Donation after circulatory death transplantation alleviates waitlist time for hard-to-transplant cardiac recipients.

Background: Donation after circulatory death (DCD) can increase the cardiac transplant donor pool and decrease waitlist time. Patients with certain characteristics may be more difficult to match with appropriate donors. This study aimed to evaluate the impact of DCD heart donations on these candidates.

Lung Protection in Donation after Circulatory Death with Thoracoabdominal Normothermic Regional Perfusion.

Donation after circulatory death (DCD) has expanded the lung transplantation donor pool akin to other solid organ transplants, and thoracoabdominal normothermic regional perfusion (TA-NRP) of DCD lung allografts is a growing area of study. There remain some concerns regarding the impact of TA-NRP on DCD lung allograft pulmonary edema and subsequent development of primary graft dysfunction impacting graft and recipient survival and postoperative lung function. Here we present a review article discussing the existing literature on DCD lung transplantation, with a focus on TA-NRP recovery, and lung protection strategies during DCD lung recovery with TA-NRP.

Thoracoabdominal Normothermic Regional Perfusion: Technical Tips for Abdominal Transplant Surgeons.

Background: Donation after circulatory death (DCD) is characterized as organ procurement after irrevocable termination of cardiopulmonary function. Historically grafts from DCD donors were used with caution due to complication rates, but new techniques have led to significant strides in utilization. Normothermic regional perfusion (NRP) establishes in situ perfusion after circulatory death pronouncement, mitigating ischemic injury seen with classic cold perfusion.

Donation after circulatory death with thoracoabdominal normothermic regional perfusion recovery has similar outcomes with donation after brain death for lung transplantation.

Introduction: Donation after circulatory death (DCD) with thoracoabdominal normothermic regional perfusion (TA-NRP) has been increasingly used to procure cardiac allografts; however, concerns persist regarding its impact on lung allografts. We present our institution's experience with DCD TA-NRP and donation after brain death (DBD) lung transplants, comparing outcomes between the two techniques.

Methods: All lung transplants recovered with DBD or DCD TA-NRP performed between October 2022 and December 2024 were included.

Outcomes After DCD Cardiac Transplantation: An International, Multicenter Retrospective Study.

Background: As donation after circulatory determination of death (DCD) heart transplantation (HT) becomes more widely adopted, there is a need to establish the most clinically effective method of organ procurement.

Objectives: This international, multicenter study compares outcomes of DCD HT across Europe and the United States between recipients whose donor hearts were retrieved using thoraco-abdominal normothermic regional perfusion (taNRP) with those whose hearts were recovered using direct procurement and perfusion (DPP).

Methods: This was a retrospective observational study across 22 heart transplant centers in Belgium, Spain, the United Kingdom, and the United States.

Significantly reduced patient and graft survival for left vs right donor lungs for lung transplant recipients.

Background: To evaluate the association of right vs left single lung transplants (SLT) from split lung donors with long-term post-transplant recipient outcomes.

Methods: We performed a retrospective review of the Scientific Registry of Transplant Recipients data of split SLT adult recipients comparing right and left lung grafts between 2005 and 2021. We used a paired donor model to account for underlying differences between donors and evaluated post-transplant patient and graft survival with Cox proportional hazard models with robust variance estimates adjusted for recipient characteristics.

The Colorado Heart Failure Acuity Risk Model: A Mortality Model for Waitlisted Cardiac Transplant Patients.

Background: Currently, there is no mathematical model used nationally to determine the medical urgency of patients on the heart transplant waitlist in the United States. While the current organ distribution system accounts for many patient factors, a truly objective model is needed to more reliably stratify patients by their medical acuity.

Objectives: The aim of the study was to develop risk scores (Colorado Heart failure Acuity Risk Model [CHARM] score) to predict mortality in adults waitlisted for heart transplant.

Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion.

Background: Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique.

Methods: A working group composed of members from The American Society of Transplant Surgeons, The International Society of Heart and Lung Transplantation, The Society of Thoracic Surgeons, and The American Association for Thoracic Surgery was convened to develop technical guidelines for TA-NRP.

Consensus Statement: Technical Standards for Thoracoabdominal Normothermic Regional Perfusion.

Background: Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique.

Methods: A working group composed of members from The American Society of Transplant Surgeons, The International Society of Heart and Lung Transplantation, The Society of Thoracic Surgeons, and The American Association for Thoracic Surgery was convened to develop technical guidelines for TA-NRP.

Noteworthy in Cardiothoracic Surgery 2023.

Noteworthy in Cardiothoracic Surgery 2023 summarizes a few of the most high-impact trials and provocative trends in cardiothoracic surgery and transplantation this past year. Transplantation using organs procured from donation after circulatory death (DCD) continues to increase, and the American Society of Transplant Surgeons released recommendations on best practices in 2023. We review a summary of data on the impact of DCD on heart and lung transplantation.

Association of procurement technique with organ yield and cost following donation after circulatory death.

Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor.

Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experience.

Objective: Donation after circulatory death (DCD) procurement and transplantation after thoracoabdominal normothermic regional perfusion (TA-NRP) remains a novel technique to improve cardiac and hepatic allograft preservation but may be complicated by lung allograft pulmonary edema. We present a single-center series on early implementation of a lung-protective protocol with strategies to mitigate posttransplant pulmonary edema in DCD lung allografts after TA-NRP procurement.

Methods: Data from all lung transplantations performed using a TA-NRP procurement strategy from October 2022 to April 2023 are presented.

Association of cardiac preservation solution with short-term outcomes after heart transplantation.

Aims: There is wide variability in the practice of cardiac preservation for heart transplantation. Prior reports suggest that the type of solution may be linked with a reduced incidence of posttransplantation complications.

Methods: Adult (≥18 years old) heart recipients who underwent transplantation between 2015 and 2021 in the United States were examined.

4D-Flow MRI intracardiac flow analysis considering different subtypes of pulmonary hypertension.

Intracardiac flow hemodynamic patterns have been considered to be an early sign of diastolic dysfunction. In this study we investigated right ventricular (RV) diastolic dysfunction between patients with pulmonary arterial hypertension (PAH) and pulmonary hypertension with chronic lung disease (PH-CLD) via 4D-Flow cardiac MRI (CMR). Patients underwent prospective, comprehensive CMR for function and size including 4D-Flow CMR protocol for intracardiac flow visualization and analysis.

Building cardiac surgical programs in lower-middle income countries.

Objectives: Medical care in low-income countries is often limited by inadequate resources, treatment facilities, and the necessary infrastructure for healthcare delivery. We hypothesized that the development of an independently functioning, internationally supported Kenyan cardiac surgical training program could address these issues through targeted investment.

Methods: A review was conducted of the programmatic structure and clinical outcomes from January 2008 to October 2021 at Tenwek Hospital, Bomet, Kenya.

Worse survival in patients with right ventricular dysfunction and COVID-19-associated acute respiratory distress requiring extracorporeal membrane oxygenation: A multicenter study from the ORACLE Group.

Objective: We sought to determine the impact of right ventricular dysfunction on the outcomes of mechanically ventilated patients with COVID-19 requiring veno-venous extracorporeal membrane oxygenation.

Methods: Six academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 stratified by support with veno-venous extracorporeal membrane oxygenation during the first wave of the pandemic (March to August 2020). Echocardiograms performed for clinical indications were reviewed for right and left ventricular function.