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Purpose Data on outcomes in lung transplant recipients with SARS-CoV-2 infection remains limited. Given the potential higher COVID-19 severity in lung recipients, the Agence de la biomedecine has limited the transplant program to patients with high-urgency status during the first epidemic wave. The program has been fully restored where possible during the second epidemic wave. This study aimed to assess the impact of COVID-19 on lung recipient mortality in France. Methods All lung recipients with COVID-19 reported in the French national registry CRISTAL between February 1st and September 30th 2020 were included in the study. Patient characteristics were extracted from CRISTAL. Cumulative number of cases by month since February (Figure 1) and case fatality rate (CFR) were calculated. Mortality rates from February to September in the whole 2019 and 2020 recipient cohorts were compared. Survival curves were estimated using Kaplan-Meier method and compared using the log-rank test. Results Of the 46 patients (median age (IQR) 51 years (39-60), 54% female, median time from transplantation 3.5 years (0.8-7.1)) 88% required hospitalization including 21% in ICU. Eight patients died (CFR: 17.4%). No difference in 3-month survival was observed between 2020 and 2019 recipient cohorts (98.6% 95%CI [98.0%-99.0%] vs 98.4% [97.8%-98.8%], respectively) (Figure 2). Conclusion COVID-19 was associated with lower fatality rate in lung recipients than in other organ transplant recipients and did not result in an excess mortality. These findings suggest that continuing lung transplant activity during the COVID-19 pandemic was a reasonable option.

Purpose The COVID-19 pandemic has deeply affected organ transplant activity across the world. While the Agence de la biomedecine in agreement with the French lung transplant community has limited the transplant program to patients with high-urgency status during the first epidemic wave, the program has been fully restored where possible during the second epidemic wave. This study aimed to examine the impact of COVID-19 on new listings, waitlist outcomes and transplant activity in France. Methods All patients newly registered on the national waiting list for lung transplantation between January and September 2018-2020 were included in the study (n=878). The numbers of new listings and transplants per million population (pmp) in 2018-2019 period and in 2020 COVID era were compared. Cumulative incidence of transplantation and waitlist mortality estimated with the competing risk analysis with transplantation and death or delisting for medical condition as the competing events were compared between the study periods. Results In 2020 compared with the 2018-2019 period, the total number of patients newly registered on the waiting list declined 34%, from 4.9 to 3.2 pmp and the number of transplants performed decreased 31%, from 3.9 to 2.6 pmp. While 3-month cumulative incidence of transplantation (Figure 1) decreased from 54% [51-58] to 46% [39-53], no difference in cumulative incidence of death or delisting for medical condition (3% [2-4] versus 4% [2-8]) (Figure 2) was observed between the periods. Conclusion In 2020 COVID era, the waitlist and transplant access significantly declined in France without change in waitlist mortality.

OBJECTIVES: The objectives of this study were to: (1) explore the proportion of HTx centers that have a multidisciplinary team and (2) assess the relationship between multidisciplinarity and the level of chronic illness management (CIM). BACKGROUND: The International Society for Heart and Lung Transplantation (ISHLT) recommends a multidisciplinary approach in heart transplant (HTx) follow-up care but little is known regarding the proportion of HTx centers that meet this recommendation and the impact on patient care. HTx centers with a multidisciplinary team may offer higher levels of CIM, a care model that has the potential to improve outcomes after HTx. METHODS: We conducted a secondary analysis of the BRIGHT study, a cross-sectional study in 11 countries. Multidisciplinarity in the 36 HTx centers was assessed through HTx director reports and was defined as having a team that was composed of physician(s), nurse(s), and another healthcare professional (either a social worker, psychiatrist, psychologist, pharmacist, dietician, physical therapist, or occupational therapist). CIM was assessed with the Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression assessed the relationship between multidisciplinarity and the level of CIM. RESULTS: Twenty-nine (80.6%) of the HTx centers had a multidisciplinary team. Furthermore, multidisciplinarity was significantly associated with higher levels of CIM (β = 5.2, P = 0.042). CONCLUSION: Majority of the HTx centers follows the ISHLT recommendation for a multidisciplinary approach. Multidisciplinarity was associated with CIM and point toward a structural factor that needs to be in place for moving toward CIM. ispartof: Heart & Lung vol:46 issue:5 pages:351-356 ispartof: location:United States status: published

We read with interest the paper by Psotka et al. ([1][1]) showing that the mean 1-year rates of heart failure clinical trial publication or reporting are low (

Background Outcomes in recipients who have undergone combined heart and kidney transplantation have mainly been addressed in small, single-center studies. We studied long-term results of combined heart and kidney transplantation in a large multicenter cohort. Methods Between 1984 and 2007, 67 consecutive patients (61 men and 6 women) from 3 French centers underwent combined heart and kidney transplantation. At transplantation, 38 (57%) were receiving dialysis. All patients received immediate triple immunosuppression therapy (anti-calcineurin, steroids, azathioprine, or mycophenolate). Results Overall actuarial survival rates were 62.0%, 60.3%, 53.3%, and 46.5% at 1, 3, 5, and 10 years, respectively. These rates were similar to those observed in 2981 isolated heart recipients at the 3 participating centers during the same period (respectively, 71.0%, 65.2%, 60.1%, and 47.2%, p = 0.6). Survival tended to improve during the last decade (1996 to 2007) and reached 71.1%, 67.5%, and 60% at 1, 3, and 5 years. Cardiac allograft rejection requiring treatment occurred in 12 (17.9%). Coronary artery vasculopathy developed in 3 (9.3%). Kidney allograft rejection occurred in 9 (13.4%). Kidney graft survival was 95.9% at 1, 3, 5, and 10 years. Conclusions Long-term survival rates in a large cohort of combined heart and kidney recipients are similar to those of isolated heart recipients in France. The rates of acute heart and kidney rejection and angiographic coronary artery vasculopathy were low in this patient population.

Coronary balloon angioplasty with stent implantation has emerged as a possible alternative to bypass grafting or repeat transplantation in left main coronary stenosis in heart transplant patients. We report 2 new cases of stent implantation for unprotected and isolated left main stenosis in heart transplant patients. Despite an initially successful procedure, restenosis prompted the performance of bypass surgery in both patients. The relative advantages and disadvantages of available techniques of revascularization are discussed in the context of the literature.

Trichilemmal carcinoma is a rare cutaneous adnexal malignant tumor deriving from the outer root sheath of hair follicles. It is only rarely reported in recipients of solid (renal) organ transplants. We describe the first case of trichilemmal carcinoma presenting with a misleading clinical aspect in a heart transplant recipient. We then briefly outline the salient clinicopathologic features of this malignancy.

s S61 Methods: 117 patients undergoing HTx at IKEM were prospectively enrolled. AKI was defined as an increase of serum creatinine level by ≥ 50% or worsening of renal function requiring renal replacement therapy (RRT) during 1st week postHTx. Serum Cystatin-C and urinary Neutrophil gelatinase-associated lipocalin (NGAL), alpha-1-microglobulin (A1M) or albumin were serially sampled. Results: 30 patients (25.6% of total) fulfilled the criteria of AKI. Preoperative renal function, demographics and comorbidities were similar between AKI and non-AKI groups. Cystatin-C displayed earliest and the most robust separation between AKI and non-AKI group, with significant difference present already 3 hours after surgery (figure left, arrow) and persisting on day 7 and 10. The increase in Cystatin-C preceded the serum creatinine elevation by 4 days. In univariate analysis, Cystatin-C> 1.6 mg/L at 3-hours after HTx predicted AKI with OR 5.1 (95%CI: 2.2-13) and in multivariate analysis (adjustment to presence of sepsis, bleeding or need of RVAD) with OR 4.4 (95% CI:1.7-12). Urinary NGAL raised significantly only on day 3 in AKI group (p= 0.003). Differences in ACR and A1M values between groups did not reach significance. Interestingly, elevated Cystatin-C (≥ 2.5mg/L at day 7) predicted also long-term mortality after HTx (figure right). Conclusion: Cystatin-C was the most useful for evaluation and prediction of AKI. Measurement of serum Cystatin-C in patients early after HTx (3h after surgery) may help to promptly identify the patients with high risk for renal complications. Elevated cystatin-C also predicts long-term outcome. (Grant NT/11269 5 and NT/ 11262-6 and Institutional support 00023001) ascending aortic diameter was also a predictor and may reflect the risks associated with an undersized allograft. The final predictor was total ischemic time emphasizing the need for improvements in allograft preservation and storage.

Background— Genes and mechanisms of action involved in human acute rejection after allogeneic heart transplantation remain to be elucidated. The use of a murine allograft model in tandem with cDNA arrays and quantitative real-time polymerase chain reaction (Q-PCR) can greatly help in identifying key genes implicated in human heart acute rejection. Methods and Results— Hearts from Balb/c mice were either not transplanted or transplanted heterotopically in the abdomen of Balb/c (isografts) and C57BL/6 (allografts) mice. Histological analysis showed acute rejection only in allografts. Total RNA was extracted from isografts (n=3), allografts (n=4), and not transplanted hearts (n=4); reverse transcribed; and labeled with P32. Each probe was hybridized to cDNA macroarrays. Eight genes were overexpressed and 7 genes were underexpressed in allografts compared with isografts. Macrophage inflammatory protein-1β (MIP-1β), an overexpressed gene, and VE-cadherin, an underexpressed gene, were validated by immunohistochemistry and Q-PCR in the murine models. Genes of interest, validated in the 3 murine groups, were then investigated in human heart tissues. Immunohistochemistry and Q-PCR performed on endomyocardial biopsies after heart transplantation showing no rejection (n=10) or grade IB (n=10) or IIIA (n=10) rejection, according to International Society of Heart and Lung Transplantation criteria, confirmed the results obtained from the murine model. Conclusions— We have demonstrated that the upregulation of MIP-1β and downregulation of VE-cadherin may strongly participate in human acute heart rejection.

● Special Urgency 1 (SU1) status was granted for 48 hours, renewable once, to critically ill patients requiring continuous infusion of intravenous inotropic drugs, with or without extracorporeal membrane oxygenator or intra-aortic balloon pump support, in whom a ventricular assist device or total artificial heart were indicated and not in place and whose recovery from transplantation was likely. ● SU2 status was granted to patients requiring long-term mechanical circulatory support with device-related thromboembolism for a period of 8 days that might be renewed several times.

MethodsRetrospective single-centre analysis of long-term posttransplant outcome, with chart collection of clinical and paraclinical data [this study assessed the long-term outcome of heart (HTx) and heart-lung transplantation (HLTx) in patients with congenital heart disease (CHD) and children with non-congenital cardiac or pulmonary disease.]ResultsFrom 1984 to 2013, 111 first-HTx, 5 HLTx and 6 re-HTx were performed (62 males), in patients aged 11.7±8.2y: 96 (79%) aged5th year in non-compliant teenagers. Overall, 33 patients died (27%), 3.5±4.6y post-Tx (1day to 16.4y, med 1.5months), due to early multivisceral failure in 6 (18%), pulmonary hypertension in 3 (9%), acute rejection in 7 (21%), graft coronary disease in 6 (18%), sepsis in 5 (15%) and miscellaneous in 6. Graft coronary disease occurred in 15 (12.4%): 4 had re-HTx, 6 died and 5 are alive. Five lymphoma occurred, 4months to 14y after HTx, cured in 4 (1 died). Patients survival was 85% at 1y, 81% at 5y, 70% at 10y and 61% at 20y post-transplant. Graft survival rates were respectively 82%, 68% and 52% at 5y, 10y and 20y post-transplant. Survival did not differ with pretransplant disease, age, gender, pretransplant mechanical support. Mortality was higher in patients with coronary disease (40%) than those free from (25%).ConclusionLong-term prognosis after HTx and HLTx is favourable. Graft coronary disease is the main cause of failure, less frequent than in the adult non-CHD heart-transplanted population.

This patient was 42 years old when he had a mandible fracture treated with an intermaxillary blockage. The patient presented with endocarditis caused by Kingella denitrificans. There was a large disinsertion of both prostheses, a paravalvular abscess, and a fistula between the aorta and the right atrium. A double valvular replacement redux associated with a closure of the communication was performed. One month later, the abscess had increased, and the 2 prostheses were disinserted again (Fig 1). The hemodynamic results were unstable, and the patient was operated on for the fourth time. This reintervention (Fig 2) was done through a superior transseptal approach. 2 The 2 prostheses and all the fibrous mitro-aortic tissue, including both trigones, were removed. This huge resection, enlarged to the roof of the left atrium and to the first 3 cm of the aortic root, allowed a complete resection of the paravalvular abscess. It left a large opening on the right and left atria, the left ventricle, and the aortic root. The 2 coronary ostia were preserved in the button, and their first 2 cm were mobilized. A cryopreserved monobloc aorto-mitral homograft was prepared with a Carpentier Physio The treatment of complex valvular endocarditis remains a surgical challenge (ie, when facing a redo operation, 1 double valvular disease, or large abscess caused by aggressive bacteria). In such a situation, we propose a technique that allows a large resection of all the septic tissue and a repair by means of a cryopreserved monobloc aorto-mitral homograft. Clinical summary. A 16-year-old boy was operated on for resection of a subvalvular aortic stenosis. Two months later, postoperative endocarditis caused by Staphylococus aureus necessitated a reoperation. A mechanical bivalvular replacement was performed, and the follow-up was uneventful.