Trasplante cardíaco

Bull Cancer. 2025 Sep 24:S0007-4551(25)00388-1. doi: 10.1016/j.bulcan.2025.07.015. Online ahead of print.

ABSTRACT

The use of haploidentical Hematopoietic Stem Cell Transplants (Haplo-HSCT) in adults has increased due to improved procedures that lower the risk of graft-versus-host disease (GvHD) and Transplant-Related Mortality (TRM). In pediatrics, haploidentical transplants, whether performed with in vivo or in vitro T-cell depletion, are considered an alternative to conventional transplants from genoidentical or phenoidentical donors with bone marrow (BM), peripheral stem cell (PBSC). This review synthesizes current knowledge, highlighting a thorough analysis of pediatric data from Haplo-HSCT for malignancies. In brief, donor selection criteria are the same as those published for adults, and the conditioning used is primarily myeloablative. The incidence of severe GvHD is lower as compared to adults, but other complications, such as hemorrhagic cystitis, veno-occusive disease and cardiac toxicity are present, and long-term follow-up data is lacking. We provide comprehensive recommendations for transplant preparation in treating pediatric AML and ALL, focusing on the "in vivo" T-cell depletion approach with high-dose post-transplant cyclophosphamide (PT-Cy).

PMID:40998674 | DOI:10.1016/j.bulcan.2025.07.015

Kyobu Geka. 2025 Sep;78(10):838-842.

ABSTRACT

Drug-resistant severe heart failure significantly impairs cardiac pump function, affecting both prognosis and quality of life (QOL). When conventional treatments are ineffective, a ventricular assist device (VAD) can support heart function. Heart transplantation remains the ultimate treatment, but donor shortages and eligibility constraints limit access. The left ventricular assist device (LVAD) is a crucial option, serving as a bridge to transplantation (BTT) or a permanent destination therapy (DT) for ineligible patients. In Japan, DT was covered by insurance in 2021, expanding from 7 to 19 facilities by 2023. Key differences between BTT and DT include the removal of the age limit (65 years) and reduced caregiver requirements. LVAD technology has advanced, with miniaturization improving implantation feasibility and reducing surgical burden. Pump designs have evolved from pulsatile to continuous-flow types, with axial and centrifugal models enhancing efficiency. Innovations in biocompatibility and wireless power transmission aim to reduce complications and improve long-term outcomes. BiVACOR, a fully implantable total artificial heart using magnetic levitation, was first clinically tested in 2024. While currently limited to temporary use before transplantation, further advancements may lead to broader applications, enhancing patient survival and QOL.

PMID:40998349

J Heart Lung Transplant. 2025 Sep 23:S1053-2498(25)02279-X. doi: 10.1016/j.healun.2025.09.011. Online ahead of print.

ABSTRACT

The use of organs between donors and recipients with HIV in solid organ transplantation is an area of growing interest. We conducted a single center observational study to compare early outcomes after heart transplantation (HTx) in HIV-positive recipients using HIV-positive or HIV-negative donors. Overall, 10 HIV-positive recipients underwent HTx, with 4 receiving HIV-positive and 6 receiving HIV-negative organs. At 3 months, both groups had similar survival (100% vs 100%, p=1.00), episodes of rejection (0, 0-0.5 vs 0, 0-1, p=0.39) and infection (0, 0-2.5 vs 1, 1-1, p=0.31) per patient, HIV suppression with antiretroviral therapy (VL <20 copies/ml or undetectable: 100% vs 100%, p=1.00) and donor derived cell free DNA (0.14, 0.06-0.22% vs 0.36, 0.12-0.59%, p=0.35). These data provide early evidence supporting the feasibility of utilizing organs from donors with HIV for HTx in recipients with HIV.

PMID:40998274 | DOI:10.1016/j.healun.2025.09.011

Am J Transplant. 2025 Sep 23:S1600-6135(25)02997-1. doi: 10.1016/j.ajt.2025.09.017. Online ahead of print.

ABSTRACT

Historically, liver transplant candidates with HIV have experienced high waitlist mortality. Since the HOPE Act expands access to organs from donors with HIV, we assessed the impact of HOPE on liver transplant rate and wait time for this population. We linked data from a multicenter HOPE in Action study to SRTR (2/21/2019-6/1/2024) and used Poisson regression to compare transplant rates among 99 candidates willing to accept HOPE donors (HOPE candidates) to 13495 candidates with or without HIV not listed as willing to accept HOPE donors (non-HOPE candidates) matched on transplant center. The median time to any deceased donor liver transplant (DDLT) was 2.3 months for HOPE and 1.1 years for non-HOPE candidates. Within two years of listing, 90.9% of HOPE versus 58.5% of non-HOPE candidates received a DDLT (p<0.001). HOPE was associated with an overall 3.11-fold higher DDLT incident rate ratio (IRR) (95% CI 2.48-3.88, p<0.001). Stratified by Model for End-Stage Liver Disease (MELD) score categories 6-14, 15-24, 25-34 and 35-40/Status 1, HOPE candidates had 10.12-fold, 5.31-fold, 1.41-fold and 2.90-fold higher DDLT rates, respectively. Willingness to accept livers from donors with HIV improves access to liver transplantation for candidates with HIV.

PMID:40998052 | DOI:10.1016/j.ajt.2025.09.017

J Card Fail. 2025 Sep 23:S1071-9164(25)00449-X. doi: 10.1016/j.cardfail.2025.09.025. Online ahead of print.

ABSTRACT

The United States national organ transplant program was established > 50 years ago, founded on the tenets of fairness, equity, and safety. Public trust is paramount to the success of every aspect of organ transplant including donor registration, organ procurement organization practices, donor hospital partnerships and allocation policy. This perspective evaluates the status of public trust in organ transplant in the context of new and concerning developments in US practices, and government responses. Our focus is on the potential impacts on heart transplantation, specifically on waitlist mortality, especially for patients without an alternative option in durable mechanical circulatory support.

PMID:40997990 | DOI:10.1016/j.cardfail.2025.09.025

Pediatr Cardiol. 2025 Sep 25. doi: 10.1007/s00246-025-04025-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are utilized in pediatric heart failure (HF) with little data on dosing or safety profile. Our aim is to report on dosing and adverse events associated with SGLT2i use in pediatric HF.

METHODS: A retrospective study was performed utilizing the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) pediatric heart failure registry. Patient demographics, medical regimen, echocardiographic data, laboratory data, adverse events, and relevant heart failure outcomes were collected at SGLT2i initiation and last follow-up.

RESULTS: At time of database query, data from 278 patients from 19 institutions were common. The most common SGLT2i prescribed was dapagliflozin (244) followed by empagliflozin (34). Median age at initiation was 15.1 years (IQR 10.7-18.2), 106 had DCM, 54 had Fontan physiology, and 67% of patients were initiated in the outpatient setting. For all patients prescribed dapagliflozin, the median mg/kg/dose at initiation was 0.11 (IQR 0.08-0.14). The median follow-up was 195 days (IQR 90-450, n = 180). In the follow-up cohort, 32 patients discontinued SGLT2i with 15 due to drug intolerance. 28 patients had a total of 34 adverse events (AE) reported. The most common AE was UTI (11) followed by AKI (10). After SGLT2i initiation, 13% of patients had a subsequent HF admission, 5% had a VAD, and 9% underwent heart transplantation.

CONCLUSION: In pediatric HF, SGLT2is are being utilized in a diverse patient population. AKI and UTI were the most common reported AE. Typical initiation dose is approximately 0.1mg/kg/dose. Prospective studies are needed to help determine efficacy.

PMID:40996542 | DOI:10.1007/s00246-025-04025-x

JACC Case Rep. 2025 Sep 25:105537. doi: 10.1016/j.jaccas.2025.105537. Online ahead of print.

ABSTRACT

BACKGROUND: Atrioventricular (AV) block is a potential complication of orthotropic heart transplantation (OHT). The optimal cardiac pacing method is largely unexplored in patients after OHT.

CASE SUMMARY: We present a patient with AV block after OHT in whom right ventricular pacing resulted in pacing-induced cardiomyopathy (PICM). Left ventricular function was restored with left bundle branch pacing.

DISCUSSION: AV block is an uncommon complication after OHT that requires ventricular pacing. Ventricular dyssynchrony induced by right ventricular pacing may be associated with increased risk for PICM in OHT recipients. Cardiac physiologic pacing should be considered as the primary pacing strategy in this population.

TAKE-HOME MESSAGES: OHT recipients may be at increased risk for PICM. Left bundle branch pacing is an effective strategy for both prevention and treatment of PICM.

PMID:40996402 | DOI:10.1016/j.jaccas.2025.105537

J Am Heart Assoc. 2025 Sep 25:e040914. doi: 10.1161/JAHA.124.040914. Online ahead of print.

ABSTRACT

BACKGROUND: The Stroke Preclinical Assessment Network tested 6 therapeutic interventions initiated at the time of reperfusion after focal ischemic stroke in young mice, aging mice, obese mice, and spontaneously hypertensive rats. This randomized, controlled trial was conducted across 6 sites with concealed treatment and blinded neurobehavior assessments. The trial had an adaptive design with preset levels of efficacy and futility interrogated after each of 4 stages. The primary outcome was turning preference on the corner test at 1 month. The PARP (poly(ADP-ribose) polymerase) inhibitor, veliparib, was considered futile after the second stage when pooling all animal models (n=231 veliparib; n=344 placebo).

METHODS: A secondary analysis was performed to evaluate veliparib treatment on primary and secondary outcomes in individual subgroup models.

RESULTS: Intravenous injection of veliparib at reperfusion failed to show a benefit on the corner test at 7 or 30 days of recovery in young mice, obese mice, or spontaneously hypertensive rats. However, in aging mice (15-18 months old), veliparib significantly improved performance on the corner test at 7 (P=0.007) and 30 (P=0.03) days and reduced foot-faults on the grid walk test at 7 (P=0.024) and 30 (P=0.008) days. These effects were independent of sex. Treatment had no effect on magnetic resonance imaging-determined lesion volume. The survival was similar with placebo and veliparib treatments across subgroups, although mortality was high in aging mice.

CONCLUSIONS: Veliparib improved functional outcome in aging mice. Because ischemic stroke predominantly occurs in the aging population, further research into the benefit of PARP inhibitors in aged animal models of stroke is warranted.

PMID:40996065 | DOI:10.1161/JAHA.124.040914

J Am Heart Assoc. 2025 Sep 25:e038892. doi: 10.1161/JAHA.124.038892. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies have reported conflicting evidence on racial disparities in heart transplant outcomes, often focusing only on short-term mortality rates. We assessed longer-term survival and a broader range of post-heart transplant outcomes by race.

METHODS: We analyzed adult heart transplant recipients from 2017 to 2022 in the SRTR (Scientific Registry for Transplant Recipients), categorizing race as Black, non-Hispanic White, or Other. The primary outcome was graft failure at 1 and 3 years. Secondary outcomes included acute rejection, renal dysfunction, and posttransplant diabetes. χ2 tests and Kaplan-Meier/logistic regression analyses were used.

RESULTS: Among 15 873 recipients (63% White, 23% Black, 14% Other), Black recipients were more likely female, publicly insured, and less likely to be college educated. They also had higher use of durable ventricular assist devices and intra-aortic balloon pump at transplant. One-year graft survival was similar across groups (91.8% Black versus 91.1% non-Black), but 3-year survival was lower among Black individuals (83.4% versus 85.7%, P=0.006). After adjusting for socioeconomic and clinical factors, Black recipients had a higher risk of graft failure at 3 years (odds ratio, 1.22 [95% CI, 1.07-1.39]). Black patients also experienced higher rates of acute rejection (12.4% versus 10.2%), diabetes (10.8% versus 7.1%), and renal dysfunction progression (40.9% versus 37.1%) at 3 years (P<0.05 for all).

CONCLUSIONS: Racial disparities in heart transplant outcomes persist, particularly in longer-term survival. These disparities may be partially mediated by differences in posttransplant complications such as rejection, renal dysfunction, and diabetes.

PMID:40996058 | DOI:10.1161/JAHA.124.038892

J Am Heart Assoc. 2025 Sep 25:e045280. doi: 10.1161/JAHA.125.045280. Online ahead of print.

NO ABSTRACT

PMID:40996047 | DOI:10.1161/JAHA.125.045280

J Am Heart Assoc. 2025 Sep 25:e040636. doi: 10.1161/JAHA.124.040636. Online ahead of print.

ABSTRACT

BACKGROUND: Heart transplant (HT) recipients tend to develop unfavorable ventricular-arterial interactions, yet the prognostic implications of this altered physiology remain unclear. We aimed to identify the presence of afterload mismatch (AM) after heart transplantation, its determinants, and its impact on long-term cardiac mortality.

METHODS: An observational, single-center study was conducted on the historical cohort of patients who received HT at our institution. Patients survived the first year after HT with a LVEF ≥50%, cardiac allograft vasculopathy grades 0 to 1, and acute cellular rejection grades 0 to 1R. Arterial elastance and ventricular elastance were calculated noninvasively using blood pressure, end-systolic volume, and end-diastolic volume. Patients were grouped as follows: low afterload (LA- arterial elastance <median), matched high afterload (MHA- arterial elastance ≥median, ventricular elastance ≥median), and AM (arterial elastance ≥median, ventricular elastance <median).

RESULTS: Overall, 345 patients who received HT were enrolled. Left ventricular ejection fraction was lower in AM (57%) than in LA and MHA (63% and 64%, respectively; P<0.0001); stroke volume was lower in AM than in LA but comparable between AM and MHA (27, 35, and 26 mL/m2 for AM, LA, and MHA, respectively; P=0.0001). Predictors of AM were male recipient/male donor (β=0.15, P=0.0067) and male recipient/female donor (β=0.6, P=0.0078). After a median of 11.3 years, 59 recipients had died. Cardiac mortality was higher in the group with AM (AM median survival: 17.2, 27.8, and 24.1 years for AM, LA, and MHA, respectively; log-rank P=0.005). After adjusting for confounding variables, AM was associated with cardiac mortality (hazard ratio [HR], 2.26 [95% CI, 1.18-4.35]; P=0.0143)as were male recipient/female donor (HR, 2.94 [95% CI], 1.18-4.35; P=0.0358).

CONCLUSION: Three phenotypes of patients who received HT were identified, and AM resulted as an independent predictor of cardiac mortality.

PMID:40996038 | DOI:10.1161/JAHA.124.040636

J Am Heart Assoc. 2025 Sep 25:e045281. doi: 10.1161/JAHA.125.045281. Online ahead of print.

NO ABSTRACT

PMID:40996029 | DOI:10.1161/JAHA.125.045281

Front Cardiovasc Med. 2025 Sep 9;12:1591208. doi: 10.3389/fcvm.2025.1591208. eCollection 2025.

ABSTRACT

OBJECTIVES: Stroke is a severe complication in patients with left ventricular assist devices (LVAD), significantly affecting quality of life and potentially leading to death. This study aimed to illustrate the clinical features, outcomes, and risk factors associated with stroke in LVAD patients, with the goal of identifying potential treatment targets.

METHODS: In a study of 249 consecutive patients who underwent LVAD implantation, detailed evaluations were conducted regarding clinical characteristics, perioperative management, cardiovascular risk factors, comorbidities, and brain imaging. The etiology, treatment, and outcomes were subsequently assessed in individuals who encountered a stroke.

RESULTS: Eighty-three cerebrovascular events (CVE) occurred in 54/249 patients during a median study period of 2.2 years (0.4-3.5) with 53 ischemic events and 22 intracranial hemorrhages (ICH). Early peri- or postoperatively CVE in context to the LVAD implantation were identified in 31 patients. Competing risks regression analysis revealed that postoperative dialysis was associated with higher risk for CVE, considering death as competing risk event (HR 3.617; 95%-CI: 1.78-7.35; p ≤ 0.001). Modified Rankin Scale at outpatient visit did not differ in early CVE [3 (IQR 2-5) vs. 3 (IQR2-4), p = 0.146]. Late CVE frequently occurred during hospitalization for sepsis or in cardiac rehabilitation [n = 16/41 events (39%)]. Competing risk analysis treating death and heart transplantation as competitors identified history of stroke as associated factor [HR 3.564; 95%-CI (1.67-7.169); p = 0.001]. Mortality was not associated with CVE [with n = 27/54 (50%) vs. without CVE 94/195 (48.2%) p = 0.183].

CONCLUSION: Patients who require postoperative dialysis face a heightened risk for early cerebrovascular events (CVE) during and after LVAD implantation. Additionally, a history of stroke and complicated clinical courses should increase awareness regarding the potential for impending CVE in the long term.

PMID:40994916 | PMC:PMC12454346 | DOI:10.3389/fcvm.2025.1591208

Front Psychol. 2025 Sep 9;16:1646086. doi: 10.3389/fpsyg.2025.1646086. eCollection 2025.

ABSTRACT

INTRODUCTION: Patients in intensive care units require advanced clinical care as well as attention to psychological social and emotional needs, often overlooked. Heart and lung transplant recipients experience a particularly complex postoperative journey, marked by physical fragility, emotional vulnerability, and identity transformation. Communication barriers caused by sedation, intubation, and disorientation, combined with a focus on physiological stability, hinder understanding of their lived experience. A lack of qualitative research in this topic limits the development of person-centered care and mismatches between professional priorities and patient needs may lead to depersonalization and dissatisfaction. This study aimed to explore ICU experiences of transplant patients through the richness and complexity of their individual journey.

METHODS: A descriptive phenomenological study was conducted at IRCCS University Hospital of Bologna. Semi-structured interviews were performed with 21 heart (average ICU stay: 6 days) and lung (average ICU stay: 13 days) transplant recipients, 2-4 days post-ICU discharge. Interviews aimed to capture patients' recollections while ensuring clinical stability. Thematic content analysis was used to identify key themes.

RESULTS: Six main themes emerged: (1) care environment, (2) sensory perceptions, (3) person's empowerment, (4) lived experiences, (5) transplant path, and (6) quality of care. Patients reported feelings of isolation, disorientation, frustration and impaired communication due to sedation and intubation. Emotional experiences ranged from fear and loneliness to hope and gratitude. Reflections on the donor revealed ambivalent emotions including guilt and appreciation. Personalized care, empathetic communication, and supportive relationships with healthcare professionals were seen as essential for emotional well-being and recovery.

DISCUSSION: Heart and lung transplantation is a deeply transformative experience. Beyond clinical care, patients need emotional and psychological support. Personalized, empathetic interventions and improved communication strategies are crucial to enhancing both recovery outcomes and the overall ICU experience.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT06773052.

PMID:40994850 | PMC:PMC12454062 | DOI:10.3389/fpsyg.2025.1646086

Transplant Proc. 2025 Sep 23:S0041-1345(25)00442-7. doi: 10.1016/j.transproceed.2025.06.022. Online ahead of print.

ABSTRACT

BACKGROUND: Sequential adaptations to Child-Pugh (CP) and MELD have improved prediction of waitlist mortality in liver transplant (LT). Despite its widespread use as a prognosticator, the association between the MELD score and perioperative adverse events during LT has yet to be evaluated. this study seeks to evaluate whether advances in MELD score calculations correspondingly improve predictions for massive transfusion (MT) and renal failure.

METHODS: Adult patients undergoing LT at a tertiary institution between 2015 and 2023 were enrolled. MELD, MELD-Na, MELD 3.0, and CP were calculated at time of LT. Massive transfusion (MT) was >6 units of red blood cells before hepatic artery ligation. Renal failure (RF) was defined as requiring dialysis on postoperative-day one. Area-under-the-receiver-operating-characteristic curves (AUC) was estimated for each score and outcome and compared using the DeLong method. Score performance was evaluated using receiver operator curves (ROC) with a high performing assay considered as an area under the curve (AUC) >0.800.

RESULTS: Total 265 patients were included; 20 (7.6%) received MT, 31 (11.8%) had RF. For MT, scores performed similarly (CP 0.70 [95% CI: 0.58, 0.81]; MELD 0.69 [0.59, 0.80]; MELD-Na 0.71 [0.61, 0.81]; MELD 3.0 0.69 [0.59, 0.80]). For RF all MELD scores outperformed CP, and MELD-Na outperformed MELD 3.0 (0.58 [0.48, 0.68], 0.66 [0.55,0.77], 0.67 [0.56, 0.78], and 0.65 [0.53, 0.77]).

CONCLUSION: MELD 3.0 did not outperform its predecessors. MELD-Na may still have a role in assessment of perioperative complications in LT recipients as well as patients with end-stage liver disease undergoing nontransplant operations.

PMID:40992988 | DOI:10.1016/j.transproceed.2025.06.022

Transplant Proc. 2025 Sep 23:S0041-1345(25)00449-X. doi: 10.1016/j.transproceed.2025.08.018. Online ahead of print.

ABSTRACT

Combined heart-liver transplantation presents significant challenges, particularly in cases requiring extended ischemic times for managing hemodynamic instability post cardiac implantation. Advances in perfusion techniques, such as the normothermic machine perfusion pump, offer advantages over traditional static cold storage by maintaining organ viability during prolonged periods. We report the first successful combined heart-liver transplant using normothermic machine perfusion for both organs from a donation after circulatory death donor. The recipient is a 45-year-old male with ischemic cardiomyopathy-induced heart failure and end-stage liver disease secondary to congestive hepatopathy. Both organs, procured from a donation after circulatory death donor were preserved on the TransMedics Organ Care System and subsequently transplanted with total post crossclamp times of 7.75 hours for the heart and 15.25 hours for the liver. At 8 months post-transplant, the patient demonstrates stable cardiac and hepatic graft function. This case highlights the critical role of normothermic machine perfusion in optimizing organ quality and mitigating ischemic injury in multi-organ transplants involving donation after circulatory death donors. Our findings support the expanded use of normothermic machine perfusion to enhance organ utilization, particularly in complex, high-risk multi-organ transplants cases.

PMID:40992987 | DOI:10.1016/j.transproceed.2025.08.018

Am J Transplant. 2025 Sep 22:S1600-6135(25)02993-4. doi: 10.1016/j.ajt.2025.09.013. Online ahead of print.

ABSTRACT

US heart transplant candidates from socioeconomically disadvantaged communities have lower access to transplant. The place-based disadvantage index that best captures this disparity is still unknown. We sought to answer this question. We studied all adult heart transplant candidates initially listed between January 1, 2019 and December 31, 2022 using the Scientific Registry of Transplant Recipients. We used competing risk regressions to estimate the association of four place-based disadvantage indices (Social Vulnerability Metric, Social Vulnerability Index, Area Deprivation Index (ADI), and Distressed Communities Index) with transplantation and death using models adjusted for characteristics that impact access to transplantation. ADI was significantly associated with receiving a transplant over the greatest range of deciles compared to other indices. Three years after listing, ADI decile 1 patients had a cumulative incidence of 83% of receiving a transplant, compared to 65.8% of decile 10 candidates. Compared to decile 1, decile 10 patients had a 156% greater risk of dying on the waitlist. In this study, we found that ADI was associated with transplantation to a greater extent than other indices studied. The forthcoming continuous distribution provides an opportunity to incorporate ADI to address disparities in heart transplantation.

PMID:40992603 | DOI:10.1016/j.ajt.2025.09.013

World J Pediatr Congenit Heart Surg. 2025 Sep 24:21501351251361497. doi: 10.1177/21501351251361497. Online ahead of print.

ABSTRACT

Coral reef aorta (CRA) is a rare, calcified aortic lesion observed primarily in adults and elderly patients. This condition can lead to resistant hypertension and impaired organ perfusion. Although surgical treatment remains the predominant approach, endovascular intervention is emerging as an alternative for suitable cases. We present a 16-year-old male patient with a history of kidney transplantation who was admitted due to hypertension. Imaging revealed severe stenosis at the isthmus level caused by a calcific lesion characteristic of CRA. Given the complexity of the lesion and the surgical challenges, an endovascular approach was chosen. A covered stent was successfully implanted, resulting in significant hemodynamic improvement. At the sixth month follow-up, the patient remained normotensive, and antihypertensive medications were discontinued. To our knowledge, this case represents the first pediatric patient reported to have undergone endovascular treatment for severe aortic coarctation associated with CRA. Our findings suggest that endovascular intervention using a covered stent may provide a viable alternative to surgery in selected pediatric cases, minimizing morbidity and mortality. Further studies are needed to assess the long-term outcomes of this approach.

PMID:40990816 | DOI:10.1177/21501351251361497

World J Pediatr Congenit Heart Surg. 2025 Sep 24:21501351251360691. doi: 10.1177/21501351251360691. Online ahead of print.

ABSTRACT

ObjectivesA minority of patients with hypoplastic left heart syndrome (HLHS) are at extremely high risk for staged palliation and can be bridged-to-heart transplantation with bilateral pulmonary artery bands, ductal stenting, and single ventricle-ventricular assist device insertion (HYBRID + sVAD). The purpose of this analysis is to assess our learning curve associated with our first ten patients with functionally univentricular ductal-dependent systemic circulation who were supported with primary HYBRID + sVAD as bridge-to-heart transplantation.MethodsPatients were temporally separated into two cohorts: the first five and second five. Demographic, perioperative, and outcome data were collected. Continuous variables are described as median [IQR](range). Categorical variables are described as N (%). P values were calculated using Fisher exact t test for categorical variables and unpaired t tests for continuous variables.ResultsTen patients underwent HYBRID + sVAD operations for HLHS (2017-2022). Patients in the initial cohort and the most recent cohort were similar in age and weight. Liver dysfunction and renal dysfunction were more common in the first five patients (2/5 = 40%) versus the next five patients (0/5 = 0%). Length of sVAD support was longer in the most recent five patients (98 days [64-138] vs 154 days [134-225], P = .08); however, no increase in sVAD-associated stroke or bleeding was seen in the most recent five patients. Despite very similar demographic and preoperative profiles, only two of the first five patients (2/5 = 40%) survived to heart transplantation, while all of the next 5 (5/5 = 100%) were successfully bridged-to-cardiac transplantation with HYBRID + sVAD and are alive today.ConclusionsOur experience with primary HYBRID + sVAD as bridge-to-heart transplantation in neonates with HLHS demonstrates an important learning curve associated with this operation and approach.

PMID:40990805 | DOI:10.1177/21501351251360691

Curr Opin Organ Transplant. 2025 Sep 25. doi: 10.1097/MOT.0000000000001251. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: Transplantation in candidates with psychotic disorders has been a controversial topic for over 40 years. Reviewing the outcomes of these candidates may inform decisions going forward, though it is unclear whether outcomes with kidney recipients is generalizable to other organs, which are life-sparing not mainly life-enhancing.

RECENT FINDINGS: Outcomes in recipients with psychotic disorders after kidney transplants were described in three studies. Outcomes with heart, lung, pancreas, and small bowel or multivisceral transplants is sparse to nonexistent. There were 26 cases and 8 case series published, mostly highly selected patients, with small sample size, and the majority had less than 3-year follow-up. Guidelines were proposed for this population based on a survey of 12 centers.

SUMMARY: More systematic study is needed on the risks and barriers to transplantation in these candidates. More data is needed regarding outcomes in those recipients with life-sparing transplants for whom there is not a rescue plan in case the graft is lost. Candidates should be evaluated on an individual basis based on known risk factors in accordance with the ethical principles of beneficence, justice, and utility in the face of scarce resources.

PMID:40990665 | DOI:10.1097/MOT.0000000000001251