Five-Year Experience of Heart Transplantation Following Donation After Circulatory Death.

Objective: The United States experience with heart transplantation following donation after circulatory death (DCD HT) has expanded since clinical adoption in 2019. We aimed to examine a large institution's outcomes associated with DCD HT vs HT following donation after brain death (DBD).

Methods: Adult heart recipients and corresponding donors at a single quaternary academic center from January 2019 to October 2024 were included.

Out-of-Sequence Donor Heart Allocation: A United Network for Organ Sharing Registry Analysis.

Background: Out-of-sequence (OOS) allocation is a mechanism by which donor organs are offered outside the standard match run, typically to expedite the placement of hard-to-match or time-sensitive allografts. Rising OOS rates are described in abdominal organ transplantation, but limited data exist regarding OOS practices in heart transplantation.

Methods: The United Network for Organ Sharing (UNOS) was used to identify all adult heart transplant recipients and corresponding donors between January 2015 and March 2024.

Ensuring access to novel donor heart preservation modalities.

Despite improvements in managing earlier stage heart disease, the population of patients needing heart transplants continues to increase in the United States. Fortunately, novel methods of procuring and preserving donor hearts, including the use of ex-vivo heart perfusion and controlled hypothermic preservation, have enabled a rise in heart transplantation. In particular, ex-vivo heart perfusion has contributed to increased utilization of donation after circulatory death (DCD), as well as enhanced use of donor hearts from increased geographic distances and extended criteria (marginal) donors.

Metabolic and Pharmacokinetic Profiling of a Ketone Ester by Background SGLT2 Inhibitor Therapy in HFrEF.

Growing evidence supports therapeutic ketosis in heart failure with reduced ejection fraction, though uncertainty exists regarding use with SGLT2i and dose-dependent effects. In a phase I trial of 2 ketone ester (KE) doses in 20 heart failure with reduced ejection fraction participants, stratified by background SGLT2i, the authors detailed pharmacokinetic parameters, noting rapid ketosis and short half-life. KE was associated with lower non-esterified fatty acid, branched-chain amino acids, and most acylcarnitines (except C2 and C4-OH, which increased); differences were observed by SGLT2i and KE dose.

Regional variation in donation after circulatory death heart allograft utilization.

Objective: Randomized data support transplantation of hearts from donors after circulatory death. This may lead to a sizeable increase in the donor pool. Regional variations in donors after circulatory death heart use were examined to help elucidate barriers to donor pool expansion.

Late follow-up for a randomized trial of surgical treatment of tricuspid valve regurgitation in patients undergoing left ventricular assist device implantation.

Background: We previously reported that concurrent tricuspid valve surgery (TVS) was not associated with a lower incidence of early right heart failure (RHF) in patients undergoing durable left ventricular assist device (LVAD) implantation. This follow-up analysis aimed to further define the clinical impact of concurrent TVS after 2 months of follow-up.

Methods: Patients with moderate or severe tricuspid regurgitation (TR) on preoperative echocardiography (n = 71) were randomized to LVAD implantation either alone (no TVS group; n = 34) or with concurrent TVS (TVS group; n = 37).

Early U.S. Heart Transplant Experience With Normothermic Regional Perfusion Following Donation After Circulatory Death.

Background: Heart transplantation following donation after circulatory death (DCD HT) has short-term survival outcomes comparable to donation after brain death and has led to a significant increase in transplantation volume. The U.S.

Early Outcomes in Patients With LVAD Undergoing Heart Transplant via Use of the SherpaPak Cardiac Transport System.

Background: Heart transplant (HT) in recipients with left ventricular assist devices (LVADs) is associated with poor early post-HT outcomes, including primary graft dysfunction (PGD). As complicated heart explants in recipients with LVADs may produce longer ischemic times, innovations in donor heart preservation may yield improved post-HT outcomes. The SherpaPak Cardiac Transport System is an organ preservation technology that maintains donor heart temperatures between 4 °C and 8 °C, which may minimize ischemic and cold-induced graft injuries.

Metabolomic profiling during ex situ normothermic perfusion before heart transplantation defines patterns of substrate utilization and correlates with markers of allograft injury.

Background: Cardiac metabolism is altered in heart failure and ischemia-reperfusion injury states. We hypothesized that metabolomic profiling during ex situ normothermic perfusion before heart transplantation (HT) would lend insight into myocardial substrate utilization and report on subclinical and clinical allograft dysfunction risk.

Methods: Metabolomic profiling was performed on serial samples of ex situ normothermic perfusate assaying biomarkers of myocardial injury in lactate and cardiac troponin I (TnI) as well as metabolites (66 acylcarnitines, 15 amino acids, nonesterified fatty acids [NEFA], ketones, and 3-hydroxybutyrate).

The Role of Recipient Thyroid Hormone Supplementation in Primary Graft Dysfunction After Heart Transplantation: A Propensity-Adjusted Analysis.

Objectives: To investigate whether recipient administration of thyroid hormone (liothyronine [T3]) is associated with reduced rates of primary graft dysfunction (PGD) after orthotopic heart transplantation.

Design: Retrospective cohort study.

Setting: Single-center, university hospital.

Inhaled Epoprostenol Compared With Nitric Oxide for Right Ventricular Support After Major Cardiac Surgery.

Background: Right ventricular failure (RVF) is a leading driver of morbidity and death after major cardiac surgery for advanced heart failure, including orthotopic heart transplantation and left ventricular assist device implantation. Inhaled pulmonary-selective vasodilators, such as inhaled epoprostenol (iEPO) and nitric oxide (iNO), are essential therapeutics for the prevention and medical management of postoperative RVF. However, there is limited evidence from clinical trials to guide agent selection despite the significant cost considerations of iNO therapy.

Transplantation Outcomes with Donor Hearts after Circulatory Death.

Background: Data showing the efficacy and safety of the transplantation of hearts obtained from donors after circulatory death as compared with hearts obtained from donors after brain death are limited.

Methods: We conducted a randomized, noninferiority trial in which adult candidates for heart transplantation were assigned in a 3:1 ratio to receive a heart after the circulatory death of the donor or a heart from a donor after brain death if that heart was available first (circulatory-death group) or to receive only a heart that had been preserved with the use of traditional cold storage after the brain death of the donor (brain-death group). The primary end point was the risk-adjusted survival at 6 months in the as-treated circulatory-death group as compared with the brain-death group.

Surgical Treatment of Tricuspid Valve Regurgitation in Patients Undergoing Left Ventricular Assist Device Implantation: Interim analysis of the TVVAD trial.

Objectives: Right heart failure remains a serious complication of left ventricular assist device therapy. Many patients presenting for left ventricular assist device implantation have significant tricuspid regurgitation. It remains unknown whether concurrent tricuspid valve surgery reduces postoperative right heart failure.

Improved Outcomes in Severe Primary Graft Dysfunction After Heart Transplantation Following Donation After Circulatory Death Compared With Donation After Brain Death.

Background: Primary graft dysfunction (PGD), the leading cause of early mortality after heart transplantation, is more common following donation after circulatory death (DCD) than donation after brain death (DBD). We conducted a single-center, retrospective cohort study to compare the incidence, severity and outcomes of patients experiencing PGD after DCD compared to DBD heart transplantation.

Methods And Results: Medical records were reviewed for all adult heart transplant recipients at our institution between March 2016 and December 2021.

In-Hospital Virtual Peer-to-Peer Consultation to Increase Guideline-Directed Medical Therapy for Heart Failure: A Pilot Randomized Trial.

Background: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) improves clinical outcomes and quality of life. Optimizing GDMT in the hospital is associated with greater long-term use in HFrEF. This study aimed to describe the efficacy of a multidisciplinary virtual HF intervention on GDMT optimization among patients with HFrEF admitted for any cause.