New renal failure was the most common complication occurring in 16 (27.1%) patients. After multivariate analysis, donor ischaemia time &amp;gt;200minutes was associated with an increased risk of renal failure (OR 1.2, P = 0.044). Conclusions Over a five-year period at a new cardiac transplant centre in one of the most remote locations of the world, we report no mortalities.

Haploidentical transplantation in pediatric non-malignant diseases: A retrospective analysis on behalf of the Spanish Group for Hematopoietic Transplantation (GETH).

Describe the GETH haploidentical stem cell transplantation (haplo-HSCT) activity in non-malignant disease (NMDs). We retrospectively analyzed data from children with NMDs who underwent haplo-HSCT. From January 2001 to December 2016, 26 pediatric patients underwent 31 haplo-HSCT through ex vivo T cell-depleted (TCD) graft platforms or post-transplantation cyclophosphamide (PT-Cy) at 7 Spanish centers. Five cases employed unmanipulated PT-Cy haplo-HSCT, 16 employed highly purified CD34+ cells, and 10 employed ex vivo TCD grafts manipulated either with CD3+ CD19+ depletion, TCRαβ+ CD19+ selection or naive CD45RA+ T-cell depletion. Peripheral blood stem cells were the sole source for patients following TCD haplo-HSCT, and bone marrow was the source for one PT-Cy haplo-HSCT. The most common indications for transplantation were primary immunodeficiency disorders (PIDs), severe aplastic anemia, osteopetrosis, and thalassemia. The 1-year cumulative incidence of graft failure was 27.4%. The 1-year III-IV acute graft-versus-host disease (GvHD) and 1-year chronic GvHD rates were 34.6% and 16.7%, respectively. The 2-year overall survival was 44.9% for PIDs, and the 2-year graft-versus-host disease-free and relapse-free survival rate was 37.6% for the other NMDs. The transplantation-related mortality at day 100 was 30.8%. Although these results are discouraging, improvements will come if procedures are centralized in centers of expertise.

CML-329: Allogeneic Stem Cell Transplantation Results in Chronic Myeloid Leukemia: A Single Center Experience

Context Two decades ago, the introduction of tyrosine kinase inhibitors (TKIs) has improved the outcome and overall survival of chronic myeloid leukemia (CML) patients and changed the use of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in this setting. Still, allo-HSCT remains the treatment of choice for patients diagnosed and/ or progressed to advanced phase (accelerated and blastic phase) and who have failed and/or are intolerant to multiple TKIs. Objective The aim of this study was to investigate the clinical outcome in 19 patients who were referred for this procedure to The Hematology and Bone Marrow Transplantation Center, Fundeni Clinical Institute. Design Retrospective single-center case series. Setting The Hematology and Bone Marrow Transplantation Center, Fundeni Clinical Institute, Bucharest, Romania. Patients We analyzed the records of 19 CML patients who underwent allo-HSCT between 2012–2020 in the Hematology and Bone Marrow Transplantation Center of Fundeni Clinical Institute. Results Median time from CML diagnosis to allo-SCT was 34 months. Out of 19 CML patients, 6 patients were in the first chronic phase (CP), and 13 patients were in the second or later CP. TKI resistance was the most common transplant indication. Mutation status was positive in two patients. TKI intolerance was present in six patients. Out of 19 CML patients, 14 patients survived the transplantation procedure and achieved major molecular response (MMR). Conclusions Allo-HSCT still represents an important therapeutic option in CML, especially for patients diagnosed or/and progressed to advanced phase or are resistant or/and intolerant to TKI treatment.

Initial experience with contrast-enhanced ultrasound in the first week after liver transplantation in children: a useful adjunct to Doppler ultrasound.

Doppler US is the primary screening for post-liver transplant vascular complications, but indeterminate findings require further imaging. To evaluate whether contrast-enhanced US improves diagnostic assessment of vascular complications suspected by Doppler US. We retrospectively reviewed Doppler US and contrast-enhanced US studies obtained in the first week following liver transplant. Doppler US was performed twice daily for the first 5 postoperative days, and CEUS in the first postoperative day and when vascular complications were suspected. We correlated Doppler US and CEUS with surgical findings, and clinical and imaging follow-up. We evaluated Doppler US and CEUS quality in demonstrating the main hepatic artery (HA) at the porta hepatis as follows: Grade 0 = not seen, Grade 1 = only segments, Grade 2 = entire main HA, and Grade 3 = entire main HA to the intrahepatic branching. We used a Wilcoxon signed rank test to test the difference between Doppler US and CEUS methods. Twenty-nine children (15 girls, 14 boys) were identified, with median age 2.2years (range 0.5-17.6years). The most common transplant indication was biliary atresia (n=13). There was significantly (P<0.0001) improved main HA visualization with CEUS. In five children, CEUS was performed to evaluate suspected vascular complications; CEUS confirmed normal vascularity in two. CEUS demonstrated portal vein thrombosis (n=2) and main HA thrombosis (n=1), confirmed at surgery. In one child the main HA thrombosis was missed; marked HA narrowing was seen retrospectively on CEUS. Immediately following liver transplantation, CEUS improves main HA visualization and diagnostic assessment of vascular complications.

High Rate of Imipenem Non-Susceptibility among Clinical Nocardia spp. Isolated from Lung Transplant Recipients

Nocardia spp. cause serious disease in lung transplant recipients, with mortality rates as high as 40%. Dual antibiotic therapy with amikacin and either imipenem or trimethoprim-sulfamethoxazole (TMP-SMX) is commonly recommended as empiric treatment. Imipenem therapy may avoid TMP-SMX and amikacin adverse effects. We evaluated the real-world activity of common antibiotics against Nocardia spp. isolated from lung transplant recipients with clinical nocardiosis. This IRB-approved, retrospective chart review included adults who underwent lung transplant after January 1, 2012 and were diagnosed with nocardiosis posttransplant. Antibiotic susceptibilities were assessed at a national reference lab. Of the 600 patients who underwent lung transplant during the study period, 13 developed nocardiosis, and 11 (85%) had susceptibility data. Of the 13 patients with nocardiosis, interstitial lung disease was the most common transplant indication, and most received basiliximab induction. The most common immunosuppressive regimen at the time of Nocardia spp. isolation was mycophenolate mofetil, tacrolimus, and prednisone. Six patients (46%) had augmented immunosuppression within 6 months before diagnosis with rituximab, anti-thymocyte globulin, or steroid pulse. Nocardiosis occurred a median of 13 months after transplant (range, 6-55); 6 patients had disseminated disease. Eight of the 13 patients (62%) survived 6 months post-diagnosis. Imipenem was active against only 4 isolates (36% susceptibility). Of the 7 non-susceptible isolates to imipenem, only 1 patient had received a carbapenem posttransplant. The most active antibiotics were TMP-SMX (100%), linezolid (100%), and amikacin (91%). The most active β-lactam was ceftriaxone (45%), followed by amoxicillin/clavulanate (40%). Five of the 13 patients (38%) received TMP-SMX for pneumocystis prophylaxis immediately preceding nocardiosis diagnosis. Despite high historical in vitro activity, imipenem was poorly active against these clinical Nocardia spp. Local epidemiologic data are needed to guide empiric therapy. Despite potential toxicities and prior prophylactic use, TMP-SMX should be the backbone of combination therapy, with the second agent selected based on the likelihood of central nervous system disease, susceptibilities, and toxicities.

A85 COLON CANCER SCREENING IN PATIENTS ASSESSED FOR LUNG TRANSPLANTATION

Abstract Background Colorectal Cancer (CRC) mortality is significantly higher after a lung transplant (1). CRC screening for average risk patients in British Columbia is done with Fecal Immunochemical Testing (FIT) every two years (2), however colonoscopy is currently the standard modality in patients undergoing lung transplant assessments in British Columbia. The yield of using FITs or Fecal Occult Blood Testing (FOBT) and colonoscopy in screening for lung transplant assessments in Canada is unknown. Aims To review the colon cancer screening results for all lung transplants done in British Columbia from 2013 to 2018. Methods This is a retrospective chart review of the 222 lung transplants done from January 2013 to December 2019. Results 220 patients were transplanted during this time period. 2 patients were re-transplanted. 136 of the 220 lung transplant patients were male (62%). The most common indication for transplantation was interstitial lung disease (44%), followed by chronic obstructive pulmonary disease (30%), cystic fibrosis (7%), and pulmonary hypertension (4%). Colonoscopies were performed in 127 of the 220 patients. Computed tomography (CT) colonography was performed in 15 of the 220 patients, and a FOBT or FIT was performed in 200 of the 220 patients. No colon cancers were found by colonoscopy or CT colonography (0/142). Of the colonoscopies performed, 38 % (49/127) had adenomatous or serrated polyps removed. Of these 36% (18/49) had high risk pathology. The positive predictive value of a FIT/FOBT positive for a polyp was 51.4 % (CI 37.6–65.1%). Conclusions The value of non-invasive screening modalities in pre-lung transplant patients are modest. Program screening should be tailored to the lung transplant candidate’s risk of CRC and the risk of an invasive procedure with a known complication rate. Funding Agencies None

Living donor liver transplantation in Alagille syndrome—Single center experience from south Asia

To analyze the clinical characteristics and the outcomes of living donor liver transplantation in children with Alagille syndrome (AGS). Clinical data of children with AGS who underwent liver transplantation between July 2009 and May 2019 in our unit were retrospectively analyzed. Primary end-points were patient and graft survival. Ten children with AGS underwent living donor liver transplantation at a median age of 28months (range, 12-84months). Jaundice was the most common initial symptom and was noted after a median duration of 20days after birth (range, 7-60days). Two patients had undergone Kasai porto-enterostomy for misdiagnosis of biliary atresia. The most common indication for transplantation was severe pruritus with poor quality of life. Explant livers in three children showed cirrhosis with early well-differentiated hepatocellular carcinoma. We have 100% patient and graft survival at a mean follow-up of 32months (range 3-72months). The median z-score for weight and height at liver transplantation was -2.66 (range: -6.44 to -0.9) and -3.6 (range: -7.96 to -0.93) while at follow-up was -1.7 (range: -3.4 to -0.35) and -2.1 (range: -3.9 to -1.4), respectively. The estimated glomerular filtration rate was normal pretransplant and follow-up. This is the first series of LDLT for Alagille syndrome in the Indian sub-continent. We report excellent post-transplant outcomes in contrast to outcomes reported from Western literature.

34. Liver Transplantation in Alagille Syndrome- Single Centre Experience from South-East Asia

Background and Aims: To analyse the clinical characteristics and the outcome of liver transplantation (LT) in children with Alagille syndrome (AGS). Methods: Clinical data of children with AGS who underwent LT between July 2009 and June 2018 in our unit was retrospectively analysed. Primary endpoints were patient and graft survival. Results: Eight children with AGS underwent living donor liver transplantation at a median age of 4 years (range, 1–7 years). Jaundice was the most common initial symptom and was noted after a median duration of 20 days after birth (range, 7–60 days). Three patients had undergone Kasai porto-enterostomy for mis-diagnosis of biliary atresia. The most common indication for transplantation was severe pruritus with poor quality of life. Explant livers in two children showed cirrhosis with early well differentiated hepatocellular carcinoma. We have 100% patient and graft survival at a mean follow up of 26 months (range 3–62 months). The median z-score for weight and height at LT were −2.7 (range: −0.9 to −6.44)/−3.6 (range: −0.93 to −7.96) while at follow-up were −1.7 (range: −0.35 to −3.4) and −2.1 (range: −1.4 to −3.9) respectively. The estimated glomerular filtration rate was normal pre-LT and follow-up. Conclusions: This is the first series of LDLT for Alagille syndrome in the Indian sub-continent. We report excellent post-transplant outcomes in our series. The authors have none to declare.

Lung transplant: the Western Australian experience.

The Western Australian lung transplant programme commenced in 2004 to serve the growing demand of patients with end-stage lung disease. This report summarises our 11-year experience in lung transplantation. Data on 115 consecutive patients and their respective donors transplanted between 2004 and 2015 were collected. The Kaplan-Meier method was used to estimate survival. Cox regression was used to analyse the impact of donor and recipient characteristics on survival. A total of 88 bilateral, 22 single-lung and 5 heart-lung transplants were performed in Western Australia during the first 11 years of the lung transplant programme. The most common indications for transplantation were interstitial lung disease (30.4%), cystic fibrosis (27.8%) and chronic obstructive pulmonary disease (excluding alpha-1 antitrypsin deficiency) (22.6%). Median recipient age was 50 years. Overall survival rates were 96% at 3 months, 93% at 1 year, 84% at 3 years and 70% at 5 years. Older age and higher BMI negatively impacted survival. Chronic lung allograft dysfunction was the leading cause of late mortality. Lung transplantation is a treatment option in end-stage lung disease, with annual transplant rates in Western Australia continuing to rise. Our patients enjoy survival rates that compare favourably against international standards.

Pediatric Corneal Transplants: Review of Current Practice Patterns.

To facilitate development of standardized guidelines for management of pediatric patients undergoing keratoplasty, particularly the youngest cohort, through a comprehensive survey assessing recent trends in practice patterns of corneal specialists and pediatric ophthalmologists. A cross-sectional, observational study of current practices pertaining to pediatric keratoplasty was performed by designing a 20-question survey focused on preoperative indications, surgical techniques, and postoperative management. This survey was sent electronically to corneal specialists and pediatric ophthalmologists. Results were compared with the findings of previous studies regarding pediatric keratoplasty. Of the 80 ophthalmologists who responded, 51.3% currently perform pediatric keratoplasty; only 20% have performed >50 cases. The majority (73.8%) completed solely corneal fellowships; all perform penetrating keratoplasty, 35.2% also perform endothelial keratoplasty, and 37% also perform lamellar keratoplasty. Peters anomaly was the most common indication for transplantation (34.3%). The majority believe that 1 to 3 months is the optimal age range to perform keratoplasty for both monocular and binocular congenital corneal opacities, although 13% stated that they would never perform keratoplasty in a patient with a monocular opacity. All surgeons report modifying their intraoperative techniques for pediatric patients, but specific practices and postoperative management protocols vary. There is a consensus regarding the importance of amblyopia therapy in these patients. Our results were consistent with the published literature regarding the indication and types of surgery performed. Variability among surgical techniques and postoperative management protocols highlights the necessity of creating standardized guidelines to optimize management of pediatric patients undergoing keratoplasty. Collaborative efforts between corneal and pediatric specialists are crucial for defining visual rehabilitation protocols to enhance visual outcomes.