Purpose As the number of heart-liver transplants increases, an understanding of the benefits and risks becomes increasingly important for appropriate multiorgan allocation. The model for end-stage liver disease and serum sodium level (MELD-Na) score is used as a predictor of survival in patient with liver disease. It is used to prioritize liver transplant recipients on the waitlist. We expected that patients with higher MELD-Na scores who underwent heart-liver transplant would have a higher postoperative survival than those patients with high MELD-Na scores who underwent heart transplant alone. The goal of our study was to determine if MELD-Na is a useful metric for allocating heart-liver transplants. Methods We retrospectively analyzed both heart-liver transplant recipients enrolled in the United Network for Organ Sharing database and all heart transplant recipients from the Stanford University with complete data for the covariates used in our model. Recipient MELD-Na scores were calculated for transplant recipients in both groups. The risk of death was assessed using a multivariable Cox proportional hazard model with adjustment for age of donor, age of recipient, recipient diabetes, and recipient intra-aortic balloon pump at time of transplant. We investigated whether MELD-Na predicted survival in heart-liver recipients. Results A total of 326 patients enrolled in UNOS underwent heart-liver transplantation and a total of 278 patients underwent heart transplantation at Stanford. The interaction effect of the type of transplant received (heart-liver vs heart alone) and MELD-Na was not significant for survival at 30 days (p = 0.812), 1 year (p = 0.859), 3 years (p = 0.621), and 5 years (p = 0.448). Furthermore, in the heart-liver cohort, MELD-Na did not significantly predict survival at 30 day (p = 0.461), 1 year (p = 0.153), 3 years (p = 0.169), and 5 years (0.169). Conclusion We found that patients with higher MELD-Na scores who underwent heart-liver transplantation did not have a higher postoperative survival when compared to those patients with high MELD-Na who underwent heart transplant alone. Therefore, MELD-Na is not a useful metric for allocating heart-liver transplants.

8-4.7] 15.0 [11.2-18.8] 13.7 [10.9-16.5] 5.5 [3.6-7.4] < 0.001HLA mismatch level at 2 alleles -no.(%)

Purpose While median survival for adult lung transplants recipients is approximately 6 years, there is a subset of patients that experiences much greater longevity. We sought to elucidate the characteristics of very long-term survivors and determine the factors associated with this outcome. Methods Utilizing the United Network for Organ Sharing Standard Transplant Analysis and Research files, we retrospectively identified adult recipients of lung transplants between 1987 and 2004. We defined the very long-term survival (VLT) cohort by those who lived ≥15 years post transplant. The remaining patients served as the control group. Baseline recipient and donor characteristics as well as outcomes were compared using chi-squared analyses for categorical data and t-tests for continuous variables. A multivariate logistic regression model was implemented to determine the influence of these factors on the odds of VLT survival. Results Between 1987 and 2004, 11,669 patients met inclusion criteria, and 1,296 (11%) survived ≥ 15 years. VLT survivors were younger (43±12 vs 49±12 years; p Conclusion Approximately 11% of lung transplant recipients from 1987 to 2004 have lived to become VLT survivors. Factors associated with the odds of VLT survival were related to younger age, race congruence between donor and recipient, and receipt of a double lung transplant. Information gleaned from VLT survivors can inform best practices for allograft selection with the aim of prolonging survival for the lung transplant population at large.

DCD donation alone should not be an indication for EVLP. DCD and EVLP-DCD lungs were nearly identical in terms of donor lung characteristics including PaO2/FiO2 ratio. DCD donor lungs, which provide equivalent survival to conventional LTx, should undergo EVLP selectively.

Adults who received first-time heart transplants from donors with blood infections from 2010 to 2018 experienced survival equivalent to controls. Although clinical judgement remains paramount, our findings discourage disqualification of an allograft due to blood infection alone.