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The advent of direct acting antivirals has allowed for utilization of HCV NAT+ donors with good short-term outcomes. The goal of this study was to compare clinical outcomes among heart transplant recipients who received hearts from HCV NAT+ donors to those from NAT- donors. We examined the UNOS registry of all primary orthotopic adult heart transplants from March 15, 2015 to August 31, 2021 and identified their donors as HCV NAT+ or NAT-. Those with multiorgan transplants or waitlisted for other organs were excluded. Baseline characteristics, three-year survival, and treatment for rejection at one year were compared between the two groups. Of 16,491 heart transplants meeting study criteria, 729(4%) hearts came from HCV NAT+ donors. HCV NAT+ donors were older (34±8 vs 32±11 years, p<0.01), more likely males(75% vs 70%, p<0.01), white race(83% vs 63%, p<0.01), and blood group O(60% vs 50%, p<0.01). They were more likely to have drug use as cause of death(59% vs 18%, p<0.01) and classified as CDC high risk (87% vs 29%, p<0.01). Recipients were more likely blood group O(48% vs 39%, p<0.01) and have positive hepatitis C serologies(5% vs 2%, p<0.01). They were less likely Status 1A (58% vs 67%, p<0.01) or Status 1 (4% vs 9%, p<0.01) or 2 (36% vs 48%, p<0.01). Distance traveled (241 vs 139 nautical miles, p<0.01) and ischemia times (3.48 vs 3.23 hours, p<0.01) were greater in the HCV NAT+ group, while wait list duration was similar (69 vs 69 days, p=0.20). Three-year survival (87% vs 85%,Figure; log-rank p=0.26) and treatment for rejection in first year post transplant (19% vs 18%, p=0.72) were not significantly different between the two groups. HCV NAT+ donors are being increasingly used for heart transplantation, particularly for lower status recipients with otherwise longer wait times. Three-year survival and treatment for rejection at one year are comparable to those from HCV NAT- donors. Therefore, HCV NAT+ donor hearts should continue to be utilized with monitoring of long-term outcomes. [ABSTRACT FROM AUTHOR]

While the outcomes of ECMO as a bridge to lung transplantation have been extensively studied, little is known regarding the use of post-operative ECMO in a contemporary cohort. The purpose of the study was the determine predictors and outcomes of post-operative ECMO in a national cohort. This was a retrospective cohort study of all adult lung transplantation recipients using the 2015 to 2022 United Network for Organ Sharing database. We used multivariable logistic regression to determine covariates associated with ECMO use at 72 hours following operation. Additionally, several outcomes including post-operative stroke, acute rejection and early (30-day and in-hospital) mortality as well as 1- and 5-year survival were compared between those requiring post-operative ECMO and all other lung recipients. Of 18,014 lung transplant recipients included in analysis, 1,430 (8%) required ECMO support following transplantation. Several recipient factors were associated with increased odds of post-operative ECMO use, including female gender (adjusted odds ratio, AOR 1.28, 95% CI 1.13-1.45), high BMI (AOR 1.05/kg/m2, 95% CI 1.04-1.06), preoperative ventilation (AOR 1.61, 95% CI 1.30-2.01) or dialysis (AOR 3.89, 95% CI 2.20-6.88), elevated serum bilirubin (AOR 1.08/mg/dL, 95% CI 1.04-1.12) and donor organ ischemic time > 4 hours (AOR 1.69, 95% CI 1.39-2.06). Those requiring post-operative ECMO experienced significantly higher rates of stroke (6% vs 2%, P<0.001), acute rejection (13% vs 7%, P<0.001) and early mortality along with decreased 1- and 5-year survival (Figure), compared to others. Patients requiring ECMO at 72 hours following lung transplantation experience markedly worse early outcomes and 5-year survival compared to all other lung recipients. Identification and management of pre-, intra-, and post-operative risk factors for severe PGD requiring post-operative ECMO may improve lung transplantation outcomes. [ABSTRACT FROM AUTHOR]

Normothermic regional perfusion is increasingly used in donation after circulatory death heart procurement, but its impact when the lung is also procured is unknown. The goal of this study was to examine utilization and outcomes of lung transplants in the setting of DCD heart procurement with or without NRP. We examined the United Network for Organ Sharing of all DCD heart donors from December 1, 2019 to June 23, 2022 with recorded brain death and cross clamp times, with a difference of greater than 30 minutes considered NRP procurements. Baseline characteristics, in-hospital outcomes, and one-year survival of lung transplant recipients were compared between those whose donors were managed with NRP versus no NRP. Of 447 DCD heart procurements with adequate data, 157(35%) were conducted with NRP. There were 62 DCD lung transplant recipients where the heart was also procured, of which 22(35%) came from NRP-managed donors and 40 (65%) from non-NRP managed donors. Lung utilization rates were not significantly different between NRP and non-NRP managed DCD heart donors (14% vs 14%, p=0.95). Donors in the NRP group were more frequently male (100% vs 70%, p<0.01) while recipients had significantly lower lung allocation scores [37 (34-41) vs 40 (36-57), p=0.02]. There were no other differences in other baseline characteristics, including EVLP use(18% vs 14%, p=0.73). Rates of ECMO (14% vs 15%, p=0.92), grade 3 PGD (18% vs 23%, p=0.70), intubation (36% vs 48%, p=0.40), and inhaled nitric use (14% vs 15%, p=0.88) 72 hours post-transplant were not significantly different. One-year survival was comparable between the two groups (86% vs 86%, p=0.94). A small number of DCD lung transplants are performed when the heart was also procured, with approximately one-third of these donors managed with NRP. While sample size was limited, NRP did not have a detrimental impact on short-term outcomes or one-year survival in lung transplant recipients. [ABSTRACT FROM AUTHOR]

Ex-vivo lung perfusion (EVLP) can be used to assess and rehabilitate donor lungs to expand the donor pool. However, the frequency of EVLP utilization and its outcomes are not well-studied. The goal of this study was to describe the characteristics and outcomes of lungs transplants performed with EVLP in the US. We conducted retrospective review of the UNOS registry of all primary adult lung transplant recipients from Feb 28, 2018 to June 30, 2021, excluding recipients with prior transplants, multiorgan transplants, and those waitlisted for other organs. Lung transplants were dichotomized as those that were performed with EVLP versus no EVLP. Baseline characteristics and short-term outcomes were compared. One-year survival was assessed by the Kaplan Meier method and multivariable Cox proportional hazards regression. Of 8,204 lung transplants performed during our study period, 426(5.2%) were performed with EVLP. Perfusion was performed by the OPO in 29(7%), transplant center in 291(68%), and external perfusion center in 106(25%) of cases. EVLP donors were older (39±13 vs 36±14 yrs, p<0.01), more likely DCD (31% vs 5%, p<0.01), and had lower P:F ratio(415±124 vs 442±130, p<0.01). Recipients had lower LAS scores[39(35-53) vs 41 (35-57), p<0.01)]. EVLP lungs traveled further[232(122-489) vs 169 (71-270) nautical miles, p<0.01], had longer ischemic times(11.5±4.1 vs 5.5±1.6 hrs, p<0.01), and were more likely double lung transplants(85% vs 76%, p<0.01). At 72 hours, recipients of EVLP lungs were more likely to remain intubated(47% vs 30%, p<0.01), be on ECMO(16% vs 8%, p<0.01), and experience PGD grade III (24% vs 17%, p<0.01). They also had higher total length of stay[21(13-39) vs 18(13-30) days, p<0.01). EVLP was associated with worse one-year survival on univariable(84% vs 88%, HR 1.41, 95% CI 1.07-1.85, p=0.02) but not multivariable analysis(aHR 1.18, 95% CI 0.88-1.59, p=0.26), particularly after adjusting for DCD donation(aHR 1.46, 95% CI 1.11-1.91) EVLP technology is used in a minority of donor lungs in the United States. A majority of the EVLP procedures are performed by the transplant centers with a higher proportion of DCD donors. The short-term outcomes and one-year survival of recipients of EVLP lungs appear worse than those not managed with EVLP. The role of this technology in the broad filed of lung transplantation remains to be defined. [ABSTRACT FROM AUTHOR]