significantly improved survival and results continue to improve with a 59% 5 year survival rate. 448 Combined Thoracic Organ and Liver Transplantation in Multi-Organ End-Stage Patients As a Successful Therapeutic Strategy B. Ramlawi, 1 L.J. Garcia-Morales, 1 J.D. Estep, 1 H. Seethamraju, 2 R.B. Kesavan, 2 B.A. Bruckner, 1 A.D. Parulekar, 2 P.J. Kolodziejski, 2 J. Nguyen, 1 K.N. Chmielowiec, 2 G.P. Noon, 2 O. Gaber, 1 M. Loebe. 2 1 Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston, TX; 2 Baylor College of Medicine, Houston, TX. Purpose: Patients with end-stage cardiac or pulmonary disease as well as advanced liver disease have limited therapeutic options and are difficult to manage clinically. Multi-organ transplantation is an elaborate treatment option with multiple clinical and logistic challenges. We aimed to review our recent institutional experience with combined liver and thoracic organ (heart or lung) transplantation. Methods and Materials: We performed a retrospective analysis of pro- spectively collected data from a single-center experience, which in- cluded 8 patients who underwent thoracic organ and liver transplanta- tion at The Methodist Hospital System between June 2004 and December 2009. Patients were followed until February 2010. The patients had not received a previous transplant at the time of surgery and have not needed re-transplantation. Follow-up includes routine laboratories tests, biopsies, regular chest radiographs, echocardiograms, ECG, cardiac catheterizations, pulmonary function tests, and abdominal ultrasound evaluations. Results: Short and mid-term survival for this case series has been 100% to date. Table below shows baseline characteristics and postoperative profile of the 8 patients in this study. On the other hand, just 2 patients experienced rejection, grade 3A and 2. Median postoperative intensive care length of stay was 5.5 days. Conclusions: Combined liver and thoracic organ transplantation can be performed safely with encouraging mid-term survival within a dedicated multi-organ transplant program. Possibility of decreased rejection episodes may point to an immune protective mechanism conferred by multi-organ transplantation. 449 Regional Differences in United States Lung Transplantation According to UNOS Geographic Regions G.J. Arnaoutakis, 1 T.J. George, 1 A. Kilic, 1 C.A. Merlo, 2 A.S. Shah. 1 1 Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore; 2 Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore. Purpose: Regional differences in patient profiles and outcomes among United States (US) lung transplant (LTx) centers can facilitate understand- ing of systems-related practices which may lead to enhanced organ allo- cation and improved outcomes for patients. Methods and Materials: We retrospectively reviewed the United Network for Organ Sharing (UNOS) dataset for adult primary LTx patients since inception of the lung allocation score (LAS) system (5/2005-12/2009). Geo- graphic location according to 11 UNOS regions was identified for all patients. Demographics including LAS values were compared across regions. Waitlist time was compared using analysis of variance (ANOVA) and 1-year (yr) mortality using Kaplan-Meier (KM) analysis. Subgroup analysis was per- formed after grouping regions into strata by LAS and wait list time. Results: Of 7109 included patients, 1791(26.1%) died during the study. The highest LTx volume was in region 2(1253), and the lowest volume region 1(176). Median LAS score was 38.4 (IQR 34.1-46.5), and region 9 had the highest average LAS (48.6) compared with lowest average LAS in region 6(40.6). Region 1 had longest wait list times (459565 days), whereas the shortest wait list times were in Region 5(169305 days). Highest 1-year survival was in Region 8(87.5%) compared with lowest 1-year survival in Region 11(79.5%). When examining patients in the upper quartile of LAS (46.5), only regions 1, 5, and 8 had 1-year mortality 20%. KM analysis revealed improved 1-yr survival among centers with longer wait times. Conclusions: In the United States, there are regional variations in lung transplant recipient profiles and clinical outcomes among the eleven UNOS geographic regions. Regions with longer wait list times have improved 1-year survival. 450 Sensitized Recipients Can Undergo Pulmonary Transplantation with Excellent Intermediate and Long-Term Outcomes L.M. Ferrer, 1 K. Mudy, 1 Y. Bell, 1 J. Gaughan, 1 S.H. Leech, 1 F. Cordova, 1 A.A. Mangi. 11 Cardiac Surgery, Temple University Hospital, Philadelphia, PA; 2 General Surgery, Temple University Hospital, Philadelphia, PA; 3 Pulmonary and Critical Care, Temple University Hospital, Philadelphia, PA; 4 Pathology, Temple University Hospital, Philadelphia, PA. Purpose: Sensitization of recipients to donor specific antigens has been shown to increase morbidity and mortality in patients undergoing pulmo- nary transplantation. The effect of pre-transplant immunomodulation on intermediate and long term survival is unclear. Methods and Materials: Forty patients underwent pulmonary transplant between February 2008 and May 2010 at our hospital. Charts were retro- spectively reviewed. The last panel reactive antibody (PRA) analyzed by flow cytometry prior to transplant was subjected to statistical analysis. Mortality was compared to the UNOS database. Results: Eight patients (20%) had PRA 24%; and 4 (10%) had PRA 11-24%. 3 (7%) underwent pre-transplant plasmapheresis and administra- tion of intravenous immunoglobulin and 2 (5%) received pre-transplant rituximab. On average PRAs were reduced from 82% prior to immuno- modulation to 12.6% after (P value = 0.25). All patients underwent virtual cross-matching, none were transplanted with an incompatible cross-match. All patients received induction with basiliximab, and standard immuno- suppression therapy with calcinuerin inhibtors, steroids and an anti-metab- olite. On univariate analysis, circulating pre-transplant PRA levels failed to predict overall mortality (P=0.6). When compared to the UNOS cohort, there was no statistically significant difference in conditional survival at 30-days, one year and two years after transplantation (P=0.93). S153 Abstracts