factors were rare and were not found to be associated with 30-day mortality in this cohort: 11 factors were excluded (RECIPENT: large male, raised PVR, circulatory support prior to transplant, diagnosis, age, gender; DONOR: inotropic support, history of drug abuse, diabetic, gender and size mis-match) and 7 were retained - RECIPIENT: peripheral vascular disease (Odds Ratio 3.5 (1.2– 10.0)), pre-transplant ventilation (2.6 (1.0 –7.1)), diabetes (2.0 (1.1–3.5)), creatinine clearance  50 mls/min at HTx (1.9 (1.2– 2.9)), 1 previous open heart operation (1.6 (0.9 –2.9)), ORGAN ischaemia time (1.4 (1.1–1.8) per increase in category from 2hrs to 2–3hrs to 3–4 hrs to 4hrs) and DONOR age (1.3 (1.1–1.6) per increase in category from 26yrs to 26 – 40yrs to 41–55yrs to 55yrs). The model showed good calibration (test for lack of fit: p = 0.57 for D and p = 0.44 for V), and moderate discrimination (area under ROC curve: 0.67 for D and 0.74 for V). This model has been used to risk stratify cases for the purpose of both intra and inter-centre audit and could be used to inform decisions about case selection and also to assist patient consent based on individual risk. 228 RENAL DYSFUNCTION IS MORE LIKELY IN RECIPIENTS BRIDGED TO HEART TRANSPLANTATION WITH INOTROPES THAN WITH LEFT VENTRICULAR ASSIST DEVICES: AN ANALYSIS OF PRE-TRANSPLANT CHARACTERISTICS IN THE MODERN ERA S.G. Drakos, 1 E.M. Gilbert, 1 S.A. Moore, 1 J.C. Stringham, 1 E.H. Hammond, 1 J.W. Long, 1 T.C. Fuller, 1 J.W. Kent, 1 D.A. Bull, 1 S.S. Schmitz, 1 M.E. Hagan, 1 B.A. Campbell, 1 J.W. Folsom, 1 L.A. Stamos, 1 B.D. Horne, 1 D.G. Renlund, 11 Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program, LDS Hospital, University of Utah School of Medicine and Veterans Affairs Medical Center, Salt Lake City, UT Determining which pre-transplant (TX) characteristics predict the development of chronic renal dysfunction (CRD) or mortality after heart TX would enable more accurate risk assessment at the time of candidate evaluation. Methods: A cohort of 278 patients (PTS) underwent TX between 1993 and 2002. Predictive models for CRD (serum creatinine [SCr]  2mg/dl) and allograft loss (death or re-TX) were constructed using logistic and Cox regression,respectively. Results: TX PTS were more likely to develop CRD if they had a larger body surface area (odds ratio [OR] = 5.8 per m2,95% confidence interval [CI] = 1.04 –31.9,p = 0.04),were inotrope dependent (OR = 1.8,CI = 0.90 –3.7,p = 0.09),or were male (OR = 2.7,CI = 0.68 – 10.5,p = 0.16). Interestingly, not having a prior median sternotomy decreased the risk of CRD (OR = 0.59,CI = 0.30 –1.2,p = 0.13) unless it involved the placement of a left ventricular assist device (LVA- D)(OR = 0.30,CI = 0.12– 0.72, p = 0.007). Mortality after TX was higher in women (29% vs 24%), diabetics (36% vs 24%), UNOS status 1 (29% vs 17%), TX with a cytomegalovirus positive donor heart (28% vs 15%), and in PTS with a prior median sternotomy (37% vs 17%). Mortality was lower in PTS with blood type B (B:13% vs. A: 27%,AB: 26%,O: 26%), lower SCr, shorter ischemic time, and in LVAD PTS (19% vs. 27%).Cox analysis demonstrated independent predictive ability of improved survival for males (HR = 0.42,CI = 0.21– 0.83,p = 0.01) and PTS who were ABO blood type B (HR = 0.32,CI = 0.10 –1.1,p = 0.06). Worse survival was observed with prior sternot- omy (HR = 3.5,CI = 2.0 – 6.0,p  0.001),diabetes (HR = 1.9,CI = 0.98 –3.9,p = 0.06),and elevated SCr (HR = 2.8 per mg/dL,CI = 1.3–5.8,p = 0.007). Conclusions:The risk of CRD after heart TX is greater in PTS bridged to TX with inotropes than with LVADs. Certain pre-TX characteristics clearly predispose to the development of CRD and decrease the likelihood of longer term survival after TX. 229 IMPACT OF BODY MASS INDEX ON SURVIVAL FOLLOWING HEART TRANSPLANTATION J. Jimenez, 1 L. Edwards, 3 J. Jara, 1 B. Bednard, 1 S. Pham, 2 S. Mallon, 11 Medicine, University of Miami, Jackson Memorial Med. Ctr., Miami, FL; 2 Surgery, University of Miami, Jackson Memorial Med. Ctr., Miami, FL; 3 Research, United Network Organ Sharing, Richmond, VA Background: Obesity and cachexia have been considered a relative contraindication for heart transplantation. Since the implementation of the UNOS status classification, there has not been a recent evaluation of the impact of body mass index (BMI) on heart trans- plantation. Purpose of the study: To determine the effect of BMI on patient survival up to 36 months following heart transplantation. Methods: All adult (18) heart transplant recipients performed between October 25, 1999 and June 30, 2002 were included in the study. BMI was stratified as underweight (16 –20), normal (20 –27), obese (27–35) and morbidly obese(35). Survival rates were com- puted using the Kaplan Meier method. Rates were compared using the log-rank test statistic. Multivariate analysis was performed using the Cox proportional hazards. Results: A total of 5,042 patients were included in the study. According to our stratification; 345 were underweight, 2,580 were normal weight, 1,917 were obese and 200 were morbidly obese. In multivariate analysis, weight (p = 0.0014) and BMI (p = 0.0001) were considered predictors of death. Kaplan Meier survival curves are shown below. Conclusions: There is a significant impact of BMI and weight on survival. Both, underweight and overweight patients have reduced survival. Despite previous data suggesting poor survival, both over and under weight patients continue to be transplanted. Eligibility for transplantation should be carefully scrutinized in patients with BMI  20 or 35. 230 SILDENAFIL IS EFFECTIVE AND SAFE IN REVERSING PULMONARY HYPERTENSION IN ADVANCED HEART FAILURE J. Alaeddini, P.A. Uber, M.H. Park, R.L. Scott, H.O. Ventura, M.R. Mehra, Ochsner Clinic Foundation, New Orleans, LA The Journal of Heart and Lung Transplantation Abstracts S119 Volume 23, Number 2S