BACKGROUND This study evaluates the impact of pretransplant HeartMate III (HM3) left ventricular assist device (LVAD) support duration on post-transplant survival in a contemporary cohort. METHODS A retrospective review of the United Network for Organ Sharing database was conducted for adult heart transplant recipients from January 2019 to December 2023 who were bridged with an HM3 LVAD. We utilized

INTRODUCTION The introduction of donor-derived cell-free DNA (dd-cfDNA) and the Molecular Microscope (MMDx) is changing how we diagnose rejection following heart transplantation (HT). This study aims to assess the accuracy of dd-cfDNA in detecting rejection as identified by MMDx and histology, with a focus on determining an optimal dd-cfDNA threshold to improve diagnostic performance. METHODS Single-center

As we have previously shown, Idiopathic pulmonary fibrosis lung transplant recipients (IPF-LTRs) with short-telomere length (STL) are prone to develop significant cytopenias and poor tolerance to cell cycle inhibitors, specifically Mycophenolate mofetil (MMF), post-transplant. We investigated the use of Belatacept as an alternative immunosuppressive agent in a prospective, open-label cohort of 9 ST-IPF-LTRs

OBJECTIVE Traditional rejection surveillance after heart transplantation (HTx) is based on endomyocardial biopsies (EMB), which are invasive, expensive and associated with complications. Monitoring using cell-free DNA (cfDNA) is promising, but most studies report only on the donor fraction (DF) as the percentage of donor derived-cfDNA (dd-cfDNA) relative to total-cfDNA. We evaluated the performance

BACKGROUND A recent study demonstrated upregulation of PANoptosis-related genes during reperfusion in human lung transplants. However, the impact of ex vivo lung perfusion (EVLP) on different cell death pathways and their relationship with inflammatory genes and clinical characteristics remains unknown. METHODS We conducted transcriptomic analyses on pre- and post-EVLP biopsies from 49 donation after

BACKGROUND Left ventricular assist devices (LVADs) improve outcomes in advanced heart failure but require anticoagulation. Vitamin K antagonists (VKAs) have significant limitations, with labile INRs and suboptimal Time in Therapeutic Range (TTR), associated with increased morbidity and mortality. Direct oral anticoagulant therapy (DOAC) has been contraindicated in LVAD patients. METHOD The ApixiVAD

BACKGROUND Custodiol® is a well-established preservation solution for organ transplantation and was the basis for the development of Custodiol-N to improve graft preservation. Previous results in coronary artery bypass graft surgery have shown effective cardiac protection without safety concerns. This study aimed to evaluate the safety and ability of Custodiol-N to preserve cardiac grafts for heart

BACKGROUND CD26/dipeptidyl peptidase 4 inhibitors (gliptins) target proinflammatory pathways that contribute to the development of chronic lung allograft dysfunction (CLAD). We analyzed longitudinal clinical data from 6 North American lung transplant centers to elucidate the effect of gliptin exposure on CLAD development after lung transplantation. METHODS This cohort included 6 North American lung

BACKGROUND While current lung ischemia-reperfusion injury (IRI) research predominantly relies on small animal models, significant interspecies physiological disparities between rodents and humans frequently lead to translational failures of promising therapies. This translational gap underscores the critical need for developing large animal models in IRI pathophysiology studies. METHODS We developed

BACKGROUND Acute lung allograft dysfunction (ALAD) is a clinical syndrome of forced expiratory volume in 1-second (FEV1) decline concerning for chronic lung allograft dysfunction (CLAD) onset. Novel diagnostic tools are needed to identify those with ALAD who will progress to CLAD and to target appropriate therapies. We hypothesized that progressive ALAD would be associated with changes in small airway

We evaluated the rate of bone mineral density (BMD) loss after heart transplant using dual-energy X-ray absorptiometry (DXA) to determine the optimal DXA surveillance frequency. This retrospective study involved 153 heart transplant recipients aged 50 years or greater, followed for up to 5,614 (median 1,111) days after transplant. Mixed-effects models with random intercepts were used to evaluate BMD

BACKGROUND Childhood interstitial lung disease (chILD) is heterogeneous, associated with significant morbidity and can cause organ failure. In these cases, lung transplantation (LuTx) is a treatment option. Data on indications and outcome after LuTx for chILD is limited. We compared characteristics of LuTx for chILD to the indications cystic fibrosis (CF) and pulmonary hypertension (PH). METHODS chILD-patients

BACKGROUND In 2023, a new United Network for Organ Sharing (UNOS) policy established criteria for a kidney allocation safety net for lung transplant recipients (LTRs) with chronic renal dysfunction. We sought to evaluate the demographics and outcomes of past lung transplant recipients who would have been eligible for a rescue kidney under the new criteria. METHODS Using the UNOS Organ Procurement and

PURPOSE We conducted a randomized trial of open lung protective ventilation (OLPV) compared to conventional ventilation (CV) in deceased donors. The primary outcome was lung utilization for transplantation. METHODS Eligible donors were ≥13 years with PaO2/FiO2 between 150 and 400 mmHg. Donors were randomized to volume control with OLPV [tidal volume (TV) 8 ml/kg, PEEP 10 cmH2O, protocolized recruitment

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

BACKGROUND There is growing evidence that many patients undergoing lung transplantation report significant distress and low physical activity (PA), which might not improve despite lung transplantation and may be associated with worse clinical outcomes. Few studies have attempted to improve psychological outcomes and functional capacity and PA after transplant. METHODS Investigational Study of Psychological

BACKGROUND Atrial fibrillation (AFib) reduces the quality of life and increases hospitalization frequency in patients with pulmonary hypertension (PH). Chronic thromboembolic pulmonary hypertension (CTEPH) is a form of PH with a specific pathophysiology, treatment methods, and demographics; however, the factors that correlate with AFib in this population have not yet been determined. This study aimed

BACKGROUND The 1.5 ventricle repair is a palliative procedure for patients with congenital heart disease with advanced right heart failure. There are limited data about patient selection and outcomes of this procedure. The purpose of this study was to describe the clinical and hemodynamic characteristics, and outcomes of adults with congenital heart disease (CHD) and 1.5 ventricle repair. METHOD We

The psychosocial evaluation plays an essential role in the multidisciplinary assessment of pediatric patients for thoracic organ transplantation or ventricular assist device (VAD) placement. However, there is considerable practice variation with regard to the content and process of the evaluation, with no known recent published guidelines. Furthermore, the pediatric evaluation necessarily differs from

Progress in the field of pediatric ventricular assist devices (VAD) have revolutionized the care and management of young patients with end-stage heart failure. However, innovation in pediatric medical devices is limited by financial and regulatory barriers due to the small and heterogenous target population. The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) was established in 2017

BACKGROUND Donation after circulatory death (DCD) donors remain an underutilized source in the United States due to concerns of ischemia-reperfusion injury (IRI) after prolonged ischemic times. Lung-derived exosomes have shown potential in mitigating pulmonary fibrosis by promoting lung repair. Here, we sought to investigate the potential of lung-derived exosomes to prevent and repair lung IRI. METHODS

BACKGROUND Access to life-saving lung transplantation remains limited by a shortage of donor organs. We have previously described rehabilitation of discarded human donor lungs to a quality suitable for transplantation using cross-circulation of whole blood between xeno-support swine and human lungs. However, the immunologic implications of transplanting rehabilitated lungs remain unknown. METHODS Human

Pulmonary arterial hypertension (PAH) guidelines advocate measures of area for right atrial (RA) dimensions, while echocardiographic guidelines recommend RA volume. We compared the prognostic value of RA echocardiographic parameters to predict transplant-free survival in 332 adult patients with PAH. RA area correlated strongly with volume (r = 0.96). After adjusting for age and sex, for every 1-standardized

BACKGROUND Current International Society for Heart and Lung Transplantation (ISHLT) criteria for pulmonary antibody-mediated rejection (AMR) is predicated on a constellation of clinical, laboratory and histopathological parameters, including the presence of donor-specific antibodies (DSA). However, molecular evidence of allograft injury is not considered. The aim of this study was to investigate if

With recent advances in xenotransplantation, an increased initiative toward clinical applications in human recipients has evolved. Along with this trend, ethical concerns and considerations have been discussed. Infants and young children have been suggested as a group of patients for consideration of early clinical application given their limited mechanical circulatory support options, high waitlist

BACKGROUND Controlled hypothermic preservation of donor hearts is associated with decreased post-transplant primary graft dysfunction compared to conventional cold storage. However, mechanisms underlying this benefit in human subjects are unclear. METHODS We randomized 20 heart transplant recipients at a single institution to receive donor hearts preserved with either controlled hypothermic preservation

BACKGROUND Ischemia-reperfusion injury (IRI) remains an important challenge in lung transplantation (LTx). Ischemia can be divided into 3 phases: cooling during procurement, preservation, and rewarming during implantation. Temperature fluctuations influence metabolic processes, exacerbating IRI. However, actual lung temperatures have not been previously studied. Therefore, we aimed to characterize

BACKGROUND Renal dysfunction is a common postoperative complication following cardiothoracic surgery, including heart and lung transplantation. Among adult lung transplant (LTx) recipients, acute kidney injury is associated with increased morbidity and mortality with those requiring renal replacement therapy having the worst outcome. The prevalence and risk factors for renal failure requiring post-transplant

BACKGROUND Most donor hearts offered for heart transplant (HT) in the United States (US) are turned down. We aimed to understand the reasons for this - focusing on those related to the potential recipient and HT center (i.e. donor-unrelated reasons for refusal). METHODS The Donor Heart Study (DHS) enrolled 4,333 adult potential heart donors in US from 2015 - 2020. Separately by donor, each HT center

Extrinsic Outflow Graft Obstruction (EOGO) is a potential complication of durable left ventricular assist device (LVAD) therapy characterized by obstructive biodebris accumulation between the outflow graft (OG) and, in the case of HM3, the bend relief (BR). Recent reports have suggested that perforating the HM3 BR may help prevent EOGO. The study objective was to histologically compare the nature and

The advent of normothermic, ex-situ heart perfusion (ESHP) enables new options for evaluation of cardiac grafts. Donation after circulatory death (DCD) is a promising solution to improve heart transplantation rates, but current ESHP evaluation approaches are recognized as suboptimal for DCD grafts. We aimed to develop a vascular function test for cardiac graft assessment during ESHP using a porcine

BACKGROUND Despite evidence that gastroesophageal reflux (GER) is harmful to the lung allograft, the mechanism of injury remains incompletely defined. We hypothesized that GER induces a humoral alloimmune response and examined the association between GER and de novo donor-specific antibody (DSA) development. METHODS 508 lung transplant recipients who underwent routine pH-impedance testing at 3 months

BACKGROUND Heart transplantation (HT) is the gold standard for end-stage heart disease. Donor heart preservation is an important factor that influences post-transplant success. Recently, temperature-controlled storage has demonstrated reduced primary graft dysfunction compared to standard cold storage though mechanisms are poorly understood. We hypothesized that alterations in gene expression and metabolomics

BACKGROUND Contemporary durable left ventricular assist devices (LVAD) have established current benchmarks for patient outcomes, but introduction of more novel technology is lacking. The BrioVAD System (BrioHealth Solutions, Burlington, MA) is an innovative, fully magnetically levitated pump intended to provide short-term (ST) and long-term (LT) mechanical circulatory support. METHODS The Investigation

BACKGROUND The impact of regional differences on primary graft dysfunction (PGD) after heart transplantation (HT) has not been assessed. This study aims to compare differences in the incidence, risk factors, and outcomes of severe PGD in the US, Canada, and Europe. METHODS This retrospective, observational study included consecutive adult HT recipients from 14 centers between 2010-2022. The primary

This is a perspective of what it was like going through the diagnosis of advanced heart failure and subsequent heart transplant surgery in 2019.

BACKGROUND Cell-free DNA (cfDNA) in ex-vivo lung perfusion (EVLP) perfusate has been shown to potentially reflect lung injury; however, the relationship between cfDNA concentration with clinical EVLP lung outcomes has not been elucidated. METHODS A discovery cohort of n = 100 clinical EVLP cases and a validation cohort (n = 50) were used in this single-center, retrospective cohort study. cfDNA was