Results: Of the 20 subjects treated with azithromycin, 19 (95%) were still alive 2 years post initiation of therapy and 17 (85%) patients at 3 years. For the group, the initial increase in FEV 1 was maintained at 12 months, with 89% of patients showing stable or improved lung function (Fig, median 90mls (range -410 to 770mls), p = 0.03). At years 2 and 3 group improvement in FEV 1 was not statistically significant, with a wide range between individuals. Four subjects at year 2 and five at year 3 deteriorated from the pre-therapy baseline, the remaining subjects maintained the original improvement in spirometry. (Fig). Conclusions: Previously the best results of interventions have been to modify the gradient of lung function decline in BOS. Although this is a retrospective, descriptive study of a small patient series, this extended follow up does highlight that some BOS patients treated with Azithromycin gain an improvement in lung function, which can be maintained for 3 years. Further controlled studies of this effect are required. 113 Effectiveness of Hormonal Resuscitation Therapy and Control of Central Venous Pressure on Increasing Organs for Transplant T.M. Abdelnour, 1 S. Rieke, 11 Procurement, LifeSource, St. Paul, MN Purpose: Hormonal Resuscitation Therapy (HRT) has been shown to increase hearts for transplant. Likewise, optimal fluid balance, as measured by central venous pressure (CVP) impacts the function of donor lungs. The purpose of this study is to examine the interplay of these two variables in Donor Management and the impact they have on organs transplanted, specifically hearts and lungs. Methods and Materials: Donor management was standardized in the regional OPO to include utilization of HRT in combination with a goal CVP of 4-6 on brain dead donors. An 8-month cohort of 58 Standard Criteria Donors (SCD), aged 10-60 was compared with a control cohort of 76 donors of the same specifications, from the same 8-month time period of the previous year. The previous cohort was managed with the goal of CVP 4-6, but with no standardization of the application of HRT. The impact of HRT, CVP, and the combination of the 2 variables in relation to individual organ outcomes were evalu- ated. Results: An increase of 24% in overall organs transplanted per donor (OTPD) was realized in donors where HRT was applied for 20 or more hours in combination with a CVP 10, versus when these variables were not met. Hearts and lungs transplanted from this group increased 69% and 164%, respectively. Kidneys and pancreas were increased 3% and 8%, respectively. When looking at variables inde- pendently, lung outcomes are most strongly associated with CVP, with a 248% increase with CVP 10. Heart outcomes are impacted by both variables independently, with a 48% increase with HRT applied 20 hours or more, and a 37% increase with a CVP 10. Conclusions: The standardization of HRT, in combination with a CVP 10, significantly increases the utilization of hearts and lungs for transplant, without negatively impacting other organ systems. HRT and CVP Impact on Hearts and Lungs OTPD Hearts/Donor Lungs/Donor HRT 20 hrs and CVP 10 3.88 0.49 0.33 HRT 20 hrs and CVP 10 4.82 0.82 0.88 114 The Impact of Donor Mechanism of Death on Survival and Rejection after Heart Transplantation R.A. Bello, 1 D.A. D’Alessandro, 1 R.J. Frumento, S. Maybaum, 2 D.J. Goldstein, 11 Department of Cardiothoracic Surgery, Montefiore-Einstein Heart Center, Bronx, NY; 2 Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY Purpose: Brain death has been shown to adversely affect myocardial function. Studies examining the influence of donor mechanism of death on post-transplantation survival and rejection have been limited by small sample size and contradictory results. We examine the role of donor mechanism of death on post-transplantation survival and rejection. Methods and Materials: UNOS provided de-identified patient data including all adult patients (n=35,749) undergoing heart transplanta- tion between October 1, 1987, and October 1, 2006. The 3 most commonly reported mechanisms of donor brain death were gunshot wound (GSW) (13.4%), blunt injury (BI) (27.5%) and intracranial hemorrhage/stroke (ICH) (28.6%). Median post-transplantation sur- vival and time to first rejection episode between these 3 groups was compared. Survival was estimated using the Kaplan-Meier method and compared using the log rank test. Cox regression was performed to determine the impact of donor mechanism of death adjusted for the effect of other predictors of survival. Results: When compared to BI (3850 days) and GSW (3925 days), median post-transplantation survival was decreased for patients receiving allografts from donors succumbing to ICH (3399 days) (both p0.0005). On multivariate analysis, the mechanism of brain death did not predict mortality while UNOS status IA (HR=1.46, p=0.046), female recipient gender (HR=1.11, p0.0005), donor age (HR=1.01, p0.0005), and ischemic time (HR=1.11, p0.0005) were predictive. When compared to BI (4302 days) and GSW (5297 days), mean freedom from rejection was increased for recipients of allografts from donors succumbing to ICH (5910 days) (both p0.0005). On multivariate analysis, the mechanism of brain death did not predict rejection while UNOS status IA (HR=0.81, p=0.002) and IB (HR=0.81, p=0.002), female recipi- ent gender (HR=1.14, p=0.03), and recipient age (HR=0.98, p0.0005) were predictive. Conclusions: In this large cohort, the donor mechanism of death did not significantly impact post-transplantation survival or freedom from rejection. 115 A Significant Association of Primary Graft Dysfunction (PGD) among Pulmonary, Renal and Cardiac Transplantation from a Same Multi-Organ Donor S100 Abstracts The Journal of Heart and Lung Transplantation February 2008