Search

Introduction: Donation after circulatory death (DCD) donors are becoming an important source of organs for heart‐transplantation (HT), but there are limited data regarding their use in multiorgan‐HT. Methods: Between January 2020 and June 2023, we identified 87 adult multiorgan‐HTs performed using DCD‐donors [77 heart–kidney, 6 heart–lung, 4 heart–liver] and 1494 multiorgan‐HTs using donation after brain death (DBD) donors (1141 heart–kidney, 165 heart–lung, 188 heart–liver) in UNOS. For heart–kidney transplantations (the most common multiorgan‐HT combination from DCD‐donors), we also compared donor/recipient characteristics, and early outcomes, including 6‐month mortality using Kaplan–Meier (KM) and Cox hazards‐ratio (Cox‐HR). Results: Use of DCD‐donors for multiorgan‐HTs in the United States increased from 1% in January to June 2020 to 12% in January–June 2023 (p < 0.001); but there was a wide variation across UNOS regions and center volumes. Compared to recipients of DBD heart–kidney transplantations, recipients of DCD heart–kidney transplantations were less likely to be of UNOS Status 1/2 at transplant (35.06% vs. 69.59%) and had lower inotrope use (22.08% vs. 43.30%), lower IABP use (2.60% vs. 26.29%), but higher durable CF‐LVAD use (19.48% vs. 12.97%), all p < 0.01. Compared to DBD‐donors, DCD‐donors used for heart–kidney transplantations were younger [28(22–34) vs. 32(25–39) years, p = 0.004]. Recipients of heart–kidney transplantations from DCD‐donors and DBD‐donors had similar 6‐month survival using both KM analysis, and unadjusted and adjusted Cox‐HR models, including in propensity matched cohorts. Rates of PGF and in‐hospital outcomes were also similar. Conclusions: Use of DCD‐donors for multiorgan‐HTs has increased rapidly in the United States and early outcomes of DCD heart–kidney transplantations are promising. [ABSTRACT FROM AUTHOR]

Aims: Patients with left ventricular assist device (LVAD) suffer from persistent exercise limitation despite improvement of their heart failure syndrome. Exercise training (ET) programmes to improve aerobic capacity have shown modest efficacy. High‐intensity interval training (HIIT), as an alternative to moderate continuous training, has not been systematically tested in this population. We examine the feasibility of a short, personalized HIIT programme in patients with LVAD and describe its effects on aerobic capacity and left ventricular remodelling. Methods and results: Patients on durable LVAD support were prospectively enrolled in a 15‐session, 5 week HIIT programme. Turndown echocardiogram, Kansas City Cardiomyopathy Questionnaire, and cardiopulmonary exercise test were performed before and after HIIT. Training workloads for each subject were based on pretraining peak cardiopulmonary exercise test work rate (W). Percentage of prescribed training workload completed and adverse events were recorded for each subject. Fifteen subjects were enrolled [10 men, age = 51 (29–71) years, HeartMate II = 12, HeartMate 3 = 3, and time on LVAD = 18 (3–64) months]. Twelve completed post‐training testing. HIIT was well tolerated, and 90% (inter‐quartile range: 78, 99%) of the prescribed workload (W) was completed with no major adverse events. Improvements were seen in aV̇O2 at ventilatory threshold [7.1 (6.5, 9.1) to 8.5 (7.7, 9.3) mL/kg/min, P = 0.04], work rate at ventilatory threshold [44 (14, 54) to 55 (21, 66) W, P = 0.05], and left ventricular end‐diastolic volume [168 (144, 216) to 159 (124, 212) mL, n = 7, P = 0.02]. HIIT had no effect on maximal oxygen consumption (V̇O2peak) or Kansas City Cardiomyopathy Questionnaire score. Conclusions: Cardiopulmonary exercise test‐guided HIIT is feasible and can improve submaximal aerobic capacity in stable patients with chronic LVAD support. Further studies are needed on its effects on the myocardium and its potential role in cardiac rehabilitation programmes. [ABSTRACT FROM AUTHOR]

Despite a record setting number of heart transplants performed annually, the national donor shortage continues to plague transplant teams across the United States. Here we describe the barriers to adaptation of numerous "non-traditional" orthotopic heart transplant donor characteristics including donors with hepatitis C virus, those meeting criteria for donation after cardiac death, donors with coronavirus disease 19 infection, donors with the human immunodeficiency virus, and grafts with left ventricular systolic dysfunction. Our center's objective was to increase our transplant volume by expanding our donor pool from "traditional" donors to these "non-traditional" donors. We detail how medical advances such as certain laboratory studies, pharmacologic interventions, and organ care systems have allowed our center to expand the donor pool thereby increasing transplantation volume without adverse effects on outcomes., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)