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Development of the Permian Basin in recent years has disrupted the global trade of oil and gas. As of January 2020, it was producing more than five million barrels of oil and 20 billion cubic feet of gas per day, with the greatest growth coming from the Delaware Basin sub-play. In this investigation, we report the results of a novel process-based life cycle assessment (LCA) of the greenhouse gas (GHG) emissions associated with oil and gas products from the Delaware Basin, employing extensive operational data including direct measurements of methane emissions. We find that if 1% of the gross gas produced is flared, then the upstream carbon intensity of crude oil is 19.5 kg CO2eq per barrel of crude oil - substantially lower than “global average” intensities reported in the literature. Moreover, the carbon intensities of gasoline, diesel and jet fuel refined from Delaware Basin crudes are approximately 10% less than the U.S. EPA and Department of Energy baselines when a 1% flaring rate is achieved. The life cycle GHG reductions are also a consequence of the physical and chemical properties of Delaware Basin crudes relative to the average crude blend for the U.S., resulting in reduced refinery GHG emissions. We also find that life cycle GHG emissions associated with natural gas from the Delaware Basin are similar to those reported for U.S. shale gas.

Inadequate bowel preparation (IBP) is a common problem in hospitalized patients; however, little is known about how to prevent IBP. In a large, multihospital system, we evaluated the association between modifiable factors and IBP rate.We reviewed data from adult (≥18 years) inpatients undergoing colonoscopy between January 2011 and June 2017. Colonoscopies performed in the intensive care unit or lacking descriptions of bowel preparation quality were excluded. Multivariate logistic regression analysis was performed to identify factors associated with IBP. A counterfactual analysis was performed to assess the potential contribution of modifiable factors to IBP.Of 8,819 patients that were included (median age of 64 years; 50.5% female), 51% had IBP. Patients with IBP stayed in the hospital one day longer than those with adequate bowel preparation (P.001). Modifiable factors associated with IBP include opiate use within three days of colonoscopy (OR, 1.31; 95% CI, 1.18, 1.45), colonoscopy performed after 12:00 pm (OR, 1.25; 95% CI, 1.1, 1.41), and solid diet the day before colonoscopy (OR, 1.37; 95% CI, 1.18, 1.59). In the counterfactual analysis, if all patients avoided these three conditions, adjusted IBP rates were reduced by 5.6%.Among hospitalized patients undergoing colonoscopy, IBP rates are high and associated with an increased length of stay. Avoiding opiates before colonoscopy, performing colonoscopy before noon, and maintaining patients on a liquid diet or nil per os might significantly reduce IBP rates.

Background and Aims Physician adherence to published colonoscopy surveillance guidelines varies. We aimed to develop and validate an automated clinical decision support algorithm that can extract procedure and pathology data from the electronic medical record (EMR) and generate surveillance intervals congruent with guidelines, which might increase physician adherence. Methods We constructed a clinical decision support (CDS) algorithm based on guidelines from the United States Multi-Society Task Force on Colorectal Cancer. We used a randomly generated validation dataset of 300 outpatient colonoscopies performed at the Cleveland Clinic from 2012 through 2016 to evaluate the accuracy of extracting data from reports stored in the EMR using natural language processing (NLP). We compared colonoscopy follow-up recommendations from the CDS algorithm, endoscopists, and task force guidelines. Using a testing dataset of 2439 colonoscopies, we compared endoscopist recommendations with those of the algorithm. Results Manual review of the validation dataset confirmed the NLP program accurately extracted procedure and pathology data for all cases. Recommendations made by endoscopists and the CDS algorithm were guideline-concordant in 62% and 99% of cases respectively. Discrepant recommendations by endoscopists were earlier than recommended in 94% of the cases. In the testing dataset, 69% of endoscopist and NLP-CDS algorithm recommendations were concordant. Discrepant recommendations by endoscopists were earlier than guidelines in 91% of cases. Conclusions We constructed and tested an automated CDS algorithm that can use NLP-extracted data from the EMR to generate follow-up colonoscopy surveillance recommendations based on published guidelines.

Importance Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia. Objective To assess the association between endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors. Design, Setting, and Participants This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors. Exposures Seven characteristics of endoscopists performing colonoscopy. Main Outcomes and Measures The ADR and pSSPDR, with a hypothesis created after data collection began. Results A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years;P Conclusions and Relevance The differences in ADRs that were associated with 7 of 7 endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.

Background and Aims Colonoscopy is commonly performed for colorectal cancer screening in the United States. Reports are often generated in a non-standardized format and are not always integrated into electronic health records. Thus, this information is not readily available for streamlining quality management, participating in endoscopy registries, or reporting of patient- and center-specific risk factors predictive of outcomes. We aim to demonstrate the use of a new hybrid approach using natural language processing of charts that have been elucidated with optical character recognition processing (OCR/NLP hybrid) to obtain relevant clinical information from scanned colonoscopy and pathology reports, a technology co-developed by Cleveland Clinic and eHealth Technologies (West Henrietta, NY, USA). Methods This was a retrospective study conducted at Cleveland Clinic, Cleveland, Ohio, and the University of Minnesota, Minneapolis, Minnesota. A randomly sampled list of outpatient screening colonoscopy procedures and pathology reports was selected. Desired variables were then collected. Two researchers first manually reviewed the reports for the desired variables. Then, the OCR/NLP algorithm was used to obtain the same variables from 3 electronic health records in use at our institution: Epic (Verona, Wisc, USA), ProVation (Minneapolis, Minn, USA) used for endoscopy reporting, and Sunquest PowerPath (Tucson, Ariz, USA) used for pathology reporting. Results Compared with manual data extraction, the accuracy of the hybrid OCR/NLP approach to detect polyps was 95.8%, adenomas 98.5%, sessile serrated polyps 99.3%, advanced adenomas 98%, inadequate bowel preparation 98.4%, and failed cecal intubation 99%. Comparison of the dataset collected via NLP alone with that collected using the hybrid OCR/NLP approach showed that the accuracy for almost all variables was >99%. Conclusions Our study is the first to validate the use of a unique hybrid OCR/NLP technology to extract desired variables from scanned procedure and pathology reports contained in image format with an accuracy >95%.

We identified patients without medical record evidence of up-to-date colorectal cancer (CRC) screening and sent an invitation letter to self-schedule a colonoscopy without requiring prior primary care or gastroenterologist consultation. The aim of the study was to evaluate the response rate to the letter and factors associated with colonoscopy completion. A computer algorithm invited patients not up to date with CRC screening, with an INR

Biliary dilation suggests obstruction and prompts further work up. Our experience with endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the symptomatic post-bariatric surgery population revealed many patients with radiographically dilated bile ducts, but endoscopically normal studies. It is unclear if this finding is phenomenological or an effect of surgery. Additionally, it is unknown whether the type of bariatric surgery alters biliary pathophysiology. Thus, we studied whether a change occurs in biliary diameter following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). A single-center retrospective study assessing biliary diameter before and after RYGB or SG based on radiographic imaging. All adult patients undergoing RYGB or SG from January 2010 to December 2013 who had imaging studies before and > 3 months after surgery were included. Those with known obstructive etiologies and those without post-operative imaging were excluded. Common bile duct (CBD) diameter was re-read by a radiologist at the same location in the CBD for pre- and post-operative imaging. Baseline clinical factors and cholecystectomy status were collected. 269 patients met inclusion criteria (193 RYGB;76 SG). Between the groups, there were no significant differences in pre-operative characteristics. Average time from surgery to repeat imaging was 24.1 months. After adjusting for pre-operative factors, subjects who underwent an RYGB had an increase in CBD diameter of 1.4 mm (95% CI 0.096, 0.18), which was greater than the change following SG 0.5 mm(95% CI − 0.007, 0.11). The magnitude of this change did not depend on prior cholecystectomy in the RYGB cohort. Within the SG group, for patients without a prior cholecystectomy, there was a significant increase in post-operative CBD diameter of 0.8 mm(95% CI 0.02, 0.14). Bariatric surgery results in CBD dilation, with changes more pronounced after RYGB. Biliary dilation occurs irrespective of cholecystectomy status. Further work is necessary to determine the cause and clinical implications of this phenomenon.

The utility of percutaneous endoscopic gastrostomy (PEG) decompression for inoperable malignant bowel obstruction is well documented. However, there are limited data on decompressive PEG for prolonged ileus, gut dysmotility, and/or complicated nonmalignant bowel obstruction. The aim of this study was to assess the safety and short-term outcomes of decompressive PEG for nonmalignant indications.After Institutional Review Board approval, we retrospectively reviewed and analyzed all PEG insertions completed at our institution between 2009 and 2014 for prolonged ileus, gut dysmotility, or nonmalignant obstruction.We identified 72 patients (42 females, 30 males; mean age, 58.8 ± 15.2 years) who underwent decompressive PEG for nonmalignant indications. There were no procedural complications or mortalities. The mean pre- and postprocedural length of stays were 14.4 ± 10.7 and 7.6 ± 11.1 days, respectively (P = .0003). The 30-day re-admission rate was 12.5% (9 patients; the majority for unrelated issues). Fifty-two (72%) of the 72 patients were discharged with a PEG for decompression for a median of 69.5 (range, 17-316) days; the remaining 20 (28%) patients were lost to follow-up and were assumed to continue follow-up with their primary referring center. Of the 72 patients, 63 (87.5%) were discharged on total parenteral nutrition (TPN); 36 (50%) of those continued to receive TPN for a median of 51 (range, 4-316) days after discharge, and resolution of their mechanical obstruction was ultimately achieved, so that they subsequently resumed enteral nutrition. Twenty-four (33%) patients were lost to follow-up; because they were referred to our tertiary referral center, we assumed they continued follow-up at their referring institution. Three (4%) patients ultimately went on to use TPN indefinitely and thus were considered to be chronically TPN-dependent.Decompressive PEG insertion is safe and effective at alleviating obstructive symptoms in patients with prolonged postoperative ileus, gut dysmotility, and/or complicated nonmalignant obstruction.

Aims Histamine and serotonin-related pharmaceuticals have the potential to modulate micturition and continence. The aim of this study was to determine if treatment with histamine and/or serotonin improves stress urinary incontinence (SUI) in female rats. Methods Twenty-six age-matched female rats underwent pudendal nerve crush and vaginal distension (PNC + VD), to produce SUI. One week after injury, rats were treated subcutaneously with saline, histamine (1.1 μg), serotonin (2μg), or the combination of both twice daily for another week. A sham injured group received sham PNC + VD and were treated with saline (n = 7). Leak point pressure (LPP) testing with simultaneous external urethral sphincter (EUS) electromyography (EMG) was conducted 2 weeks after injury. The urethra was harvested for qualitative and quantitative histology. Data were analyzed with a one-way ANOVA and Student-Newman-Keuls posthoc test with P

Aim Development of de novo HLA donor-specific antibody (dnDSA) after lung transplant (LuTx) is prevalent and associated with poorer transplant outcomes. Understanding pre-LuTx determinants helps to minimize dnDSA. The aim of this study was to investigate the impact of HLA-Epitope Mismatch Load (EpiMML) in the development of dnDSA in LuTx recipients. Methods 572 recipients received LuTx during 10/2012–10/2017 and were retrospectively analyzed for the formation of dnDSA (Mean Fluorescence Intensity ⩾ 1000). Antigenic mismatches were recorded among 422 recipients. EpiMMLs were determined by HLA-Matchmaker (Version 02) among 168 recipients who had four-digit high resolution typing. There were 18 recipients who were typed by both high and low resolution. Acute Cellular Rejection (ACR) and Antibody Mediated Rejection (AMR) were assessed for LuTx outcomes. Results Of the 572 patients, 55% developed dnDSA; 25% Class I, 39% Class II, and 36% both Class I and II. In Class II, the most prevalent dnDSA was DQ (216/235; 92%). EpiMMLs for Class I, Class II, as well as single loci of HLA-A, B, C, DR, and DQ were all significantly higher from patients with positive dnDSA than from patient with negative dnDSA (Table 1a). However, for antigen-level mismatches, only HLA-A and DQ correlated with the development of dnDSA. As shown in Table 1b, certain mismatched epitopes were more frequent among patients who developed dnDSA than those who did not. Among a subgroup of 120 recipients, EpiMMLs of Class II, especially DQ, were significantly associated with the occurrence of ACR (p = 0.02 and 0.005, respectively). There was no remarkable relevance between EpiMMLs and AMR. Conclusions Compared to HLA antigen mismatching, EpiMML is a better predictor of dnDSA development in LuTx recipients. Increasing EpiMMLs, particularly for HLA-DQ, identify patients at the highest risk to develop dnDSA and ACR. Collectively, these data support the use of EpiMML assessment especially for optimizing post-transplantation immunosuppression in LuTx recipients. Download : Download high-res image (242KB) Download : Download full-size image Download : Download high-res image (182KB) Download : Download full-size image

Aim False positive antigen specificities (FPAS) from the Luminex Single Antigen (LSA) Assay are difficult to identify due to multiple interfering factors and various corresponding resolving approaches. Over calling antibodies limits a patient’s access to deceased donor organs and can result in erroneous immune therapy. Here we report how to properly identify and resolve FPAS from LSA assays to precisely provide HLA-antibody results in supporting Thoracic Organ Transplantation (TOT). Methods We retrospectively studied 66 TOT cases that had suspected FPAS reactions with LSA assays. The initial antibody work up was tested by LSA and FlowPRA Screening Beads. Discordance between the two assays and/or ambiguity were verified by Luminex Phenotype Beads. LSA was used for all antibody follow up. If an obvious antibody increase was observed, further investigation for sensitizing events and/or possible interfering medication (such as IvIg), warranted additional testing. Detailed approaches for FPAS identification and resolution are listed in Table 1a. Results Of the 66 FPAS cases, 56 (85%) were caused by denatured antigen (dAg) and 10 (15%) were due to IvIg infusion. The distribution of complete FPAS and partial FPAS (the mixture of true positive and FPAS) from dAg and IvIg were almost equal, 54% vs 46% and 50% vs 50%, respectively. The FPAS dAg patterns with highest occurring frequencies were Cw1, Cw12, Cw15 (27%) from class I and DP1, DP11, DP13, DP6, DQ4 (34%) from class II. The elimination of FPAS reduced the average PRA by 67% from dAg and 78% from IvIg interference. 22 cases received TOT after FPAS were ruled out (Table 1b). Conclusions FPAS is the prevalent issue of LSA when false negativity is eliminated by serum EDTA treatment. Alternative assays by multiple platforms, supplementary LSA data analysis, and referencing clinical records are warranted for ruling out FPAS. This provides precise antibody testing results for successful access to TOT.

The addition of streptolysin-O (SLO) to the standard antibiotics regimen was shown to be superior to antibiotics alone after experimental infection of foals with Rhodoccocus equi (R. equi). The objective of this study is to investigate this response by determining the site-specific expression of extracellular matrix (ECM) and inflammatory response genes in biopsy samples taken from three distinct lung regions of the infected foals. Twenty-four foals were challenged by intrabronchial instillation of R. equi and assigned to four treatment groups: SLO/antibiotics adjunct therapy, antibiotics-only therapy (7.5 mg/kg clarithromycin and 5 mg/kg rifampin), SLO-only, and saline-only treatments. Treatments were administered twice daily for 16 days unless symptoms progressed to the point where the foals needed to be euthanized. Gene expressions were determined using custom-designed equine real-time qPCR arrays containing forty-eight genes from ECM remodeling and inflammation pathways. A non-parametric Wilcoxon signed-rank test for independent samples was applied to two pairs of time-matched comparison groups, SLO/antibiotics vs. antibiotics-only and SLO-only vs. saline-only, to document the significant differences in gene expressions within these groups. Several genes, MMP9, MMP2, TIMP2, COL1A1, COL12A1, ITGAL, ITGB1, FN1, CCL2, CCL3, CXCL9, TNFα, SMAD7, CD40, IL10, TGFB1, and TLR2, were significantly regulated compared to the unchallenged/untreated control foals. The results of this study demonstrate that enhancement of clinical responses by SLO is consistent with the changes in expression of critical genes in ECM remodeling and inflammatory response pathways.

Aim Intestinal transplantation (ITx) with or without liver graft is a valid treatment for patients with intestinal failure. The impact of immune-protective effect of the liver allograft in ITx recipient is not fully understood, necessitating an analysis of immunological response due to extra carriage of donor lymphoid tissues from liver allograft. Methods During 2012–2016, 67 ITx including 11 re-grafting were performed with 11 (16%) liver-contained grafts. Immunosuppressive induction with alemtuzumab or thymoglobulin was used less frequently in 2/11 (17%) liver-contained, compared to 54/56 (96%) liver-free allograft recipients. The outcome measures included acute cellular rejection (ACR), graft survival, de- novo donor specific antibody (dDSA), and acute graft vs. host disease (aGVHD). Results Rejection-free rate of liver-free graft was significantly lower than that of liver-contained (Fig. 1A). However, all the ACR of liver-contained graft was reversible without graft loss. dDSA was detected in 3 (27%) liver-contained, and 7 (13%) liver-free allograft recipients ( p = 0.40). aGVHD occurred and resulted in death in 2 (18%) recipients of liver-contained allograft, opposed to none of liver-free ( p p = 0.50) (Fig. 1B). Conclusions Considering immune-protective effect of liver allograft, reduced immunosuppressive induction was used in liver-contained ITx recipients, resulting in an increased ACR rate with a sustained aGVHD risk. However, the long-term outcome was improved with immune-protective effect of liver allograft. Download high-res image (145KB) Download full-size image

Streptolysin O (SLO) is a protein cytotoxin derived from Group A beta-hemolytic streptococci that associates with membranes and permeabilizes cells. Oxidation inactivates SLO, eliminating the characteristic hemolytic and cytotoxic activities. However, oxidized SLO produces beneficial therapeutic effects in vivo on scleroderma, scar formation and wound healing. Here we report that oxidized SLO also significantly inhibited invasion by human metastatic breast cancer MDA-MB-231 cells through Matrigel in an in vitro model of metastatic disease. This dose-dependent response corresponded to selective SLO activation of epidermal growth factor receptor (EGFR) ErbB1. SLO and EGF were equally selective in activation of EGFR, but EGF elicited larger relative increases in phosphorylation at various sites, especially pronounced for Tyr845. Addition of SLO did not affect either ERK1/2 or Akt kinases and altered the expression of only 10 of 84 metastasis-related genes in MDA-MB-231 cells. Neither SLO nor EGF promoted growth of several human breast cancer cell lines. Knockdown of EGFR by siRNA ablated the inhibitory effect of SLO on cancer cell invasion, showing SLO selectively activated ErbB1 kinase to reduce invasion without increasing cell growth. The results suggest SLO might have promise as a new therapy to inhibit metastasis.

Evidence suggests that nerve growth factor (NGF) may have antidepressant properties but the pharmacological mechanisms remain unknown. Previously, we found that NGF improved performance in the forced swim test in Flinders Sensitive Line rats, but did not appear to have similar biochemical actions with the antidepressant fluoxetine. Gene expression profiles for neurotransmitter receptors and regulator-related genes in the amygdala/hippocampus were determined in rats treated for 14days with NGF, fluoxetine, amitriptyline, or saline. Gene expression was measured using an RT(2) profiler PCR Array System to determine the basis for this effect. Compared with saline, there were numerous genes with significantly altered mRNA levels in the amygdala/hippocampal region. Overlap was found between the mRNA levels of genes altered by NGF and the two antidepressant medications including genes related to the cholinergic and dopaminergic systems. However, decreased mRNA levels of Drd5, Sstr3, Htr3a, and Cckar genes in the amygdala/hippocampus were uniquely regulated by NGF. The results of this study are consistent with a previous conclusion that the antidepressant effects of NGF are mediated through non-traditional receptors for traditionally considered neurotransmitters and may suggest a particular utility of NGF in treating comorbid depression and addiction.

Introduction Post-transplant lymphoproliferative disorders (PTLD) are mostly Epstein-Barr virus (EBV) positive lymphoid proliferations resulting from immunosuppression following allogeneic stem cell or solid organ transplantation (SOT). Despite this strong association, there is a lack of data evaluating the risk of PTLD in SOT patients (pts) with (w/) EBV viremia. The significance of EBV detection remains unclear and can lead to unwarranted preemptive treatments in SOT pts. The aim of this study is to assess the association between peripheral blood EBV viral load and risk of PTLD post SOT. Methods We identified 6468 adult and pediatric pts from the Cleveland Clinic SOT database who underwent SOT from 2002-2016. We included pts who had ≥1 EBV viral load test by PCR, and excluded pts w/ first EBV test at or after PTLD diagnosis. EBV viral load was quantified by polymerase chain reaction (PCR) of whole blood samples and expressed as log copies/mL. Lower detection limits varied from 2.00 to 2.70 log copies/mL. EBV monitoring post SOT was done at the physician's discretion. Potential risk factors for PTLD were assessed using Fine and Gray competing risk regression. Stepwise analysis was used to identify multivariable risk factors. Landmark analyses at 2 and 6 months post SOT (LM-2 and LM-6) were performed based on pts' peak pre-landmark EBV levels. Pts were excluded if they died, lost follow-up (f/u) or developed PTLD prior to the landmark. Two multivariable models were assessed at each landmark using EBV level cutoffs of 3.00 and 4.00 log. Results Of 6324 pts w/ available f/u data, 3348 (52%) had ≥1 quantitative EBV PCR test and were included in this analysis w/ a total of 91,067 tests performed. Median age at SOT was 54 years (range 0.3-79) and 63% were male. The most common SOT was kidney (38%) followed by lung (37%), liver (18%), heart (7%), pancreas (6%) and intestine (2%), w/ 7% receiving >1 organ type (Table 1). Of 3348 pts included, 1503 (45%) developed EBV viremia and 68 (2%) developed PTLD; 45/1503 (3.0%) and 23/1845 (1.2%) of pts w/ and without (w/o) EBV viremia, respectively. EBV was detected in 44% of pts w/o PTLD and 66% of pts w/ PTLD. Median age at PTLD diagnosis was 58 years (range 1-75), with a median time from SOT to PTLD of 33 months (range 2-146). PTLD morphology was DLBCL (n=39), polymorphic (n=9) Burkitt (n=5), other (n=10) and unknown (n=5). EBV-encoded RNA (EBER) testing in tumor was positive in 47%, negative in 44% and unknown in 9% of cases. In pts w/ and w/o PTLD, tacrolimus was the most common immunosuppressant used at 1 month (99% and 89%), 1 year (94% and 88%) and 2 years (81% and 74%) post SOT, respectively. First EBV was checked at a median of 54 days (range 0-5090) in pts w/o PTLD and 28 days (range 0-4308) in pts w/ PTLD. The median number of EBV tests/pt before PTLD or last f/u was 4 (range 1-214) in pts w/o PTLD and 6 (range 1-123) in pts w/ PTLD. Peak EBV levels ≥3.00 and ≥4.00 log were detected in 36% and 13% of pts w/o PTLD, and 60% and 40% of pts w/ PTLD, respectively. Median f/u in both cohorts for pts who were alive was 6.1 years. In multivariable analysis (MVA) for non-EBV risk factors for PTLD, liver (HR 2.19, 95% CI 1.31 - 3.66, p=.003) and intestine SOT (HR 4.62, 95% CI 1.84 - 11.6, p=.001) were the only factors associated w/ higher PTLD risk; age, years since SOT, gender, race, other types of SOT and >1 SOT were not significant. 1685 pts were eligible for LM-2 (43 w/ PTLD) and 2093 for LM-6 (36 w/ PTLD). In univariable analysis at LM-2 and LM-6, peak EBV levels ≥4.00 log (LM-2: HR 2.72, p=.016; LM-6: HR 7.08, p Conclusion In this large cohort of SOT pts, Figure. Figure. Disclosures Hill: Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Genentech: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Research Funding; Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Aim Autoantibodies have been implicated in the chronic rejection process after Lung Transplantation (LuT), but it is less certain if preformed non-HLA autoantibody (pAuAb) is the pre-LuT determinant for De Novo Donor Specific Antibody (dDSA) development. This study aims to investigate the relationship of pAuAb to dDSA fomation and the clinical impact of dDSA to LuT. Methods 124 recipients underwent LuT during 10/2012 −2/2014 at our center were retrospectively analyzed for dDSA (Mean Fluorescence Intensity ⩾1000). pAuAbs were detected among a subgroup of 118 patients using LABScreen™ Autoantibody (Thermofisher, panel coverage is listed in Table 1a). Cut-offs for pAuAbs were set up using 85% reference background values, which were calculated of lower than 85% population from a group of random selected non-transplanted and non-transfused individuals. Acute Cellular Rejection (ACR), Antibody Mediated Rejection (AMR) were recorded to assess LuT outcomes. Results 71 out of 124 (57%) recipients were identified with dDSA. Among dDSA recipients, Class I only, Class II only, and combined Class I and Class II were 16 (23%), 30 (42%), and 25 (35%), respectively. 53 (75%) of total dDSA was from DQ. pAuAbs to Angiotensinogen and Vimentin were clearly related to the formation of dDSA (p Conclusions The significant relevance of multiple pAuAbs to the formation of dDSA may provide a new perspective for evaluating the possibility of pAuAbs in eliciting dDSA at pre-LuT, which may help to reduce the risk of ACR and AMR related negative impact to LuT.