236 CAMPATH-1H IN CLINICAL HEART TRANSPLANTATION S.M. Pham, 1 J. Jimenez, 2 B.M. Bednar, 1 A. Panos, 1 L. Futterman, 1 E.J. Bauerlein, 2 M. Ricci, 1 S.M. Mallon, 2 E.E. Rosenkranz, 1 P. Rusconi, 31 Surgery, University of Miami, Miami, FL; 2 Medicine, University of Miami, Miami, FL; 3 Pediatric, University of Miami School of Medicine, Miami, FL Aim: Campath-1H (alemtuzumab), a humanized monoclonal antibody against CD52, is a powerful lymphocyte depleting antibody. We hypothe- sized that induction therapy with Campath-1H would reduce the doses immunosuppressive agents currently used in cardiac recipients. Methods: Since July 2004 we have treated 19 primary adult cardiac recipients with Campath-1H (0.3 mg/kg on days 0 and 4), low dose TAC (12-hr trough levels: 5–7 ng/ml), MMF (1000 mg/d) and no steroids (Group I). We compared these patients with 40 adult recipients receiving standard doses of TAC (levels = 10 –15), MMF (2000 mg/d) and steroids (Group II). Steroids were tapered with the intention to stop by 1 year. Results: Groups I and II are comparable in recipient’s and donor’s ages, and ischemic time (160.7  56.3 vs 178.0  57.6 min). Follow-up times are 270  132 and 1306  711 days, respectively (p0.05). While the survival, and freedom from rejection (grade 3A or higher) are similar, Group I received less immunosuppression, and had lower serum creatinine at 6 months (Table 1). Three is no difference in the incidence of infection or malignancy between the two groups. Table: Campath-1H Induction in Cardiac Recipients Variables Group I Group II p-value Number of patients 19 40 Survival @ 0.5 ; 1 yr (%) 100; 92.3 97.5; 97.5 NS Free from Rejection @ 0.5; 1 yr (%) 82; 64 63; 61 NS Time to 1st rejection (days) 183  50 42  4  0.001 TAC Level (ng/ml) @ 0.5 yr 6.8  2.5 12.1  3.8  0.001 Prednisone dose @ 0.5 yr (mg/d) 0 9.1  4.3  0.001 MMF dose @ 0.5 yr (mg/d) 993  495 1919  543  0.001 Creatinine @ 0.5 yr (mg/dl) 1.0  0.3 1.6  0.6 0.05 Platelet ( 1000/l) @ 0.5 yr 250  75 213  64 NS Conclusion: The early outcomes of cardiac recipients under Cam- path-1H, low dose of TAC, MMF, and no steroids compare favorably with those receiving standard doses of TAC, MMF, and steroids. Reduction of tacrolimus level in the Campath-1H group may result in less long-term nephrotoxicity. Diswclosure: The author is the recipient of research grants rom Astellas. 237 THE IMPACT OF INDUCTION ON SURVIVAL AFTER LUNG TRANSPLANTATION: AN ANALYSIS OF THE ISHLT REGISTRY R.R. Hachem, 1 L.B. Edwards, 2 R.D. Yusen, 1 M.M. Chakinala, 1 G.A. Patterson, 3 E.P. Trulock, 11 Pulmonary & Critical Care, Washington University School of Medicine, St. Louis, MO; 2 UNOS, Richmond, VA; 3 Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO The use of induction after lung transplantation (LT) remains contro- versial. In this retrospective study of the ISHLT Registry, we analyzed the impact of induction on survival after LT using a multivariable Cox regression model. Recipients who underwent LT between 1/1/00 and 3/31/04 and survived at least 14 days were included in the analysis (n=3970); among these, 2249 (57%) received no induction, 1124 (28%) received an IL2 receptor antagonist (IL2 RA), and 597 (15%) received polyclonal antilymphocyte globulins (ALG). The IL2 RA group had a higher unadjusted survival than the no induction and the ALG groups (log rank p=0.007); the 4 year survival for the IL2 RA group was 63.5% compared with 60.4% and 56.6% in the ALG and no induction groups, respectively. This survival benefit persisted in the multivariable analysis for the IL2 RA group (RR=0.82, CI 0.71– 0.95; p=0.009), but there was no significant survival benefit with ALG (RR=0.92, CI 0.78 –1.08; p=0.31) compared to no induction. Factors that adversely affected survival in the multivariable model included SLT for IPF (RR=1.29; p=0.004), sarcoidosis (RR=1.51; p=0.016), hospitalization at transplant (RR=1.38; p=0.007), chronic steroid use (RR=1.17; p=0.009), diabetic donor (RR=1.7; p=0.0002), number of HLA mismatches (RR=1.06 per mismatch; p=0.045), lower center volume (p0.0001), and recipient and donor age. The IL2 RA and no induction groups had a similar freedom from BOS at 4 years (69% and 66%, respectively), and this was significantly higher than for the ALG group (58%; log rank p=0.048). The no induction group was more likely to have an episode of treated rejection (22%) prior to transplant discharge than the IL2 RA (15%) and ALG (17.5%) groups, but less likely to have an episode of treated infection (38%) prior to transplant discharge than the IL2 RA (44.5%) and ALG (43.5%) groups. We conclude that induction with an IL2 RA is associated with a lower mortality after LT compared with no induction although the groups had similar incidences of BOS. 238 CAMPATH-1H INDUCTION AND MAINTENANCE DRUG MINIMIZATION IN LUNG TRANSPLANTATION: ONE-YEAR OUTCOMES AND COMPARISON WITH TRIPLE DRUG IMMUNOSUPPRESSION WITH OR WITHOUT DACLUZIMAB INDUCTION K.R. McCurry, 1 D.B. Zaldonis, 1 S. Husain, 1 A. Zeevi, 1 T. Starzl, 1 J. Pilewski, 11 University of Pittsburgh, Pittsburgh, PA Aim: In 2003, we initiated a maintenance drug minimization immu- nosuppressive protocol utilizing Campath-1H as induction therapy in lung transplant recipients. The aim of this study was to evaluate one-year outcomes and compare to outcomes in lung transplant recipients treated with triple immunosuppression with or without dacluzimab induction. Methods: The Campath cohort consisted of 56 unselected patients (pts) who received Campath-1H induction therapy (30 mg intraoper- atively) followed by tacrolimus (tac, target trough 12–15 ng/ml) and low dose prednisone (5 mg/day). Outcomes were compared to 1) 29 consecutive pts transplanted between 12/01 and 6/02 who received dacluzimab induction (DAC cohort) plus triple immunosuppression (tac [target trough 15–20 ng/ml], high dose prednisone and azathio- prine) and to 2) 56 consecutive pts transplanted between 1/98 and 1/00 who were treated with triple immunosuppression without induction (NI cohort). Results: One-year follow-up was completed in all pts. One-year survival was 93% in the Campath cohort. Campath cohort survival was signifi- cantly greater than the NI cohort (p=0.0002) and although higher than the DAC cohort did not reach statistical significance (p=0.28). Freedom from rejection (A2) was significantly greater in the Campath cohort compared to the NI cohort (p=0.0007) and although there was a strong trend toward greater freedom from rejection in the Campath cohort compared to the DAC cohort it did not reach statistical significance (p=0.07). Based on routine protocol, the number of transbronchial biopsies was greater in the Campath cohort. Infectious complications were not increased in the Campath cohort. Conclusions: Campath-1H induction therapy with a maintenance drug minimization strategy in lung transplantation results in equivalent to superior outcomes compared to tac-based triple immunosuppression with or without dacluzimab induction. Further study is warranted. Disclosure: The author is the recipient o research support from Pfizer. S126 Abstracts The Journal of Heart and Lung Transplantation February 2006