Mid-Term Reassessment of Waitlist and Posttransplant Outcomes Under the 2018 Heart Allocation System: Improved All-Cause Survival.

Background: This study evaluates clinical trends and mid-term waitlist and posttransplant outcomes following the 2018 heart allocation policy change.

Methods: The United Network for Organ Sharing registry was queried to analyze adult waitlisted and transplanted patients undergoing isolated heart transplantation. Two analyses were conducted: (1) waitlist and (2) posttransplant outcomes.

SOPRANO: Macitentan in patients with pulmonary hypertension following left ventricular assist device implantation.

Macitentan is a dual endothelin receptor antagonist (ERA) approved for treating pulmonary arterial hypertension (PAH). SOPRANO evaluated the efficacy and safety of macitentan versus placebo in pulmonary hypertension (PH) patients after left ventricular assist device (LVAD) implantation. SOPRANO was a phase 2, multicenter, double-blind, randomized, placebo-controlled, parallel-group study.

Association of agonal phase duration with heart utilization and post-transplant outcomes in donation after circulatory death heart transplantation.

Background: This study evaluates the impact of the agonal phase and related hemodynamic measures on post-transplant outcomes and heart utilization in donation after circulatory death (DCD) heart transplantation.

Methods: United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated DCD heart transplantation between January 1, 2019 and September 30, 2023. The recipients were stratified into 2 groups based on donor agonal period: <30 and ≥30 minutes.

Medication optimization clinic decreases hospitalizations and mortality for patients with heart failure with reduced ejection fraction.

Study Objective: To evaluate the impact of a medication optimization clinic (MOC) on GDMT and outcomes for patients with HFrEF versus usual care.

Design: Retrospective evaluation of a multi-site MOC was conducted.

Setting: Large health system with academic and community hospitals.

Right Ventricular Mass Oversizing Is Associated With Improved Post-transplant Survival in Heart Transplant Recipients With Elevated Transpulmonary Gradient.

Background: This study evaluates the effects of pre-transplant transpulmonary gradient (TPG) and donor right ventricular mass (RVM) on outcomes following heart transplantation.

Methods: UNOS registry was queried to analyze adult recipients who underwent primary isolated heart transplantation from 1/1/2010 to 12/31/2018. The recipients were dichotomized into 2 groups based on their TPG at the time of transplantation, < 12 and ≥ 12 mmHg.

Mid-term Waitlist and Posttransplant Outcomes With Hepatitis C-positive Donor Hearts.

Background: This study evaluates the clinical trends and impact of hepatitis C virus-positive (HCV+) donors on waitlist and posttransplant outcomes after heart transplantation.

Methods: The United Network for Organ Sharing registry was queried to identify adult waitlisted and transplanted patients from January 1, 2015, to December 31, 2022. In the waitlist analysis, the candidates were stratified into 2 cohorts based on whether they were willing to accept HCV+ donor offers.

Evolving Trends and Impact of Waitlist Transfusion on Recipient Outcomes Following Heart Transplantation.

Background: This study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation.

Methods: The UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist.

Impact of post-transplant stroke and subsequent functional independence on outcomes following heart transplantation under the 2018 United States heart allocation system.

Background: This study evaluates the clinical trends, risk factors, and effects of post-transplant stroke and subsequent functional independence on outcomes following orthotopic heart transplantation under the 2018 heart allocation system.

Methods: The United Network for Organ Sharing registry was queried to identify adult recipients from October 18, 2018 to December 31, 2021. The cohort was stratified into 2 groups with and without post-transplant stroke.

Improved waitlist and comparable post-transplant outcomes in simultaneous heart-kidney transplantation under the 2018 heart allocation system.

Objective: This study aimed to investigate the clinical trends and the impact of the 2018 heart allocation policy change on both waitlist and post-transplant outcomes in simultaneous heart-kidney transplantation in the United States.

Methods: The United Network for Organ Sharing registry was queried to compare adult patients before and after the allocation policy change. This study included 2 separate analyses evaluating the waitlist and post-transplant outcomes.

Clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation in the 2018 United States heart allocation system.

Background: This study evaluated the current clinical trends, risk factors, and temporal effects of post-transplant dialysis on outcomes following orthotopic heart transplantation after the 2018 United States adult heart allocation policy change.

Methods: The United Network for Organ Sharing (UNOS) registry was queried to analyze adult orthotopic heart transplant recipients after the October 18, 2018 heart allocation policy change. The cohort was stratified according to the need for post-transplant de novo dialysis.

Impact of a Medication Optimization Clinic on Heart Failure Hospitalizations.

Efforts to optimize guideline-directed medical therapy (GDMT) through team-based care may affect outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This study evaluated the impact of an innovative medication optimization clinic (MOC) on GDMT and outcomes in patients with HFrEF. Patients with HFrEF who are not receiving optimal GDMT are referred to MOC and managed by a team comprised of a nurse practitioner or physician assistant, clinical pharmacist, and HF cardiologist.

Left ventricular assist device bridging to heart transplantation: Comparison of temporary versus durable support.

Background: Since the revision of the United States heart allocation system, increasing use of mechanical circulatory support has been observed as a means to support acutely ill patients. We sought to compare outcomes between patients bridged to orthotopic heart transplantation (OHT) with either temporary (t-LVAD) or durable left ventricular assist devises (d-LVAD) under the revised system.

Methods: The United States Organ Network database was queried to identify all adult OHT recipients who were bridged to transplant with either an isolated t-LVAD or d-LVAD from 10/18/2018 to 9/30/2020.

Pre-implant left ventricular dimension is not associated with worse outcomes after left ventricular assist device implantation.

Background: Left ventricular dimension has the potential to impact clinical outcomes following implantation of left ventricular assist devices (LVAD). We investigated the effect of pre-implant left ventricular end-diastolic diameter (LVEDD) on outcomes following LVAD implantation.

Methods: Patients implanted with a continuous-flow LVAD between 2004 and 2018 at a single institution were included.

Recent Changes in Durable Left Ventricular Assist Device Bridging to Heart Transplantation.

This study evaluates the impact of the recent United Network for Organ Sharing (UNOS) allocation policy change on outcomes of patients bridged with durable left ventricular assist devices (LVADs) to orthotopic heart transplantation (OHT). Adults bridged to OHT with durable LVADs between 2010 and 2019 were included. Patients were stratified based on the temporal relationship of their OHT to the UNOS policy change on October 18, 2018.

Twenty-year survival following orthotopic heart transplantation in the United States.

Background: This study evaluated 20-year survival after adult orthotopic heart transplantation (OHT).

Methods: The United Network of Organ Sharing Registry database was queried to study adult OHT recipients between 1987 and 1998 with over 20-year posttransplant follow-up. The primary and secondary outcomes were 20-year survival and cause of death after OHT, respectively.

Evolving Trends in Adult Heart Transplant With the 2018 Heart Allocation Policy Change.

Importance: The US heart allocation policy was changed on October 18, 2018. The association of this change with recipient and donor selection and outcomes remains to be elucidated.

Objective: To evaluate changes in patient characteristics, wait list outcomes, and posttransplant outcomes after the recent allocation policy change in heart transplant.

Nationwide variability in the use of induction immunosuppression for adult heart transplantation.

Background: Institutional factors have been shown to impact outcomes following orthotopic heart transplantation (OHT). This study evaluated center variability in the utilization of induction therapy for OHT and its implications on clinical outcomes.

Methods: Adult OHT patients between 2010 and 2018 were identified from the United Network for Organ Sharing registry.

Intra-Aortic Balloon Pump Bridging to Heart Transplantation: Impact of the 2018 Allocation Change.

Background: This study evaluates the impact of the 2018 allocation policy change on outcomes of orthotopic heart transplantation (OHT) in patients bridged with intra-aortic balloon pumps (IABPs).

Methods: Adult (≥18 years) patients undergoing OHT between 2013 and 2019 who were bridged with an IABP were stratified based on temporal relation to the policy change. Univariate analysis was used to compare baseline characteristics and postoperative outcomes.

Left ventricular assist device implantation in patients with a history of malignancy.

Background: This study evaluates the impact of a history of malignancy on outcomes of left ventricular assist device (LVAD) implantation.

Methods: Adult patients with a preimplant history of malignancy who underwent LVAD implantation between 2006 and 2018 were included. The primary outcome was post-LVAD survival.

Ruptured cerebral mycotic aneurysm in a left ventricular assist device patient with bacteremia.

A 50-year-old male with a history of nonischemic dilated cardiomyopathy presented in cardiogenic shock and ultimately underwent durable left ventricular assist device implantation. He recovered well initially but developed persistent bacteremia. His indwelling pacemaker leads were extracted due to evidence of vegetation.

Sex-Based Heart Transplant Outcomes After Bridging With Centrifugal Left Ventricular Assist Devices.

Background: Prior studies demonstrated that female sex is associated with an increased mortality after orthotopic heart transplantation (OHT). The impact of sex on OHT outcomes after bridging with newer-generation durable left ventricular assist devices (LVADs) remains unclear.

Methods: The United Network for Organ Sharing database was queried to study OHT recipients bridged with a newer-generation LVAD (ie, HeartMate III or HeartWare) between 2010 and 2018.

The Preimplantation Psychosocial Evaluation and Prediction of Clinical Outcomes During Mechanical Circulatory Support: What Information Is Most Prognostic?

Background: Psychosocial evaluations are required for long-term mechanical circulatory support (MCS) candidates, no matter whether MCS will be destination therapy (DT) or a bridge to heart transplantation. Although guidelines specify psychosocial contraindications to MCS, there is no comprehensive examination of which psychosocial evaluation domains are most prognostic for clinical outcomes. We evaluated whether overall psychosocial risk, determined across all psychosocial domains, predicted outcomes, and which specific domains appeared responsible for any effects.