survival for the LDLT recipients was 60 % and 48% compared to 89%and 58% for the control cohort. The difference in Kaplan-Meiersurvival curves was statistically significant (P�0.03). There was nodifference in the incidence of acute rejection between the LDLT andcontrol cohorts. Post-transplant FEV1 and FVC were not significantlydifferent. However, freedom from bronchiolitis obliterans syndrome(BOS) at 1 and 3 years was 92% and 85% compared to 75% and 53%in the cadaveric cohort (P�0.03). Not surprisingly, the causes of deathin the LDLT population reflected this difference. Only 2/24 (8%) ofdeaths in the LDLT cohort were due to BOS compared to 8/18 (45%)of deaths in the control cohort. In contrast, 11/24 (46%) of deaths in theLDLT cohort were related to infection compared to 2/18 (11%) in thecontrol population. Based on this comparison, we conclude that LDLTcan be performed successfully in pediatric patients. Although thedecreased incidence of BOS makes us optimistic about the long-termsurvival of LDLT recipients, efforts focusing on minimizing infectiouscomplications are necessary to improve overall survival.

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SHOULD WE TRANSPLANT UNOS STATUS 2 PATIENTS?J. Jimenez,1 L. Bennett Edwards,2 R. Higgins,3 S. Pham,1 J. Bauerlein,1

S. Mallon,1 1Cardiology, Jackson Memorial Medical Center, Miami, FL;2United Network Organ Sharing, Richmond, VA; 3CardiothoracicSurgery, Medical College of Virginia, Richmond, VA; 4CardiothoracicSurgery, Jackson Memorial Medical Center, Miami, FL

Introduction: Improved outcomes with contemporary medical therapyin patients with advanced heart failure questions the benefit of trans-plantation (TX) in UNOS status 2 patients.Methods: Between January 1999 and June 2001 ; 4,255 patients werelisted for heart TX as UNOS status 2. Using a competing risk method,probabilities of events on the waiting list were computed. Additionally,a time dependent proportional hazards model was used to determinepredictors of death pre and post TX.Results: Demographics of this cohort revealed a mean age of 52.3 years,female gender (23%), ischemic etiology (48%), diabetes (21%), whiterace (85%), and mean time on the waiting list (398.5 days). Relativerisks of death (� 1 indicates an increased risk) compared to patientsremaining on the waiting list as status 2 were: upgrade to status 1A; RR14.9 (95%CI 9.7-22.2), upgrade to status 1B; RR 3.4 (95%CI 2.4-4.7),0-7 days following TX as status 2; RR 16.7 (95%CI 9.3-30.2) and 7-33days following TX as status 2; RR 6.5 (95%CI 3.7-11.2). All factor weresignificant at p�0.0001. The overall relative risk of death following TX(365� days) for status 2 patients initially listed as status 2 compared tothose that continue to wait as status 2 is shown below; RR 0.92 (95%CI0.5-1.58, p�0.8).Conclusion: After accounting for early perioperative mortality, thereappears to be little survival benefit at one year in transplanting UNOSstatus 2 patients. The point of optimal benefit from TX in UNOS status2 patients may need to be further defined.

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TIME-DEPENDENT MORTALITY RISK OF LUNGTRANSPLANTATION COMPARED WITH REMAINING ON THEWAITLISTK.P. McCullough,1 R. Bustami,1 S. Murray,1,2 T.M. Egan,3

R.M. Merion,12 1SRTR, URREA, Ann Arbor, MI; 2Dept. Surgery, UMichigan, Ann Arbor, MI; 3Dept. Surgery, U North Carolina, ChapelHill, NC

Introduction: The survival benefit of lung transplant (Tx) is not wellestablished. Cox regression models with Tx as a time-dependentcovariate were used to examine lung Tx mortality compared to remain-ing on the waitlist (WL) for patients grouped by age group anddiagnosis (Dx).Methods: Models were created for 4 Dx groups (adults) and a pediatric(Ped) group (initial WL between 1995-2001). Survival from WL todeath was censored on 2/28/02, WL removal, or loss to follow-up afterTx. Analyses within each group were adjusted for 15 demographic,functional, and hemodynamic variables. Within each group, an overallCox model with a time-dependent Tx variable estimated the effect of Txon relative mortality vs WL. Additional models with time-dependentcovariates analyzed relative mortality during specified periods after Tx.Results: For each Dx and Ped, the hazard ratio (HR) was highestimmediately after Tx and decreased over time. For Ped, CF, and IPFgroup patients, mortality risk was lower than that associated withremaining on the WL by 1, 6, and 12 months post-Tx, respectively.Overall mortality was lower for Tx than for WL for Ped (HR 0.7;p�NS) and CF (HR 0.8; p�.05). However, overall mortality was higherwith Tx for COPD (HR 2.0; p�.0001), PPH (HR 1.8; p�.05), and IPF(HR 1.3; p�.05) groups.Conclusions: Subgroups of patients with pulmonary failure can beidentified who derive benefit from lung Tx from a strict survivalstandpoint. Others have higher mortality risks after Tx compared toremaining on the WL. These findings have implications for organallocation in lung Tx.

HR for days after Tx compared with WL risk of mortality for same period

Group1 (Main Dx) 0–14 14–30 30–90 90–182 182–365 >365 Overall

A (COPD etc.) 11.7** 5.5** 2.7** 1.7** 1.5** 1.2** 2.0**B (PPH etc.) 14.3** 9.2** 3.2** 1.0 1.0 0.9 1.8*C (CF) 5.4 3.1 1.5 0.8 0.6 0.7 0.8*D (IPF etc.) 5.3** 3.3** 1.4* 1.1 0.6* 0.7* 1.3*E (Pediatric � 12 y/o) 1.5 0.7 0.7 0.4 0.6 0.7 0.7

1Groups A, B, and D include main Dx plus others with similar WL survival (Murray et al.AJT 2002; 2 (Suppl 3): A#524). **p � .0001, *p � .05.

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RISK FACTORS FOR DEATH AFTER LUNG TRANSPLANT INTHE UST. Egan,1 K. McCullough,2 S. Murray,2 R. Bustami,2 R. Merion,2

E. Garrity,3 F. Grover,4 W. Ring,5 R. Robbins,6 E. Trulock,7 D. Wood,8

L. Edwards,9 1UNC, NC; 2SRTR/URREA, MI; 3Loyola, IL; 4U CO,CO; 5U TX-SW, TX; 6Stanford, CA; 7Wash U, MO; 8U WA, WA;9UNOS, VA

We previously analyzed UNOS data from patients (pts) having lungtransplant (LTX) with the 4 most common diagnoses to identify riskfactors (RF) for death after LTX, limiting the analysis to �80% of pts.Analysis of pediatric pts showed that pts �11 yrs should be groupedwith adults. Analysis of waitlist and post-LTX survival for otherdiagnoses resulted in 4 adult diagnostic groups and a 5th pediatricgroup. RF associated with increased risk of death while waitig were

S146 Abstracts The Journal of Heart and Lung TransplantationJanuary 2003