analysed by multiple logistic regression. A secondary analysis by age group instead of AAT was also performed. Results: 114 children died during the study period. Age at transplant ranged from 0.2–19.4 years. 21 children(18%) died because of identiﬁable non-adherence. In a further 9(8%), non-adherence was a contributing factor. Summary statistics are presented below: All subjects (n  114) Gp A (n  21) Gp B (n  9) Gp C (n  84) p value M/F 59; 55 12; 9 4; 5 43; 41 0.8 Pre Tx concerns (Yes; No) 17; 97 15; 6 1; 8 1; 83 0.0005 H; HL or BL 57; 57 8; 13 4; 5 45; 39 0.4 CF; other* 44; 70 12; 9 5; 9 27; 57 0.06 AAT (yrs) 10.5 (5.6) 14.9 (2.5) 12.0 (4.1) 9.2 (5.7) 0.0005 AAD (yrs) 13.0 (6.5) 17.5 (3.1) 16.0 (5.3) 11.6 (6.6) 0.0005 CF, cystic ﬁbrosis; other, all other diagnosis. After correction for other risk factors non-adherence pre-transplant was the most important predictor of adherence related death. Older age and diagnosis of CF were also independent predictors. By secondary analysis adolescents (AAT 14 yrs) were at highest risk. Conclusion Non-adherence is a common cause of death in children following heart or lung transplantation, particularly in adolescents and in children with CF. 106 POST-OPERATIVE USE OF AEROSOLIZED AZTREONAM IN CYSTIC FIBROSIS PATIENTS COLONIZED WITH BURKHOLDERIA CEPACIA PRIOR TO LUNG TRANSPLANTATION M.S. Woo, 1 E. Perez, 1 M.V. Horn, 1 V.A. Starnes, 11 Cardiothoracic Transplant Team, Childrens Hospital Los Angeles, Los Angeles, CA Cystic ﬁbrosis (CF) pts with Burkholderia cepacia have high mor- bidity/mortality after lung transplant. We had reported that B. cepacia CF pts treated with aerosolized aztreonam had no short-term differ- ences in morbidity or mortality compared to CF pts colonized with susceptible Pseudomonas aeruginosa organisms prior to living do- nor lobar lung transplant. Does aerosolized aztreonam reduce long- term morbidity/mortality in these high-risk CF pts with B. cepacia? We compared outcomes of 5 CF pts with B. cepacia (4 M:1 F; mean age at transplant 16.7  1.1 yrs) to 5 age- and gender-matched CF pts (mean age at transplant 16.4  1.3 yrs; p = 0.73, ns) colonized with susceptible Pseudomonas aeruginosa bacteria. All pts underwent bilateral living donor lobar lung transplant by the same surgeon. CF pts colonized with B. cepacia prior to lung transplant were treated with aerosolized aztreonam mixed as 1 gram in 3– 4 cc sterile water nebulized BID and then were recommended to continue these treatments as BID for 30 days on and 30 days off after lung transplantation. The B. cepacia organisms were identiﬁed as 4 B. cepacia genomovar III (cenocepacia) and 1 B. cepacia genomovar II (multivorans) by the CF Burkholderia Reference Lab. 1 pt with B. cepacia did not continue aerosolized aztreonam and expired 7 mo after surgery. 3 pts with Pseudomonas prior to transplant surgery expired 6.6, 12.5 and 39.6 mo after transplantation (p = 0.21,ns). Average pt followup was 26.2  15.1 mo for B. cepacia pts compared to 21.4  13.0 mo for Pseudomonas pts (p = 0.61,ns). Followup throat and BAL cultures have only intermittently found B. cepacia bacteria in the remaining 4 pts who had B. cepacia prior to lung transplant. These organisms are now relatively susceptible to antibi- otic therapy. No pts on aztreonam have had signiﬁcant B. cepacia infections (no pneumonia or bacteremia). We conclude that post- operative use of aerosolized aztreonam in CF pts colonized with B. cepacia prior to lung transplant results in long-term outcomes equivalent to CF pts who were colonized with susceptible Pseudo- monas bacteria. 107 A RANDOMIZED CLINICAL TRIAL OF TACROLIMUS [PROGRAF] AND CYCLOSPORINE [NEORAL] IMMUNOSUPRRESSION IN PEDIATRIC HEART RECIPIENTS S.M. Pollock-BarZiv, 1,2 A.I. Dipchand, 1,2 B.W. McCrindle, 1,2 L.J. West, 1,2 1 Cardiology, The Hospital for Sick Children, Toronto, ON, Canada; 2 University of Toronto, Toronto, ON, Canada While Tacrolimus [Tac] and Cyclosporine [Cya] immunosuppression are used after heart transplantation (tx), few studies evaluate them in pediatrics. We randomized 26 heart recipients in a prospective, open label trial to Tac (n = 14) or Cya (n = 12) to compare their efﬁcacy. Both groups received initial adjunct therapy of azathioprine and steroids. Mean age at tx was 4 yrs for Tac and 5.8 yrs for Cya. Mean follow-up was 26 mos (11–39 mos) for Tac and 24 mos for Cya (13–33 mos). Mortality for Tac was 14%; both deaths occurred day 8, 1 of sepsis, 1 of multiorgan failure. Mortality in the Cya group was 42%; 3 deaths  1 month of primary graft failure, 1 late death (11 mos) of infection and 1 (7 mos) of accelerated graft vasculopathy. Four pts on Cya required switch to Tac; 3 for ongoing rejection, 1 for renal impairment and hyperlipidemia 1.2 yrs post tx. Two Tac pts required switch to Cya; 1 for leukopenia and oral ulcers, 1 for refractory anemia. Both resolved on Cya. Of the 12 Tac and 9 Cya survivors  1 month post-tx, freedom from acute allograft rejection at 3, 6, and 12 mos was 0.33 vs 0.44, 0.58 vs 0.78, and 0.83 vs 0.78, respectively. 58% (7/12) Tac pts and 44% on Cya (4/9) had at least 1 grade 3A rejection or worse in the ﬁrst 3 mos post-tx; 1 Tac pt had vascular rejection with eosiniphils, edema and poor ventricular function  1 month post-tx (resolved with aggressive therapy). At 12 mos 12 pts were on Tac and 4 on Cya. No difference in incidence of bacterial or viral infections, though infection accounted for a late Cya death. Seizures occurred in 1 Tac and 1 Cya pt  1 month post-tx. At 12 mos, 25% Tac and 50% Cya had hyperlipidemia, and 17% Tac and 50% Cya pts had anemia; 20% on Tac were off steroids while all 4 on Cya remained on steroids. Our experience suggests both are efﬁcacious in pediatrics. Conversion from Cya to Tac was useful for refractory rejection, though a lower incidence of cellular rejection was not observed in the Tac group. Funded by Fujisawa & Novartis 108 UTILITY OF SERIAL PANEL REACTIVE ANTIBODY DETERMINATIONS FOLLOWING PEDIATRIC HEART TRANSPLANT J.M. Lamour, 1 L.J.Addonizio, 1 S. Mital, 1 D.T. Hsu, 11 Pediatric Cardiology, Columbia University, New York, NY Background: Pre-heart transplant (HT) patients (pts) are routinely screened for the presence of anti-HLA antibodies (Ab) by panel reactive antibody (PRA). Studies associate these results with risk for early graft rejection (rej) and graft vasculopathy (GV). However, the use of post HT PRA as a tool for monitoring the immunologic status is controversial. Methods: PRAs were routinely performed in pediatric HT pts at the time of endomyocardial biopsy and if the diagnosis (Dx) of rej was suspected. The presence of anti-HLA Class I Ab was deﬁned as  10% and  50% PRA to T and B cells. The presence of anti-HLA Class II antibodies were deﬁned as  10% and  50% PRA to B cells in the absence of T cell reactivity. Data included: age at HT, Dx, race, sex, noncompliance (NC), rej history, GV and survival. Results: In 103 pts, 996 PRA values were obtained, mean 10.4  6 (range 2–37/pt). Mean age at HT was 9.4  7 yrs; 49 females, 54 S78 Abstracts The Journal of Heart and Lung Transplantation February 2004