305.4 Alemtuzumab Induction in Intestinal Transplantation is Associated with a Significantly Lower GVHD Incidence: results from 275 patients at a single center. Ahmed Farag 1,2 , Thiago Beduschi 1 , Gennaro Selvaggi 1 , Jeffrey J. Gaynor 1 , Akin Tekin 1 , Seigo Nishida 1 , Ji Fan 1 , Mahmoud Morsi 1 , Jennifer Garcia 1 , Rodrigo Vianna 1 1 Miami Transplant Institute, University of Miami, Miami, FL, United States; 2 Department of Surgery, University of Zagazig School of Medicine, Zagazig, Egypt. Introduction: Graft versus host disease (GVHD) is commonly associated with high morbidity and mortality after intestinal transplantation. Thus, we wanted to better understand the effect of different induction immunosuppres- sion protocols and type of intestinal transplant on the incidence rate of devel- oping GVHD. Methods: We retrospectively reviewed 275 intestinal transplants from 2 eras at Miami Transplant Institute: 52 consecutive cases transplanted during 2013–2015 (the most recent era) who received rabbit anti-thymocyte globu- lin(rATG) (2mg/kg x5 over 8 days) as induction vs. 223 patients transplanted from an earlier era (during 1994–2012) who received either no induction (n=28), anti-CD25 (Daclizumab or Basiliximab)(n=90), Alemtuzumab(n=87), or rATG(n=18) as induction. Type of intestinal transplant included: isolated in- testine(I)(n=84), liver-intestine(LI)(n=20), modified multivisceral(MMV)(n=30), and full multivisceral(MV)(n=141). Morbidity and mortality due to GVHD were compared by type of intestinal transplant received and induction immunosup- pression protocol used. Results: GVHD developed in 15.8% (27/171) of MMV/MV recipients vs. 1.0% (1/104) of I/LI recipients (P=.00008); all 28 events occurred during the first 18 months post-transplant. GVHD incidence was significantly lower in the Alemtuzumab group, 2.3%(2/87), vs. 11.0% (13/118) in the no induction/anti-CD25 groups combined vs. 18.6% (13/70) in the rATG groups (P=.003). Within the subgroup of 171 MMV/MV recipients, the incidence of GVHD was 4.2% (2/48) in the Alemtuzmab group vs 17.4% (12/69) in the no induction/anti-CD25 group and 24.1% (13/54) rATG group (P=.009). Death due to GVHD occurred during the first 36 months post-transplant in 35.7% (10/28) of patients who developed GVHD. Conclusion: The results showed the higher incidence of GVHD with rATG induction immunosuppression protocol and the lower incidence of GVHD wth Alemtuzumab induction immunosuppression protocol in MV/MMV recipients. 305.5 Post Transplant Lymphoproliferative Disorders and Intestinal Transplant in Children - single center experience Yung Ching Ming 1,2 1 Transplant Surgery, Children's Hospital of UPMC, Pittsburgh, PA, United States; 2 Pediatric Surgery, Linkou CGMH, Taoyuan, Taiwan. Introduction: Post transplant lymphoproliferative disorders (PTLDs) are im- portant and potentially lethal complication post intestinal transplant. We pres- ent herein our experience of pediatric intestinal transplantation with PTLDs to evaluate their relationship and to identify possible risk factors. Methods: From July 1990 to June 2016, the medical record of patients who underwent small bowel transplant in our institute were evaluated retrospec- tively. The types of graft included isolated small bowel (ISB), liver and small bowel (LSB) and multivisceral or modified multivisceral (MV or MMV). We di- vided the patients into several different groups to explore the risk factors of PTLDs. The criteria of grouping included the presence of PTLDs, type of graft, medications for pre-transplant immunoreduction, pre-transplant recipient Epsein-Barr virus (EBV) serology. The parameters for analysis included the pa- tients' demographic data, incidence of PTLDs and survival rate in each group. Results: There were 138 males and 106 females with the mean age of 5.3 years old. The overall incidence of PTLDs 21.7%(53/244). The graft for the transplantation included ISB (n=96), LSB (n=109) and MV or MMV (n=39). With avaliable record of EBV PCR since 2001, almost all our patients with PTLDs were EBV related (25/26, 96.2%). In addition, the incidence of PTLDs increased significantly with the increase of patients' age at operation. How- ever, the use of thymoglobulin for pre-transplant immunoreduction could sig- nificantly reduce the incidence of PTLDs and improved both one year and five years survival rate. There was no significant relationship between the in- cidence of PTLDs to the gender of patient, type of graft, pre-transplant recip- ient EBV serology and donor EBV serology. Conclusion: EBV infection and increased patient's age at transplant are risk factors of PTLDs in the children post intestinal transplant. Besides, optimal use of thymoglobulin for pre-transplant immunoredution could reduce the risk of PTLDs and improve the outcome after intestinal transplantation in our series. However, large prospective randomized studies are needed for the further identi- fication of the risk factors between PTLDs and pediatric intestinal transplantation. References: 1. Nassif S., Kaufman S. et al. Clinicopathologic features of post- transplantlymphoproliferative disorders arising after pediatric small bowel transplant. Pediatr Transplant. 2013 Dec;17(8):765–73. 2. Ramos E., Hernández F. et al. Post-transplant lymphoproliferative disor- ders and other malignancies after pediatric intestinal transplantation: inci- dence, clinical features and outcome. Transplant.2013 Aug;17(5):472–8. 3. Perry AM., Aoun P. et al. Early onset, EBV(-) PTLD in pediatric liver- small bowel transplantation recipients: a spectrum of plasma cell neoplasms with favorable prognosis. Blood. 2013 Feb 21;121(8):1377–83. 4. Quintini C., Kato T. et al. Analysis of risk factors for the development of posttransplant lymphoprolipherative disorder among 119 children who re- ceived primary intestinal transplants at a single center. Transplant Proc. 2006 Jul-Aug;38(6):1755–8. 5. Müller AR., Pascher A. et al. Small bowel transplantation - current status and initial. Zentralbl Chir . 2003 Oct;128(10):849–55. 6. Green M., Bueno J. et al. Predictive negative value of persistent low Epstein-Barr virus viral load after intestinal transplantation in children. Trans- plantation. 2000 Aug 27;70(4):593–6. 7. Finn L., Reyes J. et al. Epstein-Barr virus infections in children after transplantation of the small intestine. Am J Surg Pathol. 1998 Mar;22(3): 299–309. 8. Kocoshis SA. Small bowel transplantation in infants and children. Gastroenterol Clin North Am. 1994 Dec;23(4):727–42. S36 Transplantation ■ June 2017 ■ Volume 101 ■ Number S6-2 www.transplantjournal.com Copyright © 2017 Wolters Kluwer Health, Inc. 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