Methods: Over a 45-month period 125 LTx were performed in this centre. CMV serostatus of donor (D) and recipient (R) was deter- mined at time of transplant. CMV mismatches (MM=D+R-) received 3 months prophylaxis with oral ganciclovir (GCV). CMV positive recipients (CMV+) were followed up with weekly quantitative CMV-PCR, but received no prophylaxis. CMV D-/R- LTx served as control group. All patients were followed with sequential lung function testing and surveillance bronchoscopy to identify infection and episodes of acute rejection. Results: Over a study period of 10 –54 months, 25 patients developed BOS according to the ISHLT criteria. Of 31 MM recipients, three developed BOS, one of which had CMV disease. Of 49 CMV+ recipients, eight developed BOS, two of whom had CMV disease. Of the 45 CMV D-/R- group, none had evidence of CMV disease or infection. 14 patients in this group developed BOS, a significantly higher incidence compared to the other groups (p0.05) using Fisher’s exact test. Conclusions: In our series CMV-viraemia does not appear to be associated with BOS. Indeed, surprisingly the highest incidence of BOS occurred in what is generally considered the lowest risk group. The incidence of BOS was not affected by GCV treatment, acute rejection episodes or bacterial infection. The low incidence of CMV disease might be explained by our CMV protocol: only MM LTx receive GCV prophy- laxis, but we also perform QPCR surveillance for IgG+ LTx (since 2000) and introduced a viral load cut-off of 1.0x10 4 copies/ml for commenc- ing pre-emptive therapy (GCV for 2/52) in 2001. 383 SIROLIMUS-ASSOCIATED THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP): REPORT OF THREE CASES AND REVIEW OF THE LITERATURE A.E. Eyzaguirre, 1 R.B. Love, 2 D.A. Hargate, 1 R. Schilz, 1 1 Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, Cleveland, OH; 2 Cardiothoracic Surgery, University of Wisconsin, Madison, WI Background: Sirolimus (SRL) -an alternative to calcineurin inhibitors (CI)- may decrease renal toxicity and stabilize or improve pulmonary function in bronchiolitis obliterans syndrome. We report, to our knowledge, the first series of patients that developed SRL-associated thrombotic thombocytopenic purpura (TTP). Patients: Case 1: A 50-year-old male receiving FK506 and SRL (started four weeks before admission); admitted with dyspnea (see table). Diagnosis of TTP was made; plasmapheresis was instituted. It was felt that TTP was associated with SRL because recent use. Case 2: A 54-year-old male treated with FK506, and MMF. MMF was discontinued three weeks before admission; SRL was started. Routine blood work is shown. Diagnosis of SRL-induced TTP was suspected. Plasmapheresis started. SRL was held. Case 3: A 53-year-old female who discontinued FK506 due to neurotoxicity. SRL was instituted. Patient was admitted two weeks later with headache, lethargy, and echymosis. SRL-induced TTP was suspected. Plasmapheresis was instituted. Renal function did not recover. The patient elected to discontinue dialysis. Conclusion: There is no known association between SRL and TTP. The temporal association between the start of SRL and the develop- ment of TTP suggests a causal relationship. Further investigation is needed to clarify the relationship between SRL use in lung transplant patients and TTP. 384 TRICUSPID VALVE REPLACEMENT AFTER CARDIAC TRANSPLANTATION R. Alharethi, 2 F.M. Bader, 2 A.G. Kfoury, 1 E.M. Gilbert, 2 D.G. Renlund, 11 Cardiology, LDS Hospital, Salt Lake City, UT; 2 Cardiology, University of Utah, Salt Lake City, UT Background: Tricuspid valve insufficiency (TI) is common after orthotopic heart transplantation. However, severe TI requiring tricuspid valve replacement (TVR) is rare. Several factors con- tribute to the pathophysiology of severe TI. The aim of this study is to evaluate our experience with TVR in cardiac transplant recipients. Methods: Since 1985, 869 orthotopic heart transplantations were performed at the Utah Cardiac Transplant Program. Using our cardiac transplant database; we identified 17 patients who had 16 TVR, and 2 tricuspid valve repair procedures. Patient demographics, hemody- namics; as well as procedure- related findings were studied. Compar- isons were made between preoperative and postoperative states using certain clinical parameters. Results: The mean time from the diagnosis of severe TI to TVR was 16.3 months18.1 (SD). The indication for TVR was symptomatic right heart failure in 16 (89%) of 18 cases. At the time of procedure, flail leaflet was found in 16 cases (89%). Septal leaflet was more commonly involved (69%). The mean follow up time was 32.9 47.5 months. One patient died 3 days postoperatively due to cardiogenic shock, and one patient died 8 months after TVR due to progressive right heart failure. Improvement in heart failure symptoms was seen in 12 cases. The central venous pressure decreased from a mean of 17.75 mmHg 4.09 to 11.00 mmHg 7.27 (p=.013). There was no significant change in the cardiac output or renal function, measured by serum creatinine. However, the furosemide dose decreased signif- icantly from 47.69 mg/day 56.44 to 26.54 mg/day 46.43 (p=.009). Conclusion: After orthotopic heart transplantation, TVR is a safe and effective procedure to alleviate right heart failure symptoms. Flail leaflets, in a normal appearing valve, was the most common operative finding suggesting that biopsy induced trauma was the cause for severe TI in these patients. There was a significant decrease in the central venous pressure and the diuretics dose, with no change in the renal function or cardiac output. 385 EARLY EXPERIENCE WITH EZETIMIBE IN THE MANAGEMENT OF HYPERLIPIDEMIA POST-CARDIAC TRANSPLANT S.A. Virani, 1 C. Imai, 1 K.H. Humphries, 1 J. Frolich, 2 A. Ignaszewski, 11 Division of Cardiology, UBC; 2 Department of Pathology, UBC, Vancouver, BC, Canada Hyperlipidemia occurs commonly in cardiac transplant (CT) recipi- ents and is a risk factor for developing transplant vasculopathy. Many transplant recipients will have deranged lipid profiles due to poor efficacy or intolerability of statins. Ezetimibe is the first of a new class of agents that selectively blocks intestinal absorption of cholesterol. In non-transplant patients, it has demonstrated efficacy both as monotherapy and in combination with statins. It has not been studied in the CT population. This report outlines our early experience with ezetimibe in the management of hyperlipidemia post-cardiac trans- plantation. Patient 1 Patient 2 Patient 3 Hematocrit 18.3% (36.8%) 20.3 (32.9%) 20.4 (38.6%) Platelets 62,000/mm3 (199,000) 21,000/mm3 (144,000) 36,000/mm3 (107,000) Creatinine 5.1 mg/dl (2.7) 5.1 mg/dl (2.8) 7.9 mg/dl (2.2) Haptoglobin 20 mg/dl 20 mg/dl 20 mg/dl LDH 2082 U/L 1473 U/L 1601 U/L Peripheral Smear Schistocytes Schistocytes Schistocytes Sirolimus 31.6 ng/ml 6.2 ng/ml FK506 8.6 ng/ml 1.5 ng/ml Baseline values are given in parentheses. The Journal of Heart and Lung Transplantation Abstracts S167 Volume 24, Number 2S