Purpose: In a recent meta-analysis, perioperative gabapentinoid use was associated with greater risk of adverse events in surgical patients. However, it remains unclear how perioperative gabapentinoid use affects lung transplant outcomes.

Purpose: Efforts to expand the lung transplant (LT) donor pool have included geographic expansion of the area from which donors have been drawn. We evaluated the use of organs from donors outside the continental United States (US).

Purpose: Ex vivo lung perfusion (EVLP) aims to prolong organ viability, possibly allowing for increased organ transport distances. This study aimed to investigate the impact of organ transport distance on outcomes of lung transplant (LT) in EVLP vs. non-EVLP recipients.

Purpose: Donation of organs from non-mainland geographies can help expand the donor pool but may pose logistical challenges. The aim of this study was to evaluate outcomes of heart transplant from non-mainland donors.

Purpose: Heart transplantation (HT) is often a multidimensional experience for patients, with a recognized need to study its impact on all aspects of patients' lives. This study aimed to better understand the lived experience of recipients before, during, and after HT.

BACKGROUND:Nonintubated extracorporeal membrane oxygenation (ECMO) has been increasingly utilized for patients with severe respiratory failure. Since data on its use as a bridge to lung transplant remain limited, we evaluated its use in a national cohort. METHODS:Adult lung-only transplant recipients bridged with ECMO May 4, 2005 to March 8, 2023 in the United Network for Organ Sharing database were categorized by use of ECMO and mechanical ventilation (MV) at transplant (ECMO+MV vs ECMO-only). We compared post-transplant intubation and ECMO at 72 hours, length of stay, and survival. RESULTS:The 1,599 transplants identified included 902 (56.4%) bridged with ECMO+MV and 697 (43.6%) bridged with ECMO-only. ECMO-only recipients had higher median age (52 vs 49 years, p < 0.001), shorter ischemic times (5.7 vs 6.0 hours, p = 0.003), and similar lung allocation scores (89.5 vs 89.6, p = 0.11). ECMO-only recipients had lower likelihood of intubation at 72 hours (56.5% vs 77.5%; adjusted odds ratio 0.33 [95% confidence interval (CI): 0.25, 0.42], p < 0.001) and shorter lengths of stay (28 vs 35 days; coefficient -0.19 [95% CI: -0.27, -0.11], p < 0.001). ECMO-only recipients had higher 90-day survival (92.1% vs 89.1%; adjusted hazards ratio (aHR) 0.69 [95% CI: 0.48, 0.99], p = 0.04) but similar 1-year (83.1% vs 81.5%; aHR 0.87 [95% CI: 0.67, 1.12], p = 0.27) and 5-year (54.6% vs 54.7%; aHR 0.98 [95% CI: 0.82, 1.17], p = 0.83) survival. CONCLUSIONS:Nonintubated ECMO bridge to lung transplant was associated with improved perioperative outcomes and short-term survival and should be considered for candidates requiring ECMO.

Purpose: The new rescue kidney policy was implemented in June 2023. To estimate its potential impact, we investigated heart transplant (HT) recipients who would have been eligible for a kidney-after-heart transplant under this policy.

Purpose: Recipient center volume has been previously associated with improved heart transplant outcomes, but the effect of donor center volume has not yet been described. The aim of this study was to evaluate the role of donor center volume in outcomes of heart transplant.

Purpose Severe heart valve disease is a rare indication for heart transplant. We evaluated outcomes after heart transplant for valve disease vs. other indications at the national level. Methods Adult patients undergoing first-time heart-only transplant 2005-2021 were identified using the UNOS/OPTN database. We compared post-transplant outcomes of patients receiving heart transplants for valve disease vs. other diagnoses. Survival was compared using Kaplan-Meier curves and log-rank test, as well as by multivariable Cox regression adjusted for baseline recipient and donor characteristics with p<0.2 on univariate analysis. Results Of 38,663 patients identified, 618 (1.6%) received transplants for valve disease. Donor characteristics, including age, gender, and smoking history were similar by diagnosis. Recipients with valve disease were more likely to be female (32.7% vs. 25.4%, p<0.001) and have lower BMI [25.5 (22.5-28.7) vs. 27.1 (23.8-30.8) kg/m2, p<0.001]. Recipients with valve disease were more likely to be on ECMO (2.9% vs. 1.8%, p=0.04) and inotropes (49.4% vs. 38.1%, p<0.001) pre-transplant. Recipients with valve disease much more often had prior cardiac surgery (87.5% vs. 47.8%, p<0.001) and prior valve surgery (20.1% vs. 1.7%, p<0.001). Airway dehiscence (0.6% vs. 0.3%, p=0.02) and dialysis (14.2% vs. 12.0%, p=0.03) were the complications differing. Recipients with valve disease had superior post-transplant survival (Figure 1, log-rank p=0.02) and after adjustment had a 20% lower mortality risk than recipients with other diagnoses [aHR 0.80 (95% CI 0.69-0.93); p=0.004]. Conclusion Recipients with valve disease had superior post-transplant survival compared to recipients with other indications for heart transplant, suggesting heart transplant may serve as a viable last line treatment for severe valve disease.

Background: Lung transplants (LTx) are being offered to increasingly older patients, and as a result, more concomitant coronary artery disease is being encountered in LTx candidates. While concurrent coronary artery bypass grafting (CABG) and LTx have become more common, the long-term considerations of reoperative CABG in patients following CABG with concomitant LTx are not fully understood. Case presentation: A 75-year-old man with a history of bilateral LTx and concomitant CABG X 2 15 years prior presented to the emergency room with tachycardia and chest discomfort radiating to the left upper extremity. Emergent coronary angiography revealed severe three- vessel coronary artery disease with two occluded saphenous vein grafts, severe distal obtuse marginal (OM) and left circumflex disease, a collateralized chronic total occlusion of the mid LAD, and tortuosity of the proximal right innominate artery. The patient underwent a complex redo sternotomy and CABG X 2 due to dense adhesions in the mediastinum and pleura bilaterally. The postoperative course was complicated by left leg SVG harvest site cellulitis treated with IV antibiotics and hypervolemia treated with diuresis. The patient was discharged postoperatively on day 13. Discussion: To our knowledge, this is the first reported successful reoperative CABG in a patient with a history of concomitant LTx and CABG. This case demonstrates feasibility, though additional caution is required due to the technical complexity and risk of immunosuppression in such complex patients.