Contraindication For Transplantation Research Articles

Association between Early Minimal Residual Disease Detected by Flow Cytometry and Prognosis in Children with Acute Myeloid Leukemia: A Clinical Retrospective Study

To investigate the prognostic value of minimal residual disease (MRD) detected by multi-parameter flow cytometry (MFC) in pediatric patients with acute myeloid leukemia (AML) after induction chemotherapy. A retrospective study was conducted on 97 pediatric patients initially diagnosed with AML at Wuhan Children's Hospital from August 2015 to December 2022. The study analyzed the results of MRD detection using MFC after the first and second cycles of induction chemotherapy, and its association with prognosis were analyzed. Following the first cycle of induction treatment, 57 of the 97 patients tested positive for MRD (MRD1+ , 58.8%). Subsequently, 19 patients remained MRD positive (MRD2+ , 19.6%) after the second cycle of induction treatment. Kaplan-Meier survival analysis showed that the estimated 3-year overall survival (OS) rate of the 37 (64.9%) MRD1+ patients who underwent transplantation was significantly higher than that of the 20 (35.1%) MRD1+ patients who did not undergo transplantation (84.6% vs 40.0%, P =0.0001). Among the 35 MRD1+ MRD2- patients, the 3-year OS rate of the 25 children who underwent transplantation was higher than that of the 10 children who did not undergo transplantation (87.2% vs 70.0%, P =0.3229). The 3-year OS rate of the 19 MRD1+ MRD2+ patients was lower than that of the 35 MRD1+ MRD2- patients (57.4% vs 81.8%, P =0.059). In the 19 MRD2+ patients, the 3-year OS rate of the 12 children who underwent transplantation was significantly higher than that of the 7 children who did not undergo transplantation (80.8% vs 14.3%, P =0.0007). There was no significant difference in 3-year OS between the 12 MRD1+ MRD2+ patients and 25 MRD1+ MRD2- patients, both treated with transplantation (80.8% vs 87.2%, P =0.8868). In those not treated with transplantation, the 7 MRD1+ MRD2+ patients had a significantly lower 3-year OS compared with the 10 MRD1+ MRD2- patients (14.3% vs 70.7%, P =0.0114). Further multivariate analysis indicated that MRD2 positivity and transplantation were both independent prognostic factors (P =0.031, 0.000), while MRD1 positivity was not significantly associated with the overall prognosis of 97 patients (P =0.902). MRD positivity following the second cycle of induction chemotherapy is an independent risk factor for unfavorable outcomes in children with AML. MRD2 positivity indicates a poorer prognosis and can help to identify the candidates requiring transplantation. MRD2 positivity is not a contraindication for transplantation in pediatric patients, and early transplantation significantly improves the prognosis of high-risk patients.

Prognostic analysis of 8 patients with hepatic adenoma undergoing allogeneic hematopoietic stem cell transplantation

Objective: To evaluate the safety of patients with hepatic adenoma undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: A retrospective analysis of the clinical characteristics and prognosis of eight patients with hepatic adenoma who underwent allo-HSCT in the Hematology Department of Peking University People's Hospital from January 2010 to March 2024 was conducted. Results: Of the eight patients who underwent allo-HSCT with hepatic adenoma, one patient was considered MDS-h transfusion-dependent and seven had aplastic anemia. The median age of the patients was 23 years (13-48 years). The median time from the diagnosis of AA or MDS to transplantation was 14 years (6-24 years), whereas the median time from taking androgens to diagnosing hepatic adenoma was 9 years (5-13 years). Six cases underwent haplo-HSCT, one case underwent matched unrelated donor HSCT, and one case underwent matched related donor HSCT. All patients achieved neutrophil engraftment at a median time of 11.5 days (11-20 days) and PLT engraftment within 60 days at a median of 19 days (10-37 days) after haplo-HSCT. Moreover, seven patients developed CMV anemia after transplantation, three patients had hemorrhagic cystitis, and two patients developed acute GVHD. During and after transplantation, eight patients did not show severe liver function damage or rupture of hepatic adenoma. In relation to imaging size, four patients showed varying degrees of reduction in hepatic adenoma size after transplantation, whereas four patients did not show significant changes in hepatic adenoma size after transplantation. The median follow-up time was 540.5 (30-2 989) days. Of the eight patients, six survived and two died. Furthermore, no direct correlation was observed between death and hepatic adenoma. Conclusion: Patients with hepatic adenomas undergoing allo-HSCT are not contraindications for transplantation, which will not increase transplant-related mortality.

Risk for Recurrence in Long-Term Follow-Up of Children after Liver Transplantation for Hepatoblastoma or Hepatocellular Carcinoma.

The aim of this study was to assess the long-term results of liver transplantation (LT) in pediatric patients with unresectable hepatoblastoma (HB) or hepatocellular carcinoma (HCC) with special reference to the risk of tumor recurrence. We retrospectively analyzed data from 46 HB and 26 HCC patients who underwent LT between 1990 and 2022. In HCC patients, we compared outcomes depending on donor type. We evaluated the impact of a number of risk factors on recurrence-free survival after LT. Estimated patient survival after 5, 10, and 15 years was 82%, 73%, and 73% in the HB group and 79%, 75%, and 75% in the HCC group, respectively (p = 0.76). In the HCC group, living donor LT (LDLT) and deceased donor LT (DDLT) provided similar patient survival (p = 0.09). Estimated recurrence-free survival in patients who had three or fewer risk factors was significantly better than in patients with more than three risk factors (p = 0.0001). Adequate patient selection is necessary when considering LT for primary liver tumors in children. The presence of more than three risk factors is associated with a very high risk of recurrence and indicates poor prognosis, whereas extrahepatic disease may be considered a contraindication for transplantation.

Granulocyte-colony stimulating factor in decompensated liver cirrhosis: a meta-analysis of four randomized controlled trials.

Decompensated liver cirrhosis (DC) has high mortality, but liver transplantation is limited due to organ scarcity and contraindications for transplantation. Granulocyte-colony stimulating factor (GCSF) shows potential for liver disease treatment with its regenerative and immunomodulatory properties. To assess the controversial use of GCSF in DC, a meta-analysis of randomized controlled trials (RCTs) compared survival benefits in patients receiving GCSF plus standard medical therapy (SMT) versus SMT alone. A literature search was performed in four databases from data inception up to December 2022, and all registered randomized controlled (RCTs) evaluating GCSF-based therapies for cirrhotic patients were included. A study combining four RCTs assessed the impact of GCSF with SMT in 595 patients with decompensated cirrhosis. The results indicated that GCSF + SMT led to higher odds of survival compared to SMT alone [risk ratio 1.28, 95% CI (1.08-1.5)]. Heterogeneity existed among the studies, but overall, GCSF showed potential in improving survival. The intervention group exhibited improved Child-Pugh-Turcotte scores [-2.51, CI (-4.33 to -0.70)], and increased CD34 levels, but no significant improvement in MELD scores. These findings suggest GCSF may benefit patients with decompensated cirrhosis in terms of survival and liver function. These results suggest that the combination of GCSF and SMT may have a positive impact on the survival rate and improvement in CPT score in patients with DC. Further RCTs are needed to shed more light on this promising modality in end-stage liver disease.

Liver Transplantation for Incidental Cholangiocarcinoma or Combined Hepatocellular Carcinoma/Cholangiocarcinoma-Own Experiences and Review of the Literature.

Data about liver transplantation for mixed tumors from hepatocellular carcinoma to cholangiocarcinoma are limited. Furthermore, the diagnosis of intrahepatic cholangiocarcinoma or combined tumors in a cirrhotic liver is considered a contraindication for transplantation. Our aim was to evaluate the long-term outcomes of patients with incidental cholangiocarcinoma or combined tumors after liver transplantation. In our descriptive analysis, data were evaluated from all patients since 2010 who received a liver transplant due to an assumed hepatocellular carcinoma at Jena University Hospital. Survival rates were determined using the Kaplan-Meier method. Between January 2010 and December 2022, an incidental intrahepatic cholangiocarcinoma was found in eight patients post-transplant. Four combined hepatocellular and cholangiocarcinoma and four sole intrahepatic cholangiocarcinomas were found. A recurrence through distant metastases from combined hepatocellular- and cholangiocarcinoma was found in one patient at one year after transplantation. Another patient developed a pulmonary primary tumor independently one year post-transplant. The recurrence rate was at 14.3%. While two patients died, the 1- and 5-year overall survival rates post-transplant were 87.5% and 75%, respectively. Patients with intrahepatic cholangiocarcinoma or combined hepatocellular- and cholangiocarcinoma could profit from liver transplantation.

Normothermic machine perfusion for older transplant recipients.

Elderly patients (≥65 years old) are increasingly undergoing liver transplantation and are more likely to be removed from the waitlist. Normothermic machine perfusion (NMP) holds promise in expanding the number of livers available for transplant and improving outcomes for marginal donors and recipients. We aimed to determine the impact of NMP on outcomes in elderly recipients at our institution and nationally using the UNOS database. The use of NMP on outcomes in elderly recipients was reviewed using both the UNOS/SRTR database (2016-2022) and institutional data (2018-2020). Characteristics and clinical outcomes were compared between the NMP and static cold (control) groups within both populations. Nationally, using the UNOS/SRTR database, we identified 165 elderly recipients from 28 centers who received a liver allograft undergoing NMP and 4270 that underwent traditional cold static storage. NMP donors were older (48.3 vs. 43.4 years, p< 0.01), had similar rates of steatosis (8.5% vs 8.5%, p= 0.58), were more likely to be from a DCD (41.8% vs 12.3%, p< 0.01), and had a higher donor risk index (DRI; 1.70 vs. 1.60, p< 0.02). NMP recipients had similar age but had a lower MELD score at transplant (17.9 vs. 20.7, p= 0.01). Despite increased marginality of the donor graft, NMP recipients had similar allograft survival and decreased length of stay, even after accounting for recipient characteristics including MELD. Institutional data showed that 10 elderly recipients underwent NMP and 68 underwent cold static storage. At our institution, NMP recipients had a similar length of stay, rates of complications, and readmissions. NMP may mitigate donor risk factors that are relative contraindications for transplantation in elderly liver recipients, increasing the donor pool. The application of NMP in older recipients should be considered.

Burden, depression and fatigue in caregivers of lung transplantation candidates

Objective: A great deal of social support is often provided by the caregiver of the patient. The purpose of this study is to evaluate the&#x0D; burden, fatigue and depression of the primary caregiver of patients with pulmonary transplantation candidates.&#x0D; Patients and Method: The primary caregivers of patients who were admitted to our hospital’s pulmonary transplant outpatient clinic&#x0D; with end-stage pulmonary disease and no definite contraindications for transplantation, were included in the study. Zarit Burden&#x0D; Scale, Beck Depression Inventory and Short-Form (SF)-36 – Vitality questionnaires were applied to participants.&#x0D; Results: Thirty-nine patients and their caregivers were evaluated. Caregivers experienced low levels of depression. Mean score for&#x0D; Beck Depression Inventory was 12.7±10.1. Caregivers generally experienced medium levels of burden. Mean score for Zarit Burden&#x0D; Scale was 26.9±14.2. Majority of caregivers experienced clinically significant fatigue. Mean score for SF-36 – Vitality was 61±16.7.&#x0D; Zarit Burden Scale scores and Beck Depression Inventory scores showed a statistically significant positive correlation (r:0.962 p

Novel Flow Cytometry-Based Method for Detection of Anti-HLA Complement Activating Donor-Specific Antibodies in Renal Transplant Recipients and Its Comparison With Other Conventional Detection Methods

Presence of preformed donor specific antibodies (DSAs) detected by complement-dependent cytotoxicity (CDC-XM) is a strong contraindication for transplant. However, it has limitations including its sensitivity and its inability to distinguish between HLA-specific and other non-HLA-specific antibodies. In this study, we standardized CDC-XM by flow cytometry and determined its relevance by comparing its results with other methods of DSA detection, such as routine CDC-XM, antibody binding assay by flow cytometry (FC-XM), and Luminex-based crossmatch assays, such as Luminex crossmatch (LXM) and virtual crossmatch (VXM). A total of 79 serum samples were tested for DSAs by the flow cytometric complement-dependent cytotoxicity crossmatch assay (FC-CDC-XM) and then the results of FC-CDC-XM were compared with other detection methods such as CDC-XM, FC-XM, LXM, and VXM. We found that the FC-CDC-XM assay is more sensitive than routine CDC-XM. Out of total 79 sera, 24 sera were detected positive (T cells positive: 1 case and B cells positive: 23) by FC-CDC-XM as compared with 3 sera using CDC-XM; these 3 sera also showed positivity by FC-CDC-XM. After FC-XM assay, 23 samples were positive by FC-XM and out of these 23 samples, 13 were also positive by FC-CDC-XM. On comparing the FC-CDC-XM results with VXM and LXM, 10 sera of 24 FC-CDC-XM positive had HLA class II antibodies detected on a Luminex platform. The FC-CDC-XM is a more sensitive and specific method for detection of HLA-specific complement-fixing antibodies than CDC-XM and FC-XM. FC-CDC-XM should be used in tissue-typing laboratories after intra- and inter- laboratory validation.

Recalibrating Transplant Eligibility Criteria: Ensuring Equitable Access to Organ Transplantation for Intellectually Disabled Persons

The American with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act have made little progress towards preventing disability-based discrimination within the organ transplant evaluation process. Intellectual and developmental disabilities (I/DD) pose a unique problem for transplant teams and transplant physicians because I/DDs can simultaneously be a legitimate contraindication for transplantation and a mechanism for invidious discrimination against intellectually disabled persons. A culprit for ongoing disability-based discrimination is a transplant center's authority to develop its own eligibility criteria. While medical criteria for eligibility are generally well-settled, psychosocial criteria - an amorphous constellation of risk factors for post-transplant success - can serve as a facially neutral disguise for social worth determinations of individuals with I/DDs. Consequently, individuals with I/DDs are unjustifiably denied eligibility for organ transplantation and transplant-related services.This Article begins by identifying the pitfalls of current federal antidiscrimination legislation. It then discusses the foreseen benefits and drawbacks of House Resolution (H.R.) 8981, a recently proposed federal bill, that expressly prohibits disability-based discrimination within the organ transplant evaluation process. The Article ends by offering potential solutions for professional organizations and transplant centers that aim to provide for equitable access to organ transplantation and transplant-related services for intellectually disabled individuals.

Dawn of a new beginning- First renal transplant in patient with HIV in Nepal

Human immunodeficiency virus infection was traditionally considered an absolute contraindication for transplantation because of the concern that immunosuppression would accelerate HIV disease progression, resulting in increased mortality and a "waste" of organs. Since potent antiretroviral therapy became widely available in 1996, the prognosis of patients with HIV infection has dramatically improved. HIV-infected patients are now accepted recipients of both HIV-infected and HIV- uninfected donor organs in specialized transplant centers worldwide. However, due to stigma about the disease and lack of appropriate expertise, renal transplant in HIV patients has not been done in Nepal. Here, we report the first case of renal transplantation done in patient with HIV in Nepal. So, even in a resource limited setting like Nepal, HIV-positive ESRD patients with stable disease should be given the benefit of kidney transplantation as patient and graft survival are reasonably good with better quality of life.

Результаты применения мультидисциплинарного подхода в лечении больных циррозом печени в исходе хронических вирусных гепатитов

Aim – to evaluate the results of applying a multidisciplinary approach to the treatment of patients with liver cirrhosis in the outcome of chronic viral hepatitis. Material and methods. From July 2018 to September 2021, 94 orthotopic liver transplants (OTLT) from a posthumous donor were performed at the surgical clinic of the Botkin Hospital. Of 94 recipients, 48 (51.1%) indicated for surgery as liver cirrhosis as a result of chronic viral hepatitis C (CVHC), in 8 (8.5%) cirrhosis as a result of chronic viral hepatitis B (CVHB). In the case of cirrhosis as a result of CVHB, the presence of viral replication was a contraindication for transplantation; patients with its presence at the stage of placing on the waiting list were sent to an infectious disease specialist to receive antiviral therapy (AVT). Prevention of recurrence of CVHB in the graft consisted of intraoperative, as well as early and late postoperative administration of 400–800 IU of immunoglobulin against hepatitis B. Among liver transplant recipients with liver cirrhosis in the outcome of CVHC, less than half (43.75%) did not have HCV RNA against the background of passed or the OEM received by the time of the operation. The rest of the patients had contraindications to AVT, and HCV eradication was performed after transplantation. Results. The average follow-up period for hepatic transplant recipients with liver cirrhosis as a result of CVHB was 12.28 ± 4.11 (7–23) months. Satisfactory graft function against the background of constant antiviral therapy was observed in all patients. No deaths were recorded. The average follow-up time for patients with cirrhosis of the liver in the outcome of chronic hepatitis C after OTTP was 21.67 ± 4.85 (1–38) months. Antiviral therapy was prescribed to 24 patients 2.7 ± 0.34 (2–4) months after surgery. Three patients did not receive AVT after surgery due to their low adherence to treatment. Satisfactory graft function was observed in all patients, confident virological response against the background of AVT – in 17 patients (70.8%). 7 patients (29.2%) are currently undergoing antiviral therapy. Of the three patients who did not receive AVT in the postoperative period of their own free will, 1 patient (33.3%) developed graft cirrhosis and death from decompensation of liver failure at 23 months after transplantation. Conclusion. The use of a multidisciplinary approach in the treatment of patients with liver cirrhosis as a result of chronic viral hepatitis allows achieving a confident virological response, radically curing liver cirrhosis, thereby preventing associated complications, improving the quality of life of patients and restoring their ability to work.

Should Psychotic Experience Contraindicate Organ Transplant? A Narrative Review

The scarcity of organs for transplant and significant rates of organ transplantation failure mean it is important to identify factors relating to transplant success and failure. Experiencing psychosis or mania is often seen as a contraindication for transplant, and many transplant teams have been cautious at transplanting people with significant mental health difficulties. In this paper we explore whether there is any evidence to support this attitude towards psychiatric diagnosis and transplantation; consider modifiable risks to transplantation; and ask what is needed to provide equitable care for individuals with experience of psychosis. To place context to our discussion, we present the experience of a person who had a history of psychotic experience and who was assessed for double lung transplant.

P1332: PROMISING OUTCOME OF PATIENTS OLDER THAN 70 YEARS WHO UNDERWENT PERIPHERAL BLOOD HAPLOIDENTICAL HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR ACUTE MYELOID LEUKEMIA OR HIGH RISK MYELODYSPLASTIC SYNDROME

Background: Allogeneic stem cell transplantation is a curative option of patients older than 60 years of age with AML and high risk MDS. In this situation, the development of haploidentical transplantation (Haplo-SCT) using post transplantation cyclophosphamide (PT-Cy) allowed extending the feasibility of Allo-HSCT. However, there is few data specifically focusing on Haplo-SCT in patients over 70 years of age with AML and MDS, for whom the benefit-risk balance of Haplo-SCT is still a matter of debate. Aims: To evaluate the outcome of patients older than 70 years with AML or high risk MDS who underwent Haplo-SCT. Methods: This retrospective study included consecutive AML or MDS patients older than 70 years who received first Haplo-SCT from 2013 to 2021 in our center. All patients had the same transplantation modalities: 1) Non-myeloablative conditioning regimen as described by the Baltimore’s group (Fludarabine, cyclophosphamide and 2-Gray TBI); 2) Peripheral blood stem cells (PBSC) as graft source; 3) GVHD prophylaxis using PT-Cy, cyclosporine A and mycophenolate mofetil; 4) G-CSF from day+5 to neutrophil recovery. Prophylactic donor lymphocyte infusion (DLI) was initially planned after day+60 in absence of GVHD. Results: We analyzed 45 patients who met inclusion criteria, 23 with AML and 22 with MDS. The median age was 72 years (range: 70-75). HCT-CI was >= 3 in 22 patients (49%). At the time of Haplo-SCT, 22/23 AML patients were in CR (17 CR1 and 5 CR2) and one patient had refractory AML. Disease status at Haplo-SCT was CR, PR, marrow CR and active disease in 12, 2, 1 and 7 patients, respectively. All patients received pre transplantation treatment with intensive chemotherapy and/or azacytidine, except one MDS patients who underwent upfront Haplo-SCT. Disease risk index was high or very high in 11 patients (24%), and intermediate in 34 patients (76%). Median follow up using the reverse Kaplan Meier method was 36 months (95%CI: 25-43). Grade 2-4 and 3-4 acute GVHD at day+100 was 33% and 7%, respectively. There was no early death (at day+100: OS=100%; NRM=0%). At 3 years after Haplo-SCT, the cumulative incidence of all grades and moderate to severe chronic GVHD was 37% and 28%. Half of the cases of chronic GVHD occurred after prophylactic DLI. The 3-year cumulative incidence of NRM was 20%. In AML patients, the 3-year CIR, PFS and OS were 17%, 61% and 64% respectively. Corresponding values for MDS patients were 26%, 56% and 66%, respectively. Ten patients received prophylactic DLI. Among them, one died from late NMR (urothelial metastatic cancer after 2 years post Haplo-SCT) and one patient relapsed and subsequently died from AML (complex karyotype, CR2). The 8 remaining patients who received prophylactic DLI are still disease free at last follow up. As surrogate marker of quality of life, we evaluated the prevalence of GVHD and immunosuppressive treatment (IST) in disease free patients. At 2 years after Haplo-SCT, 87% of disease free patients are living without GVHD and without IST. Summary/Conclusion: Haplo-SCT in patients older than 70 years with AML or high risk MDS is feasible without early NRM. The use of PBSC and prophylactic DLI may explain the low incidence of relapse and long-term survival. Our results support that selected patients older than 70 years can achieve promising outcomes after non-myeloablative Haplo-SCT using PBSC, confirming that age by itself and the absence of an HLA-matched donor should not be considered as firm contraindication for transplantation.

Kidney Transplantation in Patients After Bariatric Surgery: High-Volume Bariatric and Transplant Center Experience

Kidney transplantation (KTx) is the best type of treatment for patients with end-stage renal disease (ESRD). Unfortunately, obesity may be a contraindication for transplantation. Our study aimed to evaluate the results of KTx in patients who had bariatric surgery (BS) prior to transplantation. A single center, with experience in bariatric and transplant surgery, presents a retrospective study of 13 patients who received a kidney transplant after a gastric bypass (GB) operation between 2012 and 2019. Thirteen patients, who were potential candidates for KTx, were previously qualified for BS because of a body mass index (BMI) > 35 kg/m2. Additionally, all patients had arterial hypertension, 60% of patients had diabetes, and 30% of patients had coronary artery disease. Patients were activated on the waiting list when their BMI was < 35 kg/m2. KTx was performed between 5 and 29 months after BS. One patient needed reoperation due to a urinary leak and another patient needed reoperation because of a high-pressure lymphocele. We diagnosed 2 delayed graft functions (DGFs) and 1 acute rejection. One patient died for reasons independent of surgery. The KTx observation period ranged from 3 to 8 years. Currently, 11 patients has stable renal function: creatinine concentration is 0.8-1.8 mg/dL and BMI is between 23 and 35 kg/m2. Despite the small group of patients, we can assume that kidney transplantation can be safely performed in patients with end-stage renal disease (ESRD) who have previously undergone gastric bypass (GB) as a graft bridging procedure. In some cases, BS may be the only chance of getting an organ.

Bench bioprosthetic aortic valve replacement in a donor heart before transplantation

Critical donor shortages have impulsed the need to expand donor heart eligibility through the use of marginal hearts in cardiac transplantation. Donor valvular disease has been considered as an absolute contraindication for transplant. A 39-year-old male patient with end-stage non-compaction cardiomyopathy, an INTERMACS II heart failure, and a left ventricular ejection fraction of 8% was taken to an orthotopic heart transplantation. During donor bench graft examination, a congenital bicuspidand calcified aortic valve was found. The native bicuspid valve was removed and the annular calcification debrided; a #21 bioprosthetic aortic valve was then implanted.

Right Ventricular Failure Following Left Ventricular Assist Device Implant: An Intermacs Analysis

<h3>Purpose</h3> Right heart failure (RHF) management following LVAD include inotropes, right ventricular mechanical support and heart transplant. We analyzed the outcomes of severe RHF following implant of a fully magnetically levitated or hybrid magnetic centrifugal durable LVAD. <h3>Methods</h3> In this INTERMACS analysis we identified patients who developed severe RHF following LVAD from 2013 until 2020 as bridge to recovery or transplant. Patients were categorized in three groups based on RHF treatment strategy: inotrope support (group 1), temporary mechanical support (group 2), and durable centrifugal RVAD (group 3). Kaplan Meier and Cox-regression survival analysis between groups was undertaken. Logistic regression analysis for new onset dialysis was conducted. <h3>Results</h3> 2509 patients developed severe RHF after LVAD. 2199 (87.6%) patients were managed with inotropes (group 1), 233 (9.3%) with temporary RVAD (group 2) and 77 (3.1%) with durable RVAD (group 3). Group 1 had fewer patients with INTERMACS profile 1 and 2 (21.6%, p<0.001). One year survival was 84.6%, 59.3%, and 63.8% in groups 1,2, and 3 (mortality HR=2.4 and 3.3 for groups 2 and 3 vs. group 1, p<0.05). One year survival to transplant was 27%, 36.5%, and 53.6% in groups 1, 2, and 3, respectively (p<0.05). Group 2 had higher incidence of new onset dialysis (42.6%, p=0.049). <h3>Conclusion</h3> Survival with RHF following LVAD implant varies based on treatment strategy; inotrope support is associated with increased survival. Patients with durable RVAD are more likely to survive to transplant. Patient selection studies for durable RVAD with contraindications for transplant are necessary.

Outcomes After Lung or Combined Heart Lung Transplantation for PAH and CTEPH According to Baseline Kidney Function

<h3>Purpose</h3> Decreased renal function is often considered as a contraindication for lung (LTX) or combined heart-lung (HLTX) transplantation due to poorer prognosis and risk of further decline due to nephrotoxic medication. Severe pulmonary hypertension (PH) may decrease renal function because of low cardiac output and renal congestion, which may be reversible with transplantation. We aimed to assess whether pre-transplant kidney function is a predictor for mortality or need for renal replacement therapy (RRT) and evaluated the evolution of renal function after LTX or HLTX in PH patients. <h3>Methods</h3> We conducted a retrospective study in 68 consecutive patients diagnosed with PAH, chronic thromboembolic pulmonary hypertension (CTEPH) or PAH due to congenital heart disease who had undergone LTX or HLTX in our center between 1996 and 2019. 3 year survival according to pre-transplant kidney function was evaluated using the Kaplan-Meier method and by log-rank test. The evolution of eGFR according to pre-transplant kidney function was evaluated using mixed model effect test. Predictors of the need for RRT in the first 90 days and mortality after 1 year were identified by univariate analysis. <h3>Results</h3> 35 of 68 patients had an abnormal pre-transplant creatinine (cut off >1.15mg/dL for males, >0.95mg/dL for females). eGFR range was 38-121 ml/min/1.73m². 3 year survival was similar in both groups (67% versus 69%). In all patients, there was a trend to an improvement of kidney function at one month (eGFR +11.5 ml/min, P=0.055). At 6 months there was no longer a significant difference between the eGFR of both groups. A pre-transplant right atrial pressure of >15 mmHg was predictive for the need of RRT in the first 90 days, a baseline abnormal creatinine was not. The need for RRT in the first 90 days was predictive for mortality in the first year. <h3>Conclusion</h3> In patients with PAH, CTEPH or PAH related to congenital heart disease, a mild abnormal kidney function does not correlate with a higher risk of RRT or mortality after LTX or HLTX. eGFR may improve at one month suggesting an impairment due to hemodynamic status pre-transplant. At 6 months, there was no difference in eGFR according to the baseline kidney function. This suggests that pre-transplant kidney dysfunction is mostly determined by a hemodynamic factor and that it should only be considered as a relative contraindication for transplantation.

Combined cardiac surgery procedures and liver transplant: a single-center experience.

Morbidity and mortality rates associated with liver transplant are high for patients with concomitant heart disease. Traditionally, such cases were considered contraindications for transplant. The objective of our study was to assess the outcome of combined surgical approaches. A prospectively maintained database was analyzed of patients undergoing cardiac surgery and liver transplant at our institution. Twelve identified patients underwent combined cardiac operation and liver transplant. A control group was created (n = 24) with the same selection criteria. Median patient age was 64.94years in the combined group vs 63.80 in the control, and in both groups, 58% were male. Left ventricular ejection fraction (0.60), body mass index (30.1), and median (range) score of the Model for End-stage Liver Disease (18 [9-33]) were the same in both groups. The cardiac operations combined with liver transplant were coronary artery bypass grafting, valve replacement procedures, and ascending thoracic aortic aneurysm repair. Piggyback liver transplant was performed for all patients. Survival periods of 1, 5, and 10years for control vs combined cases were 90 vs 62%, 79 vs 55%, and 70 vs 45%, respectively (P = 0.03). Concomitant cardiac procedure and liver transplant is a valid treatment option and should be considered with risk stratification criteria of the patient with end-stage liver disease and cardiac surgical pathologic characteristics.

Barriers for Liver Transplant in Patients with Alcohol-Related Hepatitis

Liver transplantation (LT) for alcohol-related liver disease has historically been reserved for patients who have been six months abstinent. Given the increasing incidence of alcohol-related hepatitis (AH) and dismal survival in patients who fail medical therapy, transplant centers are extending their acceptance criteria for patients with less than 6 months of sobriety. We sought to determine the barriers for listing. We conducted a retrospective chart review of all inpatient LT referrals for a diagnosis of AH between September 2019 and December 2020. LT evaluations were performed by a multidisciplinary team. Descriptive statistics were reported using mean and standard deviation (SD) or percentage where appropriate. During our study period, 82 patients were evaluated for LT. Of these 82 patients, 62 were declined for liver transplantation. The mean (SD) age of the 62-patient cohort was 44 years (10.7), and most patients were men. The mean (SD) number of reasons for denial was 2 (0.97). Four patients had medical contraindications for transplant. Twenty-seven (44%) and 35 (56%) patients lacked insight and were at risk of alcohol relapse, respectively. Forty-three (69%) and fourteen (22.5%) patients had insufficient social support and an inability to maintain a therapeutic relationship with the transplant team, respectively. Patients are more likely denied for psychosocial factors than medical comorbidities. The majority were due to lack of insight, insufficient social support, and inability to maintain a therapeutic relationship with the transplant team. Resources should be allocated to address these issues.

Cardiac Transplantation in HIV-Positive Patients: A Narrative Review.

Before the introduction of highly active antiretroviral therapy, patients infected with HIV experienced poor prognosis including high rates of opportunistic infections, rapid progression to AIDS, and significant mortality. Increased life expectancy after therapeutic improvements has led to an increase in other chronic diseases for these patients, including cardiovascular disease and, in particular, end-stage heart failure. Historically, HIV infection was deemed an absolute contraindication for transplantation. Since the development of highly active antiretroviral therapy, however, life expectancy for HIV-positive patients has significantly improved. In addition, there is a low incidence of opportunistic infections and the current antiretrovirals have an improved toxicity profile. Despite this, the current status of cardiac transplants in HIV-positive patients remains unclear. With this in mind, we conducted a narrative review on cardiac transplantation in patients with HIV.