Core signature of rejection-associated cytokines and chemokines in endomyocardial biopsies after heart transplantation.

Background: Rejection remains a limiting factor for survival after heart transplantation (HTx), and predictive biomarkers are still missing. Therefore, we aimed to define the cytokine/chemokine microenvironment in endomyocardial biopsies (EMB) and plasma after HTx and to identify patterns that reflect ischemia/reperfusion injury as well as allograft rejection. Therefore, we hypothesize distinct cytokine/chemokine patterns in heart biopsies with histopathologically proven rejection compared with the microenvironment in unsuspicious biopsies.

[Innovations in transplantation medicine].

More than 70 years after the first successful organ transplant between identical twins, transplantation medicine still faces significant challenges today: How can the large number of people waiting for a new kidney, liver, lung, or heart receive a suitable organ more quickly? How can survival on the waiting list be extended? How can long-term graft survival with high quality of life be ensured after transplantation? The various disciplines of transplantation medicine are working daily to address these challenges. The goal of this overview article is to provide practicing physicians with an overview of the current state and medium-term perspectives of transplantation medicine. For this purpose, an interdisciplinary team of transplantation experts from the largest transplant center in Germany has come together to summarize the current innovations and future perspectives of transplantation medicine in a compact and organ-overarching format.

Post-operative management of children after lung transplantation.

Post-operative care for children and adolescents who undergo lung transplantation is a challenge because of the potential for numerous complications during this period, which can considerably impact the short- and long-term outcomes. The immediate post-operative phase is particularly critical, and complications are frequent; therefore, knowledge, early recognition, and appropriate treatment of these complications are imperative and can only be achieved through close collaboration between a wide range of medical specialties. The aim of this review is to provide an abbreviated overview of the optimal post-operative management of children in an intensive care unit, as well as to describe frequently occurring complications and their treatment.

Infant lung transplantation: First German experience including two cases of ABO blood group incompatible transplantations.

Background: Infant lung transplantation (LuTx) has been rarely performed in Europe and poses unique challenges.

Methods: We reviewed referrals for LuTx to our center for patients below 1 year of age from January 1, 2018 to December 31, 2022. Clinical data and outcomes of transplanted infants and data on patients who were declined for evaluation, not listed after evaluation, or died before LuTx were collected.

Pulmonary Hypertension and Lung Transplantation.

Pulmonary artery hypertension (PAH), a subtype of pulmonary hypertension, is a rare end-stage lung disease. Bilateral lung and combined heart and lung transplantation have long been considered as a gold standard therapy for PAH.This manuscript reviewed the most up-to-date literature on lung transplantation for PAH, focusing particularly on risk stratification, donor allocation, bridging to transplantation (BTT), and intra- and postoperative management in both adult and pediatric patients.

Pediatric lung transplantation for childhood interstitial lung disease: Indications and outcome.

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 outcomes after LuTx for chILD are limited.

Impact of donor organ quality on recipient outcomes in lung transplantation: 14-Year single-center experience using the Eurotransplant lung donor score.

Background: The use of extended-criteria donor (ECD) organs has increased in lung transplantation, but their impact on long-term outcomes remains unclear. This retrospective single-center study evaluates the impact of donor quality, as defined by the Eurotransplant (ET) lung donor score, on long-term graft function and survival.

Methods: Records of recipients transplanted between January 2010 and May 2023 were reviewed.

A multicenter analysis of lung transplantation outcomes comparing donation after circulatory death and donation after brain death.

Background: Donor organ shortage is a barrier to lung transplantation. Donation after circulatory death (DCD) may offer a solution, although it is underutilized. The objective of this study was to compare survival and other postoperative outcomes between DCD and donation after brain death (DBD).

Depletion of alloreactive B cells by drug-resistant chimeric alloantigen receptor T cells to prevent transplant rejection.

Antibody-mediated rejection (AMR) remains a major complication after solid organ transplantation (SOT). Current treatment options are inefficient and result in drastic impairment of the general immunity. To selectively eliminate responsible alloreactive B cells characterized by anti-donor-HLA B cell receptors (BCRs), we generated T cells overcoming rejection by antibodies (CORA-Ts) engineered with a novel chimeric receptor comprising a truncated donor-HLA molecule as antigen recognition domain.

Lung Transplantation—Indications, Follow-Up Care and Long-Term Results.

Background: Lung transplantation is the treatment of choice for end-stage nonmalignant lung disease. It has become a routine procedure through advances in donor lung preservation, extracorporeal membrane oxygenation, immunosuppression, intensive care medicine, and follow-up care.

Methods: This review is based on publications about lung transplantation that were retrieved by a selective literature search, and on the procedures and experience of two large-volume lung transplantation centers.

Extracorporeal membrane oxygenation as a bridge to transplant in severe pulmonary hypertension.

Objectives: Severe pulmonary hypertension (PH) is the leading indication for a lung transplant in younger patients. Despite the availability of validated risk scores, their influence on lung allocation has been negligible, with continued reliance on decompensation and bridging with extracorporeal membrane oxygenation (ECMO).This single-centre, retrospective study assessed outcome of ECMO bridging in lung transplant for PH and evaluated short-term predictability of ECMO bridging.

Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries: A Network Comparison of Del Nido, Histidine-Tryptophan-Ketoglutarate, and Blood Cardioplegia.

: The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries (MICS) remains debated, as prolonged myocardial protection is essential to avoid interruptions to the surgical flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass time, especially in the constrained surgical field. We conducted a network meta-analysis to evaluate the safety and efficacy of the del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), blood cardioplegia (BC), and St. Thomas' (STH) solutions in MICS.

Can Obesity Serve as a Barrier to Minimally Invasive Mitral Valve Surgery? Overcoming the Limitations-A Multivariate Logistic Regression Analysis.

Over the past two decades, significant advancements in mitral valve surgery have focused on minimally invasive techniques. Some surgeons consider obesity as a relative contraindication for minimally invasive mitral valve surgery (MIMVS). The aim of this study is to evaluate whether the specific characteristics of obese patients contribute to increased surgical complexity and whether this, in turn, leads to worse clinical outcomes compared to non-obese patients.

Hemopexin alleviates sterile inflammation in ischemia-reperfusion-induced lung injury.

Introduction: Pulmonary ischemia-reperfusion (IR) injury (IRI) plays a significant role in various lung disorders and is a key factor in the development of primary graft dysfunction following lung transplantation. Hemopexin (Hx) is the major serum scavenger protein for heme, which is a prooxidant and pro-inflammatory compound. In the current study, we hypothesized that Hx could confer beneficial effects in sterile inflammation induced by IR-mediated lung injury.

Pushing the Survival Bar Higher: Two Decades of Innovation in Lung Transplantation.

Survival after lung transplantation has significantly improved during the last two decades. The refinement of the already existing extracorporeal life support (ECLS) systems, such as extracorporeal membrane oxygenation (ECMO), and the introduction of new techniques for donor lung optimization, such as ex vivo lung perfusion (EVLP), have allowed the extension of transplant indication to patients with end-stage lung failure after acute respiratory distress syndrome (ARDS) and the expansion of the donor organ pool, due to the better evaluation and optimization of extended-criteria donor (ECD) lungs and of donors after circulatory death (DCD). The close monitoring of anti-HLA donor-specific antibodies (DSAs) has allowed the early recognition of pulmonary antibody-mediated rejection (AMR), which requires a completely different treatment and has a worse prognosis than acute cellular rejection (ACR).

Sutureless Aortic Valve Replacement with Perceval Bioprosthesis Superior to Transcatheter Aortic Valve Implantation: A Promising Option for the Gray-Zone of Aortic Valve Replacement Procedures-A State-of-the-Art Systematic Review, Meta-Analysis, and Future Directions.

: The management of patients with aortic valve pathologies can sometimes fall into a "gray zone", where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the "gray zone" of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods.

Hypothermic Ventricular Fibrillation in Redo Minimally Invasive Mitral Valve Surgery: A Promising Solution for a Surgical Challenge.

: Minimally invasive mitral valve surgery (MIMVS) is a treatment for severe mitral valve pathologies. In redo cases, especially after coronary artery bypass grafting (CABG) surgery with patent mammary bypass grafts, establishing aortic clamping followed by antegrade cardioplegia application might be challenging. Here, we present the outcome of hypothermic ventricular fibrillation as an alternative to conventional cardioprotection.

Minimally Invasive Surgery through Right Mini-Thoracotomy for Mitral Valve Infective Endocarditis: Contraindicated or Safely Possible?

: Mitral valve infective endocarditis (IE) still has a high mortality. Minimally invasive mitral valve surgery (MIMVS) is technically more challenging, especially in patients with endocarditis. Here, we compare the early postoperative outcome of patients with endocarditis and other indications for MIMVS.