330 LONG-TERM OUTCOME OF COMBINED HEART-LUNG TRANSPLANTATION: PRIMARY PULMONARY HYPERTENSION VS. SECONDARY PULMONARY HYPERTENSION DUE TO CONGENITAL HEART DISEASES Y. Toyoda, 1 R. Santos, 1 J. Thacker, 1 J. Bhama, 1 D. Nguyen, 1 C. Bermudez, 1 B.G. Hattler, 1 R.L. Kormos, 1 J. Pilewski, 2 D. McNamara, 2 K.R. McCurry, 11 Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; 2 Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA Purpose: Previously, we have shown that the mid-term outcome of cardiopulmonary transplantation for congenital heart diseases (CHD) is comparable to that for non-CHD adults. However, the long-term outcome of combined heart-lung transplantation for CHD as com- pared to primary pulmonary hypertension (PPH) remains unknown. Methods and Materials: Retrospective analysis of prospectively collected data was performed for 52 patients with PPH and 41 with CHD who underwent combined heart-lung transplantation from 1982 to 2006. Results: There was no significant differences between PPH and CHD in recipient age (35.5+/-1.3 vs. 33.7+/-1.4 years old), recipient gender (18male/34female vs. 20male/21female), donor age (26.4+/- 1.8 vs. 23.0+/-2.0 years old), and donor gender (25male/27female vs. 22male/19female). The preoperative systolic, diastolic and mean pulmonary artery pressures were significantly (p0.05) higher in CHD vs. PPH (109+/-8 vs. 86+/- 4mmHg, 58+/-5 vs. 40+/-3mmHg, and 74+/-5 vs. 57+/-3mmHg). The ischemic time was significantly (p0.05) longer in CHD vs. PPH (244+/-15 vs. 210+/-13 minutes). There was no significant difference in overall survival between PPH and CHD with 10-year survival of 30.2+/-6.9% and 32.2+/-7.5%. However, for patients who received combined heart-lung transplant after July of 1993, over all survival in PPH patients (n=9) is signifi- cantly (p=0.015) better than that in CHD (n=18) with 100% 10-year survival vs. 40.7+/-2.3%. Conclusions: The long-term outcome of combined heart-lung trans- plantation remains quite poor for congenital heart diseases with little evidence for improvement in the past decade although significantly better survival has been observed for primary pulmonary hyperten- sion. 331 GENE EXPRESSION PROFILES IN PERIPHERAL BLOOD FOR THE NONINVASIVE DIAGNOSIS OF CHRONIC LUNG ALLOGRAFT REJECTION S.M. Studer, 1 T. Richards, 1 W. Wu, 1 K.R. McCurry, 2 N. Kaminski, 1 1 Division of Pulmonary, Allergy & Critical Care, University of Pittsburgh, Pittsburgh, PA; 2 Division of Thoracic & Foregut Surgery, University of Pittsburgh, Pittsburgh, PA Purpose: BOS is the leading cause of late death following lung transplantation. Early noninvasive detection of BOS is desirable as it would allow earlier therapeutic intervention. We hypothesized that the changes in gene expression in peripheral blood mononu- clear cells (PBMCs) would distinguish between chronic rejection (OB) and no evidence of rejection (NER) following lung transplan- tation. Of particular interest was expression of C-C and C-X-C motif chemokine receptors since CCR5 expression was significantly up-regulated and CXCR4 was significantly down-regulated in PB- MCs from subjects with acute graft rejection in our previous cross-sectional study. Methods and Materials: We evaluated gene expression profiles in a cross sectional study of 30 lung transplant recipients (LTRs) divided between OB (n=14) and no evidence of rejection (NER, n=16). Blood was obtained from consented subjects by venipunc- ture at time of routine outpatient visits in CPT tubes and PBMCs stored at -80 degrees in Trizol until batched RNA isolation. We utilized an Illumina platform representing 23,454 genes. Results: Preliminary analysis of our data reveals a gene expression profile in circulating PBMCs that distinguishes OB from NER. CCR2 expression was significantly upregulated in OB compared to NER (p0.05) while CCR5 and CXCR4 were not differentially ex- pressed. Conclusions: Early results of PBMC gene expression profiles suggest a noninvasive biomarker signal in LTRs PBMCs that may distinguish OB from NER. Specifically, CCR2 expression was significantly increased consistent with previously published work of Belperio et. al (J Clin Invest. 2001 Aug;108(4):547-56) demon- strating increased CCR2 expression in a murine model of OB. Furthermore, the lack of differential expression of CCR5 and CXCR4 suggests that the PBMC profile in OB may be distinct from that observed in acute lung graft rejection. These findings will be amenable to future validation by RT-PCR studies and longitudinal gene expression studies of LTRs. 332 DOES THE UNOS LUNG ALLOCATION SCORE PREDICT EARLY MORTALITY IN LUNG TRANSPLANTATION? EARLY OUTCOMES WITH THE NEW US ALLOCATION SYSTEM A.S. Shah, 1 C.A. Merlo, 2 M.C. Borja, 1 M. Diener-West, 3 J.V. Conte, 1 J.B. Orens, 21 Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, MD; 2 Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; 3 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Purpose: The UNOS/OPTN Lung Allocation Score (LAS) has dramat- ically changed organ allocation in lung transplantation (LT). The impact of this change on patient outcomes is unknown. The purpose of the study was to examine mortality within one year after LT under this new system. Methods and Materials: All patients undergoing LT reported to UNOS during the period May 1, 2005 through July 15, 2006 were included in the study. The cohort was divided into quintiles by LAS. For a comparison analysis, a High Risk (H) group (LAS  44.4) and a Low Risk (L) group (LAS  44.4) were constructed. A time-to-event analysis for risk of death after LT was performed. Cox proportional hazards models were constructed to identify risk factors for death after adjusting for potential confounders. Results: There were 1,486 patients who underwent LT during the study period. The mean follow-up time for the cohort was 61.5 days. The average age was 50.514.7 and 44.4% were females. Patients in the H group were more likely to have IPF (49% vs 23%, p.001), incr. O2 req., be hospitalized at time of LT and have longer ischemic times and hospital stays. The H group was similar with respect to age, BMI, pCO2, and donor characteristics when compared with patients in the L group. One year survival was significantly worse in the H group (56% vs 73%, p = .0001 log rank). Patients in the H group were also found to have increased risk of death (HR=2.1, 95% CI 1.5 - 3.0) when compared to the L group. Conclusions: This study reveals important consequences of the LAS system. First, mortality is significantly worse than previous reports. More importantly, the risk of death is significantly increased among patients with a LAS  44.4. The Journal of Heart and Lung Transplantation Abstracts S179 Volume 26, Number 2S