Total cholesterol LDL cholesterol baseline 6–12 weeks baseline 6 weeks Study 211 mg/dl 177 mg/dl (p = 0.003) 125 mg/dl 98 mg/dl (p = 0.0006) (168–244) (136–241) (73–161) (57–146) Controls 184 mg/dl 188 mg/dl (NS) 110 mg/dl 109 mg/dl (NS) (126–237) (136–241) (76–180) (79–194) 124 STENOSIS OF CAVAL CONNECTIONS IN ORTHOTOPIC HEART TRANSPLANTATION: AN UNDERESTIMATED COMPLICATION? W. Tack, F. Wellens, M. Goethals, J. Bartunek, H. Vandekerckhove, R. De Geest, I. Degrieck, F. Van Praet, H. Vanermen, Heart Failure and Transplant Program, Onze Lieve Vrouw Clinic, Aalst, Belgium Objective: To evaluate the incidence of a caval gradient and/or stenosis after Bicaval Orthotopic Heart Transplantation (HTx) and to analyze its clinical impact. Methods: Prospective analysis of 31 patients, out of a group of 67 pts who did undergo HTx with bicaval anastomoses between April 1996 and March 2001, underwent evaluation of the caval vein anastomoses between July 2000 and September 2001. The study population consisted of 24 men and 7 women, mean age 59 years (y)(age range 38-70 y). Indication for HTx was ischemic heartdisease in 15 patients, congestive ideopathic cardiomyopa- thy in 14 pts and valvular cardiomyopathy in 2 patients. All patients did undergo pressure gradient measurements at the superior and inferior caval anastomosis during routine biopsy or at the first annual checkup. Results: Seventeen patients presented with inferior vena cava (IVS) stenosis with a mean gradient of 5.0 mmHg (2.2 mmHg). Three pts presented with superior vena cava (SVC) stenosis with a mean gradient of 3.8 mmHg (1.9 mmHg). Clinical symptoms were present in 2 pts with IVC stenosis, however none of the patients with SVC stenosis was symptomatic. Angiography was performed in 2 pts with IVC stenosis, stenting was performed in one of them. Conclusion: In Bicaval Orthotopic HTx, stenotic anastomosis of caval veins is present in a considerable number of patients and is more frequent at the inferior site. Invasive interventions are required in the group of patients with residual symptoms resistant to medical therapy. 125 THE POSITVE B-CELL CROSSMATCH: ARE ALL CROSSMATCHES CREATED EQUAL? B.K. Rayburn, J.K. Kirklin, R.N. Brown, J.F. George, J.M. Thomas, R.W. Senkbeil, A.L. Lobashevsky, D.C. McGiffin, R.C. Bourge, R.L. Benza, B.A. Foley, Transplantation, University of Alabama at Birmingham, Birmingham, AL The ominous implications of a positive B-cell crossmatch(B- CCM) at the time of transplant(Tx) have been previously re- ported. To evaluate the incidence and outcome of a positive BCCM with recent modes of immunosuppression (Immun), the following analysis was undertaken. Methods: Between 1/1997 and 1/1/2000, 121 patients(pts) under- went primary Tx at one center, all with a prospective or retro- spective crossmatch by flow cytometry(FC). A BCCM was posi- tive(pos) if the number of channel shifts, compared to negative(neg) controls, on FC exceeded 70. Autocrossmatches were not routinely performed. No pt was denied Tx because of a pos BCCM (all T-cell crossmatches at Tx were neg). Results: The FC BCCM was pos in 74 of 121 (61%) pts. The incidence of pos BCCM varied by year (34% in 1997, 59% 1998, 96% 1999, 67% 2000). The median number of FC channel shifts for all pts (and those with pos BCCM) by Tx year were: 1997 34(131), 1998 79(132), 1999 209(210), 2000 98(140). Among pos BCCM pts, OKT3 induction (7-10d) was used in 47(64%), Zenapax alone in 6(8%), Zenapax/placebo study in 7(9%) and no induction in 14(19%). Among all pts, the 1, 2 and 4 yr actuarial survival was 92%, 88%, and 86%. Actuarial survival at 2 yrs was highest (93%) for pts with pos BCCM who received OKT3 induction, compared to 78% for those with pos BCCM without OKT3 induction, although differences may be due to chance (p=.12). Cumulative rejection was less in pos BCCM group treated with OKT3 induction (1.6 episodes at 1 yr) vs. no OKT3 (2.3 episodes, p=.05). Rejection with hemodynamic compromise was less frequent in pos BCCM with OKT3 than without (13% vs 36%, p=.05). Inferences: 1) The potentially adverse effect of pos BCCM on cumulative rejection is in part neutralized by OKT3 induction. 2) Survival and freedom from graft dysfunction is excellent with OKT3 induction in the presence of pos BCCM. 3) The variability in pos BCCM between Tx yrs and among institutions suggests differences in FC methodologies, sensitivity and specificties. 126 ARE NON-BRAIN-STEM-DEAD CARDIAC DONORS ACCEPTABLE DONORS? H. Luckraz, J. Parameshwar, K. McNeil, S. Tsui, J. Dunning, J. Wallwork, S. Large, Papworth Hospital, Cambridge, United Kingdom The deleterious effects of brain stem death (BSD) on donor cardiac function and endothelial integrity have been previously documented in the literature. Moreover, there is now emerging evidence of endothelial cell activation in hearts explanted from cystic fibrosis patients. Aim: This study evaluates acute and chronic rejection in heart recipients of BSD donors (cadaveric) compared to domino hearts explanted from cystic fibrosis patients who underwent heart-lung transplantation. Methods and Results: Patients who underwent cardiac transplan- tation between April 1989 and August 2001 at Papworth Hospital were included (n=571). Domino donor hearts were used in 81 (14%) of cases. Two year actuarial survival rates (95% CI) were 78%(69%, 87%) and 69% (65%, 73%) in the domino and cadaveric groups respectively. There was no difference in 30-day mortality (5.1% v 8.7%, p=0.38) or in actuarial survival (p=0.72). Ischaemic time was significantly longer in the cadaveric group (p0.001). Acute rejection and infection episodes were not significantly different (p= 0.24 & 0.08). Relative to the cadaveric group, the risk (95% CI) of acute rejection in the domino group was 0.89 (0.73, 1.08). Similarly, the relative risk of infection was 0.78 (0.59, 1.03). Angiography data at 2 years or later was available in 50 (62%) and 254 (52%) of the domino and cadaveric patients respectively. The 2-year “freedom from CAV” rates were 96% (91,100) and 93% (90, 96) respectively. Conclusion: Despite the effect of endothelial cell activation, domino hearts perform as well as those retrieved from BSD- donors with no difference in acute and chronic rejection episodes. 100 Abstracts The Journal of Heart and Lung Transplantation January 2002