BACKGROUND:Abdominal Normothermic Regional Perfusion (A-NRP) improves outcomes for transplanted abdominal organs from Donation after Circulatory Death (DCD) donors. Concerns have been raised about the effect of A-NRP on lungs procured during multi-organ donation. We present the UK experience of performing direct procurement (DRP) of lungs from DCD donors with A-NRP. METHODS:Retrospective analysis of all 487 UK DCD lung donors between April 1, 2011 and December 31, 2023. Organ transplantation rate and 30-day, 90-day and 1-year survival rates were compared between DRP of DCD lungs, DRP of DCD lungs with A-NRP and donation after brainstem death (DBD) lungs. Primary graft dysfunction (PGD) rates were compared between DCD lungs with and without A-NRP. RESULTS:Three hundred ninety-seven DCD donors resulted in a lung transplant (22 retrieved by DRP with A-NRP). There was no difference in lung transplantation rates between DRP and DRP with A-NRP. Of the 390 first adult-only lung transplants performed from DCD donors, there was no significant difference in 30-day, 90-day and 1-year survival between DRP of DCD lungs and DRP with A-NRP. There was a significant difference in survival between standard DCD donors and DBD donors at 30-days and 90-days, but not 1 year. There was no significant difference in grade 3 PGD rates at 72 hours post-implantation for DCD lungs with or without A-NRP. CONCLUSION:In the UK experience, use of A-NRP is not detrimental to procurement of DCD lungs. We advocate the use of this technique until further studies can explore the safety and efficacy of thoraco-abdominal NRP for lungs in multi-organ retrieval.

Host defences to infection are based upon an integrated system of physical and biochemical barriers, innate and adaptive immunity. Weakness in any of these defensive elements leads to increased susceptibility to specific pathogens. Understanding how medical therapies disrupt host defences is key to the successful prevention, diagnosis and management of respiratory infection in the immunocompromised host.

Background. Parenthood after lung transplantation (LuTx) is uncommon. Although data exist regarding practice patterns surrounding pregnancy after heart transplantation, there are no data specific to LuTx recipients and parenthood more broadly. Methods. We conducted a voluntary, anonymous online survey between October and December 2021. It was distributed electronically to select LuTx units and advertised to LuTx providers internationally. Results. A total of 103 responses were included in our analysis. Respondents were primarily women (n = 63; 62%) and included LuTx pulmonologists (n = 59; 58%) or nurses and transplant coordinators (n = 28; 27%). The majority were from centers performing >40 LuTx annually (n = 53; 52%) and had >10 y of transplant experience (n = 56; 55%). Most respondents discuss fertility issues with recipients (n = 63; 62%), but centers lacked clear policies relating to female (n = 51; 70%) and male (n = 62; 83%) fertility and parenthood. Few were aware of policies regarding assisted reproduction and fertility preservation (n = 13; 13%) or pregnancy (n = 23; 22%). Many cited ethical concerns regarding parenthood post-LuTx (n = 38; 37%), but most were supportive of the use of surrogacy by female recipients (n = 74; 92%) and felt there were no contraindications to parenthood in male recipients (n = 59; 59%). Although geography influenced some logistical issues around care provision, general attitudes toward parenthood in LuTx recipients were unaffected by respondent age, sex, location, or experience. Conclusions. Although providers were overall supportive of post-LuTx parenthood, the absence of peer-reviewed evidence, expert consensus, and policy-driven guidance may be a significant barrier to safe and successful parenthood in LuTx recipients.

Fungal infections are common and frequently associated with clinical failure in patients receiving extracorporeal membrane oxygenation (ECMO). Antifungal drugs have physicochemical characteristics associated with a higher likelihood of sequestration onto ECMO circuitry potentially leading to a subtherapeutic drug concentration. The percentage of sequestration of the antifungal drugs—caspofungin, posaconazole, and voriconazole—was determined using an ex vivo ECMO model. The circuits were primed with whole human blood, sodium chloride 0.9%, and human albumin solution. Serial 2 ml samples were taken at baseline, 0.5, 1, 2, 6, 12, and 24 hours after drug addition, paired with non-ECMO controls stored in a water bath at 37°C. Mean loss from the blood-primed ECMO circuits and controls at 24 hours relative to baseline were 80% and 61% for caspofungin ( p = ns), 64% and 11% for posaconazole ( p < 0.005), and 27% and 19% for voriconazole ( p < 0.05). Calculated AUC 0–24 showed a 44% for caspofungin ( p = ns), 30.6% posaconazole ( p < 0.005), and 9% loss for voriconazole ( p = 0.003) compared with the controls, suggesting therapeutic concentrations of these antifungal agents cannot be guaranteed with standard dosing in patients on ECMO. Posaconazole exhibited the greatest loss to the ECMO circuit correlating with both high lipophilicity and protein binding of the drug.

Pregnancy after thoracic organ transplantation is feasible for select individuals but requires multidisciplinary subspecialty care. Key components for a successful pregnancy after lung or heart transplantation include preconception and contraceptive planning, thorough risk stratification, optimization of maternal comorbidities and fetal health through careful monitoring, and open communication with shared decision-making. The goal of this consensus statement is to summarize the current evidence and provide guidance surrounding preconception counseling, patient risk assessment, medical management, maternal and fetal outcomes, obstetric management, and pharmacologic considerations.

To the Editor: Solid organ transplant recipients are at high risk from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with reported mortality rates of up to 39%, with emerging data demonstrating impaired humoral responses to vaccination (1, 2).Sparse data exist examining T-cell immunity (3-6).The calcineurin inhibitors, tacrolimus and cyclosporin, specifically inhibit T-cell activity.We hypothesized that highly immunosuppressed cardiothoracic transplant recipients (HICTTR) on triple immunosuppression are at an immunological disadvantage and are unlikely to produce robust humoral or cellular immune responses to the SARS-CoV-2 vaccination.

Introduction: Airway complications after Lung Transplantation(LTx) include bronchial stenoses which require balloon dilatations and stenting and cause complications such as infection and granulation tissue. Biodegradable stents may provide a safer alternative. Aims: To describe two recently transplanted patients with bronchial stenoses treated using customised, biodegradable, polydioxanone stents (PDS). Methods: Two lung transplant recipients with cystic fibrosis were diagnosed with bronchus intermedius (Pt 1) and bilateral (left main bronchus and bronchus intermedius–Pt 2) stenoses in the first 3 months post LTx. Results: Pt 1 (46-year-old, male) was managed with 6 balloon dilatations and required 2 admissions for infections for Pseudomonas aeruginosa(PsA) before a PDS was inserted.FEV1 improved from 1.7L to >3L, with no admissions for infection since.Pt 2 (21 year old, female) positive for Burkholderia multivorans and PsA was initially managed with bilateral metal stents which were converted to PDS.There was significant reduction in granulation tissue caused by the metal stents after PDS insertion. Stents were absorbed within 8 weeks. Conclusions: PDS were safe and effective in restoring the patency of the airway in post LTx airway stenoses and were absorbed by the bronchial mucosa without granulation tissue formation or infections. More experience is required to assess their long term efficacy.

Introduction: Cryptococcosis is common in solid organ transplant (SOT) recipients, but there is limited knowledge of the disease course in heart or lung organ recipients Aim: To describe the clinical course of 3 patients with Cryptococcus infection Method: Retrospective analysis of the medical records of 3 transplant patients (2 lung, 1 heart) reviewing their presentation, investigations, management and outcomes Results: Conclusion: Unrecognized and untreated cryptococcosis is often fatal but timely treatment can lead to complete recovery. Current treatment is based on experiences of Cryptococcosis in the HIV-positive population. Cryptococcosis should always be considered in our transplant population along with other common fungal infections, and more experience is needed to ensure management is optimized.

Introduction: People with cystic fibrosis (PwCF) have unpredictable clinical courses, making timing and listing for lung transplantation (LTx) difficult. FEV1 <30% predicted remains the gold standard as the referral threshold but is a blunt tool. Stanojevic et al (ERJ 2019; 54; 1900224) created a 2-year mortality prediction model, with the aim of identifying high-risk patients (defined as risk of mortality >20% over 2 years). Aim: To establish whether this model would have identified patients who died without LTx as high risk of mortality at time of referral or death (whichever came first). Method: Retrospective application of the mortality prediction model to PwCF who were transplanted (n=32) or died with a respiratory-related illness without LTx (n=36) 2015-2019. The model was applied at time of decision to refer, decision not to refer or death. Results: In the transplanted group, all PwCF had a risk of death >20% within 2 years at time of referral (median risk of death 58%, range 30%-91%). In the group that died (n=36), 58% (n=21) had a risk of death <20% within 2 years, (median risk of death 17%, range 7%-42%). Of these, 71% (n=15) had started transplant discussions or had already had a transplant decision made. Conclusion: Most PwCF die from respiratory failure and many have acute unpredictable declines, which prediction models do not have the sensitivity to discern. Although this model identified many patients appropriately for LTx, it was not sensitive enough to identify 58% of the patients who died, many of whom the clinical team had recognised as being at high risk of mortality. Better prediction models are needed given the variable clinical course.

printing supported by . Visit Chiesi at Stand D.30 SUNDAY, SEPTEMBER 25TH 2011 (r=0.805, p<0.0001), and for 130 normal (r=0.758, p<0.0001) and 82 abnormal sites (r=0.654, p<0.0001). For malignant cases, there was significant correlation in the total 160 sites (r=0.810, p<0.0001), 112 normal (r=0.782, p<0.0001) and 48 abnormal (r=0.564, p<0.0001). Benign cases showed significant correlations in the total 52 sites (r=0.780, p<0.0001), 18 normal (r=0.778, p<0.0001) and 34 abnormal sites (r=0.731, p<0.0001). Conclusions: This EBUS technique was successful in establishing accurate airway measurements for suitable airway stent sizes in interventional procedures, especially in cases with tracheobrochial malacia. P611 Bronchoscopic application of mitomycin-C as adjuvant treatment of postintubation tracheal stenosis Filipa Viveiros, Joana Gomes, Ana Oliveira, Sofia Neves, José Almeida, João Moura e Sá. Pulmonology Service, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal Introduction: Postintubation tracheal stenosis (PITS) continues to be a challenge in the diagnosis, management, and prevention.Mitomycin-C (MMC) is an antineoplastic antibiotic that inhibits fibroblast proliferation, modulating wound healing and scarring.Its topical application, as adjuvant treatment in endoscopic management of stenosis, has showed good results. Aim: Evaluate the results of MMC application by Rigid Bronchoscopy (RB) in PITS. Methods: Selected patients with PITS, in whom MMC was applied.It was used in a concentration of 0,4 mg/ml, applied with a cotton stiletto around granulation tissue, for 2-3 minutes, after RB dilatation or laser. Re-evaluation and MMC application was done according to evolution. Patients were evaluated for kind, location and stenosis size (%), treatment procedures and results with adjuvant MMC application. Results: 7 patients, 71,4% women, mean age 55,4y. Mean initial stenosis diameter 50% of airway lumen, mostly located 1-3cm below vocal cords, with 1-2 tracheal rings involvement. Stenosis RB dilatation, laser and MMC were made in all patients. Mean MMC sessions 2.7, with good and lasting decrease in granulation tissue in 43%, moderate in 29% and relapsing in 29%. At this moment, after MMC use, the mean time since granulation and symptoms improvement is 17,3 m, and mean final airway diameter 70% of the lumen. Conclusions: Our experience revealed that topical application of MMC can be beneficial in the modulation of wound healing and in the decreasing scar formation in the treatment of airway stenosis. Further research and randomized prospective clinical trials are needed to determine the most effective concentration, time and frequency of exposure to MMC. P612 The management of post-intubation/tracheostomy stenosis with silicone stent Ji-Hyun Kim, Jeong-Eun Kim, Kyung Woo Kang. Division of Respiratory and Critical Care, Department of Internal Medicine, Changwon Samsung Hospital, Sungkyunkwan University, School of Medicine, Changwon, Korea Benign tracheal stenosis in adult patients may occur as a complication of intubation, tracheostomy or surgical procedure. Silicone airway stenting has opened up a new way to treat patients with post-intubation stenosis.We investigated the clinical efficacy through a review of patients with post-intubation stenosis who underwent consecutive Natural silicone stent. Between January 2005 and December 2009, 19 patients underwent ballooning, ablation using electro-surgical unit, or bougienation by rigid bronchoscopy, followed by placement of the Natural stent. All patients reported subjective symptomatic relief immediately after stent placement. Spirometry data was collected at baseline, 3 month, and 24 month. The baseline and follow-up spirometry data was available in 11 patient. The baseline median FEV1% predicted was 40% (range, 22% to 62%). Follow-up spirometry data showed 37% improvement (range, 19% to 74%) at 3 month later, and 41% improvement (range, 21% to 77%) at 24 month later: The Natural stent were removed successfully in 10 patients (52.6%) after median of 16months. Other 5 patients (26.3%) were required re-stenting, and 4 patients died due to acute pulmonary edema with ESRD, myocardial infarction, intracranial hemorrhage.The Natural silicone stent proved to be effective and feasible therapeutic modality in improving quality of life with relief of dyspnea. P613 Long term outcomes of patients with benign tracheal stenosis after multidisciplinary management Gregoris Sratakos1, Dimitris Chiotis2, Charalampos Zisis3, Magda Stratiki2 , Niki Gianniou2, Philippos Emmanouil1, Nikos Koufos1, Sofianna Gennimata1, Manos Alchanatis1, Spyros Zakynthinos2. 11st Pulmonary Medicine Department of Athens University, “Sotiria” Hospital, Athens, Greece; 2Pulmonary and Critical Care Department of Athens University, “Sotiria” Hospital, Athens, Greece; 3Thoracic Surgery Department, “Sotiria” Hospital, Athens, Greece Treatment for benign tracheal stenosis remains controversial. Endoscopic management is often considered conflicting to surgery. We aimed to evaluate the long term results of multidisciplinary management in our patients cohort during the last 5 years. 24 patients (17 males), aged 48,5±20,2 (mean ± st.dev) with symptomatic tracheal stenosis were referred to our center. Patients were stratified in 5 groups as A: short/web stenoses (n=5), B: long/complex stenoses (n=11), C: Post-surgery relapse (n=4), D: Complications/Relapse after stent placement (n=2) and E: External compression (n=2). Therapeutic decisions were made on the principle that operable complex stenoses should be operated whereas short stenoses should first undergo interventional endoscopy reserving surgery for recurrence. If surgery was declined, patients were interventionally treated. 7 patients (groups A:1, B:5, C:1), underwent surgical tracheal resection and anastomosis. 3 patients (group A) underwent simple bronchoscopic resection and dilatation and never relapsed since. 15 patients (Groups A:1, B:7, C:3, D:2, E:2) received stent placement. 1 of them (group B) finally underwent surgery due to relapse. All patients were successfully treated and reported well after 34,9±23,8 months of follow up. No deaths occurred. Major complications included 1 case of bilateral pneumothorax during bronchoscopic intervention and a severe relapse of stenosis over a tracheal stent, both successfully undertaken by surgeons. Interventional bronchoscopy and tracheal surgery are both valuable options. Multidisciplinary counseling on each case using a simple therapeutic algorithm, may lead to successful long term results in practically all patients. P614 Evolution and therapeutical features in post-intubation tracheal stenosis in COPD patients Emilia Crisan1, Alina Croitoru1, Ruxandra Ulmeanu1, Mihai Alexe1, Ion Cordos2, Nicolae Galie2, Cristian Paleru2, Codin Saon2, Genoveva Cadar3, Iolanda Ion3. 1Bronchology Department, National Institute of Pneumology, Bucharest, Romania; 2Thoracic Surgery Department, National Institute of Pneumology, Bucharest, Romania; 3ICU Department, National Institute of Pneumology, Bucharest, Romania Post-intubation tracheal stenosis represents a severe complication in patients with hypercapnic respiratory failure due to COPD. We present a series of iatrogenic tracheal stenoses in COPD patients addressed to the Bronchology Department during 5 years. There were 13 patients (10 males, 46% over 60 years-old), COPD stage III-IV GOLD, who suffered a severe exacerbation that required oro-tracheal intubation; 8 needed tracheotomy.Tracheal stenoses developed after a mean period of 24 days (7-42) and were clinically significant. Bronchoscopy revealed tracheal stenosis with diameter less than 5 mm. 8 were located in proximal trachea and 5 in medial trachea, with length more than 2 cm in 7 cases and less than 2 cm in other 6. Initially, all were treated with interventional bronchoscopy (dilatation, granuloma resection) but the results were instable in time, requiring other methods: prosthetics (8 cases) or surgery (5 cases). In the patients treated by prosthesis, the stent was removed in 3 cases after 1,5-2 years, the rest remained chronic carriers of prostheses. The patients treated by surgery had significant complications: 1 death by mediastinis, 3 stenosis relapse on the anastomosis line (finally resolved with interventional bronchoscopy). Only one case was successfully solved after surgery. In conclusion, interventional bronchoscopy had a higher success rate (37%) than surgical therapy (20%), also solving the cases complicated post-surgery with reoccurrence of stenosis. While for different etiologies of tracheal stenosis, surgical resection is the first choice of treatment, in patients suffering from COPD, interventional bronchoscopy remains the only way to solve it. P615 RespiStent – A new concept for a viable stent for the treatment of endobronchial stenosis Christian Cornelissen1, Stefan Krüger1, Jan Spillner2, Stefan Weinandy3, Stefan Jockenhoevel3. 1Medizinische Klinik I Sektion Pneumologie, RWTH, Aachen, Germany; 2Klinik für Herzund Thoraxchirurgie, RWTH, Aachen, Germany; 3Applied Medical Engineering, RWTH, Aachen, Germany Endobronchial stent therapy is an accepted method for the treatment of endobronchial stenosis. It is limited by a loss of physiologic surface and, thus, mucus retention. We developed a novel concept for a vitalized endobronchial stent (fig. 1 A). The concept is based on the combination of stent technologies with the principles of tissue engineering. The RespiStent provides (1) a functional respiratory epithelium on the luminal side, which allows the maintenance of the mucociliary function in the stented area and hereby will help to reduce complications of mucus retention, (2) embedded microor nanosphere formulations, enabling the sus93s Thematic Poster Session Hall 2-6 12:50-14:40 Abstract printing supported by . Visit Chiesi at Stand D.30printing supported by . Visit Chiesi at Stand D.3

Although endoscopic management of malignant central airway obstruction (mCAO) is well established, not enough survival and quality of life (QoL) data exist comparing it with sole chemo-radiotherapy. We prospectively studied patients referred to our unit for mCAO using the EORTC QoL questionnaire, at one day before, 1 week after and every following month. 40 patients (31 males) aged 66.2±12.3 (mean ± st.dev) with either non-small cell lung cancer (n:35) or metastatic malignancies, were included. 31 patients (intervention group) underwent extensive interventional bronchoscopic management as indicated, whereas 9 declined endoscopic treatment (control group). Patients of the two groups did not statistically differ in age, comorbidities, type of malignancy and level of obstruction. Overall follow up time was 6±6.2 (range 1-26) months. 13 patients are still alive followed for 6.6±7.6 months (range 1-26). QoL and dyspnea significantly improved in all patients of the intervention group up to 1 month after the procedure (p Interventional bronchoscopy, may achieve prolonged survival, significant and sustained QoL and dyspnea improvement, in patients with airway obstructing malignancies.