Purpose of review Genetic testing is increasingly common in the live organ donation context and raises numerous ethical questions. Recent findings Existing guidelines and expert recommendations regarding genetic testing in live organ donation are limited, and leave many ethical questions unanswered. Summary Decisions regarding use of genetic testing in live organ donation should be examined in light of existing ethical frameworks that guide live organ donation for all organ types.
Purpose of review This review is timely and relevant because the population of adults with congenital heart disease (ACHD) in the United States continues to grow, and as more individuals survive into adulthood, heart failure has become the leading cause of morbidity and mortality in this population. There is a growing need to understand the economic impact of healthcare utilization and financial burden for patients with ACHD and end-stage heart failure. Recent findings Recent literature highlights that adults with complex congenital heart disease face disproportionately high financial burden with lifetime direct and indirect costs reaching up to $3.35 million per patient. These costs include frequent hospitalizations, surgeries, diagnostic testing, and ongoing medical care, as well as lost income for patients and families. The cost burden increases further towards the end of life, and ACHD patients with heart failure experience longer hospital stays, and higher healthcare costs compared to non-ACHD populations. Early referrals can mitigate some of the increasing cost by implementing multidisciplinary care strategies and timely interventions to potentially improve the trajectory of ACHD patients with heart failure. Summary The findings underscore the need for early referral to specialized, high-volume ACHD and heart transplant centers and the development of multidisciplinary care pathways to improve outcomes and reduce costs for ACHD patients with advanced heart failure.
Purpose of review Inherited cardiomyopathies are increasingly recognized among patients with advanced heart failure, yet genetic testing remains substantially underutilized. This review examines the evolving clinical utility of genetic testing across advanced heart failure and transplantation and highlights opportunities to integrate genetics into routine advanced heart failure care. Recent findings Pathogenic or likely pathogenic cardiomyopathy variants are identified in approximately one-third of heart transplant recipients and in up to 44% of explanted hearts from patients with idiopathic cardiomyopathy. Recent studies have linked genotype to heart failure progression, ventricular arrhythmias, and outcomes after advanced therapies, including a higher risk of right ventricular failure following left ventricular assist device implantation. Genetic diagnoses can also uncover multisystem disease relevant to transplant evaluation and posttransplant management. At the same time, the emergence of gene replacement, gene editing, and RNA-based therapies is creating new therapeutic implications for establishing a molecular diagnosis before end-stage disease. Summary Genetic testing is becoming an increasingly actionable component of advanced heart failure care. Integrating genetics into advanced heart failure programs may improve recognition of inherited disease, individualize management, and better position patients and their families for emerging precision therapies.
Purpose of review Early allograft dysfunction (EAD) is one of the most challenging complications following liver transplantation. With the shortage of deceased donor organs, living donor liver transplants are increasing, especially in the Asia Pacific region. With continuously evolving practices and literature, an overview of prevailing EAD definitions (including subtle differences between deceased and living donor-related EAD), donor-specific and recipient-specific risk factors, predictive scoring models, status of biomarkers, and current management practices, has become imperative. Recent findings Post living donor liver transplantation (LDLT), EAD is a distinct clinicopathological entity from post deceased donor liver transplantation (DDLT) and is primarily characterized by functional graft insufficiency rather than ischaemia–reperfusion injury (IRI)-mediated necroinflammation of DDLT. A novel preoperative risk score (e-GLR) demonstrates excellent discriminative ability for predicting early graft loss secondary to graft dysfunction in LDLT. In a mixed DDLT–LDLT cohort, acute liver failure (ALF), donor age, and warm ischaemic time (WIT) are the principal determinants of EAD. Summary There is also need for individualized risk stratification in EAD, including donor quality, graft volume, recipient disease severity, and intraoperative parameters. The increasing use of marginal grafts owing to organ scarcity has led to increase in its incidence. Preoperative scoring tools such as early graft loss score (e-GLR) can help guide donor–recipient matching and counsel families before live-donor hepatectomy.
