Extended travel for donor organs: Is cold static storage still relevant.

Background: Traditional limitations of cold static storage (CSS) on ice at 4 °C during lung transplantation have necessitated limiting cold ischemic time (CIT) to 4-6 hours. lung perfusion (EVLP) can extend this preservation time through the suspension of CIT and normothermic perfusion. As we continue to further expand the donor pool in all aspects of lung transplantation, teams are frequently traveling further distances to procure organs.

Unilateral vs Bilateral Lung Transplantation After Ex Vivo Lung Perfusion.

Background: Ex vivo lung perfusion (EVLP) has increased, but a knowledge gap in outcomes of unilateral and bilateral lung transplantation following EVLP exists.

Methods: Lung transplantations after EVLP were identified from the United Network for Organ Sharing Database from February 28, 2018 to March 31, 2024. Recipients were stratified into unilateral and bilateral lung transplant groups.

Trends in survival after heart transplantation based on Social Vulnerability Index in the United States.

Background: The association of social vulnerability (SV) and cardiac transplant survival remains poorly defined, particularly related to long-term outcomes. The purpose of this study was to define the impact of SV on survival among heart transplant recipients with at least 1 year of survival post-transplant.

Methods: Heart transplant recipients were identified using the United Network for Organ Sharing database between June 1, 2006, and December 31, 2020.

Lung transplantation following prior cardiac surgical procedures.

Background: As lung transplant candidates are older with increased comorbidities, we sought to examine the prevalence and outcomes of lung transplant recipients after prior cardiac surgery.

Methods: Lung transplants were identified from the United Network for Organ Sharing/Organ Procurement and Transplantation Network Database. Patients were stratified based on prior cardiac surgery (no surgery [NS], prior coronary artery bypass grafting [CABG], prior valve [Valve]).

Adaptive Chest Cavity Expansion Following Lung Allograft Oversizing in Idiopathic Pulmonary Fibrosis.

Introduction: Due to parenchymal fibrosis and chest wall contraction in idiopathic pulmonary fibrosis (IPF), donor lung allografts are generally undersized to accommodate smaller diseased chest cavities. We hypothesized that transplanting oversized allografts (OAs) in recipients with IPF would be associated with thoracic cavity expansion.

Methods: A single center retrospective study of IPF patients who underwent lung transplant between 2014 and 2022 was conducted.

Transcatheter Versus Surgical Aortic Valve Replacement for Patients With Pulmonary Hypertension.

Introduction: Transcatheter aortic valve replacement (TAVR) has become a viable alternative to surgical aortic valve replacement (SAVR) for high-risk patients with aortic stenosis. One such high-risk group is patients with pulmonary hypertension (PH), which is known to increase surgical risk and adversely affect outcomes. This study aims to compare midterm and long-term survival in TAVR and SAVR among patients with PH.

Rise of the machines: Normothermic regional perfusion use in heart transplantation in the United States.

Background: Normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) allow for transplantation with donation after circulatory death (DCD) hearts. This study aimed to characterize the use of and variations in NRP and DPP for DCD transplants in the United States.

Methods: Heart transplants performed between December 1, 2019 and March 31, 2024, were identified from the United Network for Organ Sharing database.

Ex Vivo Lung Perfusion in Donation After Cardiac and Brain Death Donation.

Background: Allografts from donation after circulatory death (DCD) or brain death donors may be evaluated by ex vivo lung perfusion (EVLP) to assess quality for transplantation. We sought to determine the association of donor type with transplantation outcomes at a national level.

Methods: The United Network for Organ Sharing database was queried for lung transplant recipients, who were stratified into DCD EVLP, brain death EVLP, standard DCD, and standard brain death, followed by an unadjusted analysis.

Extended ischemic times during ex vivo lung perfusion is not associated with increased mortality.

Background: The purpose of this study was to identify the association of increasing ischemic times in recipients who receive lungs evaluated by ex vivo lung perfusion (EVLP) and their association with outcomes following lung transplantation.

Methods: Lung transplant recipients who received an allograft evaluated by EVLP were identified from the United Network for Organ Sharing (UNOS) Database from 2016-2023. Recipients were stratified into three groups based on total ischemic time (TOT): short TOT (STOT, 0 to <7 h), medium TOT (MTOT, 7> to <14 h), and long TOT (LTOT, +14 h).

The impact of ex vivo lung perfusion location on lung transplant outcomes.

Background: Ex vivo lung perfusion (EVLP) conducted outside of the transplant center has increased in recent years to mitigate its limitation by resources and expertise. We sought to evaluate EVLP performed at transplant centers and externally.

Methods: Lung transplant recipients were identified from the United Network for Organ Sharing Database.

Ex Vivo Lung Perfusion and Primary Graft Dysfunction Following Lung Transplantation: A Contemporary United Network for Organ Sharing Database Analysis.

Primary graft dysfunction (PGD) has detrimental effects on recipients following lung transplantation. Here, we determined the contemporary trends of PGD in a national database, factors associated with the development of PGD grade 3 (PGD3) and ex vivo lung perfusion's (EVLP) effect on this harmful postoperative complication. The United Network for Organ Sharing database was queried from 2015 to 2023, and recipients were stratified into No-PGD, PGD1/2, or PGD3.

Racial and Ethnic Disparities in Peri-and Post-operative Cardiac Surgery.

Purpose Of Review: Despite efforts to curtail its impact on medical care, race remains a powerful risk factor for morbidity and mortality following cardiac surgery. While patients from racial and ethnic minority groups are underrepresented in cardiac surgery, they experience a disproportionally elevated number of adverse outcomes following various cardiac surgical procedures. This review provides a summary of existing literature highlighting disparities in coronary artery bypass surgery, valvular surgery, cardiac transplantation, and mechanical circulatory support.

Early Extubation: Who Qualifies Postoperatively in Lung Transplantation?

Introduction: Early extubation has been adopted in many settings within cardiothoracic surgery, with several advantages for patients. We sought to determine the association of timing of extubation in lung transplant recipients' short- and long-term outcomes.

Methods: Adult, primary lung transplants were identified from the United Network for Organ Sharing database.

Prime editing-mediated correction of the leptin receptor in muscle cells of db/db mice.

Genetic diseases can be caused by monogenic diseases, which result from a single gene mutation in the DNA sequence. Many innovative approaches have been developed to cure monogenic genetic diseases, namely by genome editing. A specific type of genomic editing, prime editing, has the potential advantage to edit the human genome without requiring double-strand breaks or donor DNA templates for editing.

An Unexpected Partnership: Alexis Carrel, Charles Lindbergh, and Normothermic Machine Perfusion.

Organ transplantation is a triumph of modern medicine which represents a culmination of science and imagination, saving thousands of lives a year. However, transplantation is severely limited by suitable donor allografts. To expand the donor pool and make transplantation achievable for all, normothermic machine perfusion (NMP) is being employed more frequently.

Is Time Scheduling Important? An Analysis of Donor Heart Cross-clamp Times During Heart Transplantation.

Background: Outcomes in heart transplantation are affected by a variety of variables and patient factors. However, the impact of circadian rhythms, gene expression, and transcription remain underexplored. We thus evaluated the potential role of donor heart cross-clamp times on short-term and long-term outcomes after heart transplantation.

Ex vivo lung perfusion in donation after circulatory death: A post hoc analysis of the Normothermic Ex Vivo Lung Perfusion as an Assessment of Extended/Marginal Donors Lungs trial.

Objective: Donation after circulatory death (DCD) donors offer the ability to expand the lung donor pool and ex vivo lung perfusion (EVLP) further contributes to this ability by allowing for additional evaluation and resuscitation of these extended criteria donors. We sought to determine the outcomes of recipients receiving organs from DCD EVLP donors in a multicenter setting.

Methods: This was an unplanned post hoc analysis of a multicenter, prospective, nonrandomized trial that took place during 2011 to 2017 with 3 years of follow-up.

Does Size Matter? The Effect of Size of Distal Perfusion Catheter on Acute Limb Ischemia: A Meta-Analysis.

Prevention of limb ischemia in patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is primarily achieved through the use of distal perfusion catheters (DPC). Our objective was to assess the role of DPC, and specifically the size of the catheter, in reducing the incidence of acute limb ischemia (ALI) through a meta-analysis. Seventeen studies met criteria for analysis.

Long-Term Survival Following Primary Graft Dysfunction Development in Lung Transplantation.

Introduction: Primary graft dysfunction (PGD) is a known risk factor for early mortality following lung transplant (LT). However, the outcomes of patients who achieve long-term survival following index hospitalization are unknown. We aimed to determine the long-term association of PGD grade 3 (PGD3) in patients without in-hospital mortality.

Is timing everything? Examining operative time in lung transplants from 2006 to 2023.

Background: Several studies have tried to find a link between timing of lung transplant surgery and patient outcomes. However, there has been conflicting results. This study sought to evaluate the association of operative times and recipient outcomes.

The role of CD38 in ischemia reperfusion injury in cardiopulmonary bypass and thoracic transplantation: a narrative review.

Background And Objective: Ischemia reperfusion injury (IRI) is often the underlying cause of endothelium breakdown and damage in cardiac or transplantation operations, which can lead to disastrous post-operative consequences. Recent studies of cluster of differentiation 38 (CD38) have identified its critical role in IRI. Our objective is to provide a comprehensive overview of CD38-mediated axis, pathways, and potential CD38 translational therapies for reducing inflammation associated with cardiopulmonary bypass (CPB) or thoracic transplantation and IRI.