This study aims to evaluate the entire experience in heart-lung transplantation (HLTx) in a country of the European Union with 47 million inhabitants according to the etiologies that motivated the procedure. A retrospective study on 1,751 consecutive transplants (HLTx: 78) was performed from 1990 to 2020 in two centers. Overall survival, adjusted for clinical profile and etiological subgroups, was compared. 7 subgroups were considered: 1) Cardiomyopathy with pulmonary hypertension (CM + PH). 2) Eisenmenger syndrome. 3) Congenital heart disease (CHD). 4) Idiopathic pulmonary arterial hypertension (IPAH). 5) Cystic fibrosis. 6) Chronic obstructive pulmonary disease (COPD)/Emphysema. 7) Diffuse interstitial lung disease (ILD). Early mortality was 44% and that of the rest of the follow-up was 31%. There were differences between HTLx and HTx in survival, also comparing groups with a similar clinical profile with propensity score (p= 0.04). Median survival was low in CM + PH (18 days), ILD (29 days) and CHD (114 days), intermediate in Eisenmenger syndrome (600 days), and longer in IPAH, COPD/Emphysema and cystic fibrosis. HLTx has a high mortality. The etiological analysis is of the utmost interest to make the most of the organs and improve survival.

The waiting list for heart transplants is a valuable data registry that would offer very useful information on the characteristics of patients who have various outcomes while waiting in the list. The purpose of this study was to look at the prognosis of those waiting for heart transplants as well as the factors that increase mortality. Advanced heart failure patients' demographic, clinical, hemodynamic, and echocardiographic results, as well as their prognosis, were retrieved from the national registry for heart transplantation between 2011 and 2018. The study population was defined and compared in four groups: 1) Death while awaiting HTX, 2) Death after HTX, 3) Alive without a transplant, 4) Transplanted and alive. The data of 207 patients [75% male, mean (SD) age of 34(10) years] were analyzed. The most common etiology of heart failure was idiopathic dilated cardiomyopathy. A total of 86 patients (41%) were successfully transplanted, with a median (IQR) time between listing and transplantation of 84 (30¬219) days, 54 patients (26.1%) were dead and 32% were still alive. The multivariate analysis showed right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and systolic blood pressure at the time of listing as independent predictors of death. The study on HTX waiting list is very useful for both allocation strategies and administrative planning for patients with advanced heart failure by development of accurate models and scoring systems using predictors of death in the waiting list.

In-utero xenotransplantation of stem cells in abnormal fetuses effectively treats several genetic illnesses. The current research aimed to evaluate structural and morphological alterations in the liver of rabbit fetuses following xenotransplantation of human Wharton's jelly-derived mesenchymal stromal cells (hWJ-MSCs), using a stereological technique. All hWJ-MSCs were isolated from the human umbilical cord, and their authenticity was established by flowcytometry and differentiation. At gestational day 14, the rabbits were anesthetized, and hWJ-MSCs were injected into the uteri of 24 fetuses. Twenty-two fetuses were born successfully. Ten rabbit liver specimens were prepared from injected fetuses including; eight rabbits on day three following birth and two rabbits on the 21st post-natal day. The non-injected fetuses were considered positive controls. The livers of the control and hWJ-MSCs-treated rabbits were fixed, processed, stained, and examined through stereological approaches. In the hWJ-MSCs-treated group, the mean liver weight and volume increased by 42% and 78% compared to the control group. The total volume of the hepatocytes increased by 63%, and that of sinusoids by three folds in the treated rabbits. The total volume of the central veins increased by 70%. The total number corresponding to hepatocytes in the experimental group increased by 112% compared to the rabbits in the control. The total volume of the hepatocyte nuclei in the experimental group increased by 117% compared to the rabbits in the control. After xenotransplantation of human MSCs, host tissue microenvironments (here, the rabbit liver) were altered and these included quantitative factors corresponding to the liver tissue and hepatocyte morphometric indices.

This study aims to propose an initial development of the FACT-Liver Transplant (FACT-LT) scale to assess the major physical and emotional concerns of patients before and after Orthotopic Liver transplant (OLT) due to acute and chronic liver failure and hepatocellular carcinoma. The FACT-LT was developed in two phases. In Phase I, items were generated: 1) through interviews with 10 OLT experts and 15 candidates for or recipients of both oncological and non-oncological OLT which identified relevant topics; 2) from the FACIT item bank. In Phase II, a questionnaire to assess item frequency, applicability, and comprehension was administered to 20 OLT experts and, to assess item difficulty, embarrassment and content irrelevance, to 30 transplant recipients or candidate patients (15 oncological, 15 non-oncological). In Phase I, 44 items were formulated/reviewed, and 30 items were maintained. All the healthcare professionals interviewed rejected the recommendation to develop two different modules for cancer and non-cancer patients. In Phase II, the majority of the experts and patients expressed an overall satisfaction with the questionnaire, indicating that the items were relevant, comprehensible and not embarrassing (range 75% - 99%). The first version of the FACT-LT includes 28 items defining four QOL domains: 5 items relating to Physical Well-Being, 8 to Functional Well-Being, 13 to Emotional Well-Being, and 2 to Social/Family Well-Being. The preliminary results obtained were promising; however further studies are needed, in order to proceed with a FACT-LT validation process.