Incomes High School High School Diploma (N = 109) College Degree (N = 95) Professional Degree (N = 35) $50,000 87.5% 60% 39% 15% $50,000 - $100,000 12.5% 24% 33% 42% $100,000 - $200,000 0% 10% 19% 21% $200,000 0% 6% 9% 22% 589 A Participatory Approach to Online Education and Support Curriculum Development for Parents of a Child with a Heart Transplant D.B. Nicholas, 1 L.J. West, 2 S. Urschel, 2 B. Dodd. 31 Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, AB, Canada; 2 University of Alberta, Edmonton, AB, Canada; 3 Alberta Health Services, Edmonton, AB, Canada. Purpose: Pediatric heart transplant (HTx) offers life-saving outcomes; however it also introduces complex care requirements. Families must navigate care demands and multiple health care relationships associated with HTx follow up. The provision of effective education and support may be critical in determining how well families manage care demands. To support parents and their families, this project comprised an evidence- informed process of developing pediatric HTx support curriculum. This curriculum was ultimately used in a pediatric online parent support inter- vention trial that is currently underway. Methods and Materials: Development of this curriculum reflected a mixed methods approach drawing from participatory action research. This comprised an initial extensive review of the pediatric HTx family educa- tion and social support literature, and subsequent qualitative interviews with key informants regarding (i) informational and educational needs of families, and (ii) optimal means to convey that information. Participants included n=10 interdisciplinary team members (medicine, surgery, nurs- ing, social work, rehabilitation medicine, nutrition, education and research methodology) and n=8 patients and parents. Results: Key domains included: HTx care management, innovation in HTx treatment, quality of life, transitions, impacts on family relationships, and strategies for moving forward. Participants recommended information and support that is evidence-informed, user-friendly, interactive and suited to both novice and experienced families in HTx. Participants strongly supported the use of web applications in order to increase information and support accessi- bility. Conclusions: These findings inform curriculum development, knowledge translation and capacity building for families, online application in social support provision, and parent experience relative to pediatric HTx. 590 Long-Term Outcome of Pediatric Heart Transplant Patients with Incidental Subclinical Cellular Rejection during Annual Study M.A. Kuhn, 1 D.D. Deming, 1 J. Fitts, 1 L.L. Bailey, 2 R.E. Chinnock. 1 1 Pediatrics, Loma Linda University Children’s Hospital, Loma Linda, CA; 2 Cardiothoracic Surgery, Loma Linda University Children’s Hospital, Loma Linda, CA. Purpose: Positive biopsies (Bx+) have been found late in children during their annual study and have been considered subclinical rejection. This study retrospec- tively evaluated the long-term outcome of patients (pts) who had one or more Bx+ during their annual study compared to those biopsy negative (Bx-). Methods and Materials: All children who had a heart transplant (tx) at our institution were included except those followed elsewhere, or died or had a recent tx. Bx + was defined as either a 3A or 2R bx found on annual catheterization on/after the 3rd year. Outcome variables included graft loss (GL), death, retx, cellular/vascular causes (e.g. allograft vasculopathy, chronic graft dysfunction, acute rejection), and other causes (e.g. sepsis, lymphoma). Variables were com- pared using chi-square. Freedom from GL was evaluated using Kaplan-Meier analysis. Student’s t-test was used to evaluate the differences between the groups. A p-value  0.05 was considered significant. Results: 267 pts met inclusion criteria. (Bx-: 184, Bx+: 82, time of Bx+: 3-18 years post-tx). There was no statistical difference in tx age or follow-up. Bx+ pts had a higher incidence of GL (p=0.003), a higher death rate (p=0.038), and occurred from cellular/vascular causes (p=0.002). Other causes and retx were not significantly different. The bx+ group had a lower rate of survival (0.33  0.09 vs. 0.63  0.05, p = 0.05) at 23 yrs compared to the bx - group. Conclusions: Pts who have incidental 3A/2R biopsies had a poorer long- term outcome compared to those who were Bx-. This group suffered from a significantly higher incidence of cellular or vascular disease as the cause of graft loss. The cause of this difference is unclear. 591 Waiting List Risk Factors in Pediatric Heart Transplant Center in the Developing Country A.S. Cauduro,L.F.P. Moreira, C. Tanamati, L.F. Caneo, J. Penha, M.B. Jatene. Pediatric Cardiac Surgery Unit, Heart Institute of Sao Paulo University School of Medicine, Sao Paulo, SP, Brazil. Purpose: Most of data upon waiting list risk factors are based in studies done in developed countries. In this study we aimed to identify what are these risk factors in a health system enviroment of a developing country like Brazil. Methods and Materials: Time on the waiting list was defined as the time of initial listing to the time of removal due a transplant, death, recovery or removed. Survival time in the waiting list was estimated using the Kaplan- Meier method. Univariate and multivariate relationships were evaluated with the Cox proportional hazards model. Results: Of 222 patients the median age was 3.9 yrs, median weight 13 Kg; female 52%. Dilated cardiomyopathy 62%, congenital heart disease 25%, restrictive cardiomyopathy10%, chronic graft failure 3%. We had 45%listed as priority. 41% transplant, 40% died, 14% were removed, 5% are still waiting. Survival were 73% in 30 days, 60% in 90, 51% in 6m. S204 The Journal of Heart and Lung Transplantation, Vol 31, No 4S, April 2012