Anxiety , depression and coping in patients awaiting lung transplantation

printing supported by . Visit Chiesi at Stand D.30 MONDAY, SEPTEMBER 26TH 2011 Conclusions: Antibiotic treatment was associated with QR-GNB. Airway colonization with QR-GNB was associated with mortality and with BOS. We suggest that narrow spectrum antibiotics should be preferred in lung transplant recipients. P2441 Anxiety, depression and coping in patients awaiting lung transplantation Torunn Stavnes Soyseth1, Aasta Heldal3, Gro Killi Haugstad4, Vidar Soyseth5, Oystein Bjortuft2 , May Brit Lund2. 1Division of Rehabilitation; Non-Clinical Service Unit, Rikshospitalet, Oslo University Hospital, Oslo, Norway; 2Department of Respiratory Medicine,Division of Cardiovascular and Respiratory Medicine and Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway; 3Department of Neuropsychiatry and Psychosomatic Medicine,Division of Clinical Neuroscience, Rikshospitalet, Oslo University Hospital, Oslo, Norway; 4Department of Mensendieck (Physiotherapy), Faculty of Health Sciences, Oslo University College, Oslo, Norway; 5Department of Respiratory Medicine, Akershus University Hospital, Lorenskog, Norway Knowledge is scarce about the mental aspects of living with terminal lung disease. We aimed to assess anxiety, depression and coping in patients waiting for lung transplantation. Material and methods: A national cohort of 121 consecutive patients were evaluated by psychometric instruments, Hospital Anxiety and Depression Scale (HAD) and General Health Questionnaire (GHQ).89 (45 females) had COPD, 18 (9 females) fibrosis, and 14 (8 females) various other lung diseases. Mean (SD) age was respectively 56 (5), 52 (6) and 46 (8) years. Patients with cystic fibrosis were excluded. Results: See table. COPD (n=89) Fibrosis (n=18) Other (n=14) mean (SD) mean (SD) mean (SD) HAD Anxiety 4,8 (4,0) 3,2 (3,6) 5,7 (2,9) Depression 3,8 (3,0) 2,2 (1,9) 3,8 (1,9) GHQ Anxiety 0,81 (0,49) 0,71 (0,54) 1,09 (0,6) Depression 0,61 (0,51) 0,47 (0,28) 0,57 (0,29) Restrained coping 0,99 (0,32) 0,89 (0,29) 1,2 (0,41) For all groups, mean values were within the normal range. However, the ranges were wide. Males tended to be more depressive than females (mean (SD) HAD score 4,1 (3,0) vs 3,1 (2,5), p=0,07), and have higher restrained coping scores than females (mean (SD) GHQ score 1,05 (0,05) vs 0,93 (0,05), p=0,08). The association between anxiety and restrained coping was highly significant, p=0,0001 as well as the association between depression and restrained coping, p=0,0001. Conclusions: The strong association between anxiety and depression and restrained coping may be of clinical relevance after transplantation. Males may be more vulnerable than females in this respect. P2442 Significance of a spirometric obstructive pattern immediately after lung transplantation Hendrik Suhling1, Jessica Rademacher1, Tobias Welte1, Gregor Warnecke2, Sabine Dettmer3, Jens Gottlieb1. 1Dpt. of Pulmonary Medicine, Hannover Medical School, Hannover, Germany; 2Dpt. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; 3Dpt. of Radiology, Hannover Medical School, Hannover, Germany To increase the donor pool, cadaveric lungs with extended donor criteria are increasingly accepted for lung transplantation. In this study the impact and outcome of lung transplant recipients with an obstructive spirometric pattern as possible indicator of structural damaged lungs immediately after lung transplantations was investigated. Analyzing all patients undergoing double lung transplantation between 1.09.2007 and 01.10.2009, we separated patients with obstructive (FEV1/VC < 0.7) and a non-obstructive pattern (FEV1/VC > 0.7) in pulmonary function tests 3 months after transplantation. Pulmonary function measurement including body phelthysmography, bronchoscopy, laboratory parameter, CT and outcome was analyzed up to 36 months after transplantation. From 122 recipients included, 17 (14%) were identified with an obstructive pattern, these were older at transplantation and had a lower donor oxygenation index and significant higher TLC. Obstructive patients developed peak FEV1 earlier after LTx and developed significantly more frequently bronchiolitis obliterans syndrome (47% vs. 14%). Obstructive lung function pattern is associated with earlier development of BOS and might worsen the outcome after double lung transplantation. The OP in association with increase TLC and donor history suggests that the obstruction was of donor origin. Factors like smoking status, age of the donor lung and FiO2 were indicators of a later obstructive pattern in recipients. P2443 Probe-based confocal laser endomicroscopy in acute lung allograft rejection Jonas Yserbyt1, Christophe Dooms1, Wim Janssens1, Geert Verleden1, Vincent Ninane2, Marc Decramer1. 1Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium; 2Respiratory Diseases, CHU Saint-Pierre, Brussels, Belgium Several aspects of normal alveolar tissue in probe-based confocal laser endomicroscopy (pCLE) have been elucidated; a description of the alveoloscopic findings in different pulmonary disorders is still largely lacking. In a prospective study, we evaluated 40 lung transplant recipients using probe-based confocal laser endomicroscopy (pCLE) preceding BAL and transbronchial lung biopsy (TBLB) during bronchoscopy. In 6 patients (15%) acute rejection (AR) was diagnosed using TBLB. The recordings of the pCLE images were digitally processed and analyzed for the following parameters: alveolar duct diameter, alveolar elastin thickness, macrophage diameter, number of macrophages per microscopic field and quantification of the autofluorescence signal of macrophages. In 5 out of 6 AR cases, a diffuse infiltration of autofluorescent cells with a mean diameter of 26.2±13.3μm, was recognized in all examined segments. The number of macrophages per microscopic field and their autofluorescence intensity were significantly higher in the AR group than in the non-AR group (p < 0.001 and p = 0.03 respectively). In all affected segments there appeared to be more than 100 cells per microscopic field, frequently presenting as clustering cells. The elastin network in the alveolar ducts of AR appeared to be of a normal architecture (alveolar elastin thickness mean 8.3±4.9μm, alveolar mouth diameter mean 371±131μm), and did not differ from the patient group without AR (7.8±3.7μm and 323±89 μm, respectively). In the lung transplant recipient group studied, our preliminary findings suggest that pCLE is able to detect an alveoloscopic pattern that might correlate with AR. P2444 Frequency and characteristics of prolonged viral shedding of influenza A/H1N1 virus in lung transplant recipients Macé M. Schuurmans, Alice Zuercher, Gabrielo M. Tini, Gregory Fretz, Christian Benden, Erich W. Russi, Annette Boehler. Pulmonology, University Hospital, Zurich, Switzerland Influenza infection may harm lung transplant recipients (LTR) because it potentially triggers allograft rejection. Prolonged viral shedding (PVS) is defined as positive detection of influenza A/H1N1 virus (H1N1) by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) at day 7 or later after diagnosis. The aim was to quantify and characterise PVS of H1N1 infections among LTR in consecutive influenza seasons. Methods: Influenza vaccination is routinely offered at follow-up visits in our outpatient clinic. LTR are also instructed to contact and visit our clinic when signs of infection occur or home lung function deteriorates 10% or more. We then frequently perform nasopharyngeal swabs (NPS) for viral and bacterial analysis. In 443s Thematic Poster Session Hall 2-22 12:50-14:40 Abstract printing supported by . Visit Chiesi at Stand D.30printing supported by . Visit Chiesi at Stand D.30 MONDAY, SEPTEMBER 26TH 2011 case of suggestive symptoms for influenza infection we start oseltamivir (Tamiflu) and moxifloxacin treatment pending NPS results. For proven H1N1 infection we continue treatment until weekly NPS return negative. Results: In winter 2009/2010 7 patients had H1N1 infection of which 2 had PVS (28%). No serious complication occurred. 2/7 LTR were vaccinated for H1N1. For 2010/2011 we have so far documented 11 H1N1 infections and PVS in 8 LTR (73%). All LTR were vaccinated with at least 1 dose containing H1N1. Three LTR were hospitalised. 5 LTR had PVS for 2-6 weeks. Quantification of viral results and drug resistance testing are being performed. Influenza B was detected in 4 other LTR. Conclusion: In this ongoing study we report an increase in frequency of PVS for H1N1 infections in LTR from 28 to 73% in consecutive influenza seasons. Most infections occurred despite vaccination and had a favourable outcome rarely requiring hospitalisation. P2445 Opto-electronic plethysmographic study of the chest volume changes after lung transplantation Marianna Laviola2, Emilia Privitera1, Mario Nosotti1, Andrea Aliverti2, Luigi Santambrogio1, Davide Tosi1, Lorenzo Rosso1. 1Thoracic Surgery, Fondazione Cà Granda Ospedale Policlinico, Milano, Italy; 2Bioingegneria, Politecnico di Milano, Milano, Italy Background: Lung transplantation is the established surgical therapy for pulmonary end-stage disease. Aims: Even though the pulmonary function after lung transplantation is well studied, the chest volume changes remain uninvestigated. The aim of the present study was to examine such changes by the opto-electronic plethysmography (OEP), a non invasive technology. Methods: Seven patients with end-stage pulmonary disease were studied before and after lung transplantation by OEP during quiet and forced breathing. Standard pulmonary function tests were also obtained. Three patients with pulmonary fibrosis had single lung transplantation and four patients with cystic fibrosis had bilateral. Result: The functional tests demonstrated increasing in pulmonary function (e.g. FEV1% from 44±15 to 83±6). After bilateral transplantation, the OEP revealed a volume rearrangemen