330.16 Vitamin D Deficiency is Associated with an Increased Risk of Post-Transplant Lymphoproliferative Disorder Following Small Intestinal and Multivisceral Transplantation Adam McCulloch 1 , Dunecan Massey 1 , Lisa Sharkey 1 , Stephen Middleton 1 , Jackie Green 2 , Neil Russell 2 , Andrew Butler 2 , Jeremy Woodward 1 1 Gastroenterology, Cambridge University Hospital Trust, Cambridge, United Kingdom; 2 Transplant Surgery, Cambridge University Hospital Trust, Cambridge, United Kingdom. Introduction: Vitamin D exerts a number of immunomodulatory effects. Studies have shown a link between vitamin D deficiency and incidence of acute rejection and infection in solid organ transplant recipients but none have examined small bowel and multivisceral transplantation. We hypothesised that vitamin D deficiency following small bowel or multivisceral transplant may increase the risk of acute rejection, cytomegalovirus (CMV) infection, sepsis or post-transplant lymphoproliferative disorder (PTLD). Methods: This was a single centre retrospective review of patients who had received small intestinal or multivisceral transplants from January 2007 to August 2016. Opportunistically measured post-transplantation vitamin D levels were reviewed and compared with the onset of significant immunolog- ical events within 6 months of each measurement. The control vitamin D values included all transplant recipients’ vitamin D measures that did not cor- respond with an immunological event within 6 months. Results: A total of 57 transplants (11 intestinal, 15 modified multivisceral, 31 multivisceral) in 54 patients were evaluated (females: 26, avg age at trans- plantation: 43.4 yrs, age range: 19–62). 8 patients were excluded due to insuf- ficient data. Vitamin D deficiency (<30 nmol/L as defined by the Endocrine Society Clinical Practice 2011 guideline) was seen in 61.1% of patients post-transplantation. A total of 205 vitamin D levels were reviewed with 65.0% of vitamin D measurements not corresponding with an immunological event. Vitamin D deficiency was significantly associated with PTLD (OR 9.31, 95% CI 1.82 - 47.7, p value 0.005). The average length of time between the vitamin D level and PTLD diagnosis was 37 days (range 0 – 125). Average length of time from transplantation to PTLD diagnosis was 211.5 days (range: 76 – 566). Low vitamin D levels were also significantly associated with mild acute rejection (OR 3.6, 95% CI 1.4 – 9.1, p-value 0.008). Conclusions: We have shown a strong association between vitamin D de- ficiency and PTLD following multivisceral and small intestinal transplantation. Vitamin D deficiency may increase susceptibility to Epstein-Barr virus infec- tion leading to PTLD. Vitamin D deficiency had a significant association with mild rejection but not more advanced grades of rejection. This may be due a direct effect of vitamin D levels on intestinal apoptotic cell counts rather than a risk factor for rejection and may lead to overdiagnosis of mild rejection. 330.17 Quality of Life (QoL) in Children After Small Bowel Transplantation (SBTx) Using a Validated Generic Scoring System, the Euroqol EQ-5DY Lindsay Hogg 1 , Sarah Pugh 1 , Girish Gupte 1 , Jane Hartley 1 , Rob Jobe 1 , Jacqueline Blyth 1 , Jemma Mears 1 , Thamera Perera 2 , Paola Muiesan 2 , Darius Mirza 2 , Khalid Sharif 1 , Sue Beath 1 1 The Liver Unit, Birmingham Children's Hospital, Birmingham, United Kingdom; 2 The Hepatobiliary and Transplant Unit, The Queen Elizabeth Hospital, Birmingham, United Kingdom. Introduction: Quality of life (QoL) is a subjective entity which can be difficult to assess in children who estimate QoL differently from adults e.g. children will usually value acceptance by peers above independence. The aim of this pilot study was to evaluate the acceptability of a generic test of QoL and compare the results with those of European population norms. The Euroqol EQ-5DY was used – it is a fully validated questionnaire suitable for children older than 8 yrs (http://www.euroqol.org). Subjects & Methods: Forty children & teenagers as of 1st Dec 2016 are in follow up after SBTx in our programme, of whom 15/25 eligible patients were assessed during their annual review. All 15 children rated themselves by marking a visual analogue scale (VAS) 0–100 (100 being the best health they could imagine), & choosing one of three responses to questions about mobil- ity; self care; activities; pain; worries. 15 patients were excluded (age <8yr = 6; age > 25 yr = 1; unwell with rejection or gastroenteritis = 5; recent SBTx= 3). Results: Male 11; female 4. Median age =16.3 yrs (range 8.3 -21.0yr); me- dian time since SBTx = 10 yrs (range 5–17); median age at transplant = 1.6yrs (range 0.5-11.75). All had experienced intestinal failure since birth (aetiology: short bowel = 9; dysmotility = 6). Type of grafts were: combined liver & bowel = 10; isolated SBTx =2; sequential liver then SBTx =2; modified multivisceral SBTx =1. VAS: mean = 84.2; median = 90 (range 5–100) 25th centile = 76; and 75th centile =100. Domain results see table 1. The EQ-5DY was completed within 5 minutes & most children (12/15) rated themselves as having a quality of life as good as their peer group (VAS score greater than 80). However, in two of the domains: some children reported major concerns for pain and worries. In the domain for worries, there was a trend (p=0.09) for older children, in the process of transition to adult services, to score lower than children <14 yrs of age. One young adult who was addicted to opiates reported very low quality of life with a VAS score of 5/100. There was no association between the pres- ence of a stoma, or type of graft and QoL scores. Conclusion: The EQ-5DY is simple to use and was helpful as a screening test at annual structured assessments for identifying individual children with lower scores and facilitating targeted additional physiotherapy with orthopaedic review (in two cases where hip pain was reported) and psychological support. We gratefully acknowledge the expertise of the nursing staff of ward 8 Birmingham Children’s Hospital and the collaborations with paediatric gastroenterologists who have referred their patients and undertaken shared care with us. Reference: 1. Reference: Burström K, Bartonek Å, Broström EW, Sun S, Egmar AC (2014). EQ-5D-Yas a health-related quality of life measure in children and ad- olescents with functional disability in Sweden: testing feasibility and validity. Acta Paediatr; 103(4):426–35. FIGURE 1. S88 Transplantation ■ June 2017 ■ Volume 101 ■ Number S6-2 www.transplantjournal.com Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.