Conclusions: SRI derived from TDI could be of clinical value in monitoring sub-clinical acute rejection in heart transplant recipients. 460 EZETIMIBE EFFECTIVELY LOWERS LDL CHOLESTEROL IN CARDIAC ALLOGRAFT RECIPIENTS ON STABLE STATIN THERAPY M.H. Konstandin, 1 S. Celik, 1 A. Do ¨sch, 1 A. Koch, 2 F.-U. Sack, 2 H.A. Katus, 1 T.J. Dengler, 11 Cardiology, Universita ¨tsklinik Heidelberg, Heidelberg, Germany; 2 Cardiac Surgery, Universita ¨tsklinik Heidelberg, Heidelberg, Germany Purpose: We prospectively investigated the tolerability and efficacy of daily treatment with 10mg ezetimibe in 28 heart allograft transplant patients already on stable statin therapy (mean equivalent dose of 49.3  4.3 mg pravastatin). Methods and Materials: Total cholesterol (TC), LDL-cholesterol (LDL- C), HDL-cholesterol (HDL-C), triglycerides (TG), immunosuppressant drug levels, creatinine, liver enzymes, creatine kinase, full blood count, blood pressure and heart rate were measured before, 4 months after and 1 year after initiation of ezetimibe treatment. Results: Ezetimibe was generally well tolerated, nausea (n= 2) and dizziness (n= 2) resolved spontaneously; only two patients discontin- ued ezetimibe due to stomach pain or headache. Mean TC decreased from 222.6  6.9 mg before ezetimibe therapy to 200.0  8.6 mg after 4 months and to 191.2  6.2 mg after one year (p0.01). Mean LDL-C decreased from 135.5  5.7 mg to 118.2  7.9 mg (month 4) and to 102.6  4.9 mg (one year) (p0.001). 21 patients showed a relative reduction of LDL-C ranging from 12.5% to 56.2% independent of statin dose; 5 patients did not show any reduction of LDL-C. TG and HDL-C were unchanged. There was a slight increase of AST concentrations after one year of ezetimibe therapy; immunosup- pressant drug doses and concentrations were unchanged as well as other laboratory and clinical parameters. Conclusions: Ezetimibe appears a safe and effective therapy for further reduction of TC and LDL-C in heart allograft recipients already on stable statin therapy. 461 RECURRENT MILD REJECTION IN THE FIRST YEAR AFTER HEART TRANSPLANTATION DOES NOT AFFECT OUTCOMES: VALIDATION OF THE REVISED ISHLT GRADING SYSTEM J.K. Patel, 1 J.C. Kawano, 1 G.W. Wu, 1 L. Chinakarn, 1 M.A. Kawano, 1 B.I. Kobashigawa, 1 M.M. Kittleson, 1 A.L. Gordon, 1 S.M. Kagimoto, 1 J.A. Kobashigawa, 11 Medicine, University of California at Los Angeles, Los Angeles, CA Purpose: There is contention as to whether recurrent mild rejection in the first year after heart transplantation is associated with poor out- come. The revised ISHLT grading system combines 1A and 1B rejection into one category of mild rejection, implying that there is no clinical significance to these grades of rejection. This study examined the clinical significance of recurrent mild rejection in patients in their first year after transplant. Methods and Materials: We reviewed 292 heart transplant patients transplanted between 1994 and 2001 on cyclosporine (N=256) or tacrolimus (N=36) based immunosuppression who survived to one year. None of these patients received induction immunosuppression. Patients were divided into those with recurrent mild rejection and those without. Recurrent mild rejection was defined as  50% of at least 10 endomyocardial biopsies with ISHLT grade 1A or 1B in the first post-transplant year. Five year survival and incidence of cardiac allograft vasculopathy (CAV) were recorded for both groups. Results: There were 49 patients with and 243 patients without recurrent mild rejection. Between the recurrent mild rejection group and the control group, survival (87.8% vs. 87.6%, p= 0.96) and the incidence of CAV (71.4% vs. 68.3%, p= 0.57) was comparable. Further- more, the grade of recurrent rejection (1A or 1B) did not effect outcomes. Conclusions: Recurrent mild rejection in the first year after transplant is not associated with adverse outcomes. This data validates the new ISHLT classification system which combines grade 1A and 1B rejection and supports current clinical practice of not augmenting immunosup- pressive therapy in response to mild rejection. Astellas, Novartis, Roche, XDx. 462 EVOLUTION OF RENAL FUNCTION AND PROGNOSTIC IMPLICATIONS OF IMPAIRED RENAL FUNCTION ONE YEAR AFTER HEART TRANSPLANTATION S. Arora, 1 A.K. Andreassen, 1 S. Simonsen, 1 A. Relbo, 1 O. Geiran, 2,3 L. Gullestad, 11 Department of Cardiology, Rikshospitalet- Radiumhospitalet Medical Center, Oslo, Norway; 2 Department of Cardiothoracic Surgery, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway; 3 Faculty Division Rikshospitalet, University of Oslo, Oslo, Norway Purpose: Impaired renal function in end-stage heart failure, which in large part is due to deteriorated hemodynamics, is a risk factor for all-cause mortality. After heart transplantation (HTx), hemodynamics improve but the implication of impaired renal function is unclear. We assessed the effect of impaired renal function prior to HTx and at one year post-HTx on mortality. Methods and Materials: 381 consecutive adult HTx recipients attend- ing their first annual follow-up were studied. Median follow-up was 7.4 years and data regarding age, gender, smoking, HTx etiology, hyperten- sion, diabetes, drug regime, serum creatinine, cholesterol and donor data was collected. Estimated GFR (ml/min/1.73 m 2 ) was calculated using the MDRD formula. Results: Overall, 199 (52%) patients had impaired renal function (GFR60) at one year post-HTx and 122 patients died during the follow-up period. Multvariate Cox analysis identified GFR at one year post-HTx as a predictor of mortality with an adjusted hazard ratio (HR) of 1.6 (95% CI 1.1-2.4;p= 0.02) for patients with a GFR between 30-60 and 3.2 (95% CI 1.4-7.2; p=0.006) for GFR30. Impaired renal function prior to HTx was not associated with an increased risk of mortality. S226 Abstracts The Journal of Heart and Lung Transplantation February 2007