Background:Our study aims to describe the French heart-lung graft allocation system, to compare it with allocation systems used in other countries, and to explore potential solutions to improve access to this rare transplantation procedure. Methods:Our study integrates published literature and multidisciplinary expert opinions to examine heart-lung graft allocation in France. Results:The heart-lung transplantation (HLTx) programme was initiated in France in 1987. The number of procedures then increased steadily until the 2010s. Improved knowledge on right ventricular function recovery after double lung transplantation (LTx) for pulmonary hypertension combined with the organ shortage then led to a sharp drop in the number of HLTx recipients worldwide. In France, the number of HLTx procedures is only about ten per year and the main indication is Eisenmenger syndrome. Most HLTx candidates in France receive grafts only if they are in the high-urgency category highlighting the difficulty of access to heart-lung transplants. A re-appraisal of graft allocation rules thus seems mandatory to allow graft access to patients who do not meet high-urgency criteria and whose better general health predicts better post-HLTx outcomes. Conclusions:As HLTx candidates in France are placed on the heart-transplant list in competition with heart-only transplant candidate, one option would be to reconsider the heart score assigned to HLTx candidates upon listing.

Invasive mold infections (IMIs) are rare but severe complications after heart transplantation. This multicenter case-control study aimed to update risk factors and outcomes in this population. Conducted across 14 French centers (2008-2022), it included 120 cases of probable or proven IMIs (European Organisation for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium 2020 criteria) matched to 120 controls, corresponding to the next transplant patient in the same center. Conditional logistic regression identified risk factors for infection, and Cox regression assessed mortality predictors within 90 days. The mean 1 year posttransplant incidence of IMIs was 3.1% (94/3073). The median delay between transplantation and IMI onset was 121 days (Q1-Q3: 43-285) and the 3 month mortality among infected patients was 25% (30/120). In multivariable analysis, age >60 years (adjusted odds ratio [aOR] 2.44, 95% confidence interval [CI]: 1.38-4.32), prolonged intensive care unit stay >15 days (aOR 2.66, 95% CI: 1.24-5.71), and surgical revision (aOR 2.88, 95% CI: 1.04-8.00) were independently associated with IMIs. Among infected patients, hemodialysis (4.57, 95% CI: 2.47-8.45, P < .001) and disseminated infection (adjusted hazard ratio 2.43, 95% CI: 1.25-4.71, P = .009) predicted 90-day mortality. These factors could help identify heart transplant recipients at a higher risk of fungal infections and guide future prophylaxis studies.

Heart-lung transplantation (HLTx) is a life-saving intervention for patients with advanced cardiopulmonary disease. Its use has declined significantly in recent decades, and the pulmonary indications for HLTx remain unclear. This study aimed to explore current expert opinions and areas of agreement and disagreement on pulmonary indications for HLTx using a 2-round modified Delphi survey sent to 94 experts at 6 French HLTx centers, including pulmonologists, cardiologists, thoracic surgeons, cardiac surgeons, and anesthesiologists-intensivists. Items relevant to 9 key domains were selected by a working group based on literature reviews. Both surveys had 57 items. Consensus regarding each domain was evaluated by determining the intraclass correlation coefficient (ICC), with an ICC >0.8 indicating strong consensus. In round 1, 40/94 experts responded. The items were scored from 1 to 9: 11 scored >7, 7 scored <3, and 39 had intermediate scores and were reformulated for the second round. The wide interquartile ranges indicated significant variability in responses, and for no domain was the ICC above 0.8. In round 2, which was offered to all experts, the response rate dropped to 25, precluding further statistical analysis. Key areas of disagreement included HLTx indications in severe PAH, right ventricular dysfunction, and congenital heart disease. These findings highlight the absence of a shared consensus and reflect the intrinsic complexity, rarity of the procedure, and variability in institutional expertise. Rather than establishing prescriptive criteria, this expert review underscores the need for individualized, multidisciplinary, and center-specific decision-making, while acknowledging ethical considerations related to donor scarcity. Future efforts should focus on multicenter data collection and predictive models integrating clinical variables and expert judgment to better identify patients who may benefit from HLTx.

Solid organ transplantation (SOT) faces significant challenges in managing allograft rejection, with current immunosuppressive therapies often associated with substantial adverse effects. Extracorporeal photopheresis (ECP) has emerged as a promising adjunctive treatment for rejection prevention and management in heart and lung transplants, with growing evidence supporting its use in kidney and liver transplants. Despite this, the availability of ECP and its place in standard treatment pathway is widely variable across Europe. This narrative review, supported by a European survey of 51 transplant clinicians, highlights the current usage of ECP in SOT. Findings reveal that ECP is primarily used for recurrent rejection in heart and lung transplants, with limited application currently in kidney and liver transplants. ECP has shown some efficacy in managing acute and chronic rejection, and stabilizing graft function. Barriers including lack of standardized protocols, availability of ECP, lack of high-quality clinical trial data and lack of a defined mechanism of action hinder its broader adoption. Future directions include the development of standardized protocols, multicenter registries, and further controlled clinical trials to define the role of ECP. Increased awareness, cost-effectiveness studies, mechanistic studies and equitable access are essential to integrate ECP into routine SOT management.

The annual meeting of the French GTI (Transplantation and Infection Group) focused on donor-derived infections (DDIs) in solid organ transplant (SOT) recipients. Given the ongoing organ shortage, rigorous donor screening is essential to detect potential infectious risks. Donor evaluation should include medical history, travel, vaccination status, serologies, and exposures. Various pathogens are of concern, including viruses (HIV, hepatitis, BK polyomavirus), multidrug-resistant bacteria, fungi, and emerging arboviruses like West Nile virus and dengue. HIV-positive donor to HIV-positive recipient (D+/R+) transplantations are increasingly accepted, with promising outcomes. Hepatitis E (HEV) is now the most common viral hepatitis and may lead to chronic infection in SOT recipients, requiring ribavirin treatment. Non-Candida fungal infections, though rare, are associated with high mortality and demand early recognition. Climate change and globalization are expanding the range of vector-borne infections, necessitating seasonal and regional screening. BK polyomavirus remains a major complication in kidney transplant recipients, and monitoring viral load is critical. Bacterial infections from donors are uncommon but should be evaluated based on site, organism, resistance profile, and treatment history. Overall, maintaining safety in transplantation requires constant vigilance, updated knowledge, and personalized risk-benefit analysis to adapt to emerging infectious threats—especially amid ongoing organ scarcity.

While studies have shown an association between microRNAs and cardiac rejection, the clinical relevance of a preidentified miRNA signature as a noninvasive biomarker has never been assessed in prospective multicentric unselected cohorts. To address this unmet need, we designed a prospective study (NCT02672683) including recipients from 11 centers between August 2016 to March 2018. The objective was to validate the association between 3 previously identified circulating microRNA (10a, 92a, 155) and the histopathological diagnosis of rejection. Both relative and absolute (sensitivity analysis) quantifications of microRNAs were performed. Overall, 461 patients were included (831 biopsies, 79 rejections). A per-protocol interim analysis (258 biopsies, 49 rejections) did not find any association between microRNA and rejection (microRNA 10a: odds ratio (OR) = 1.05, 95% confidence intervals (CI) = 0.87-1.27, p = 0.61; 92a: OR = 0.98, 95%CI = 0.87-1.10, p = 0.68; 155: OR = 0.91, 95%CI = 0.76-1.10, p = 0.33). These results were confirmed in the sensitivity analysis. The analysis of the remaining sera was stopped for futility. This study shows no clinical utility of circulating microRNAs 10a, 92a, and 155 monitoring in heart allograft recipients.

Abstract Aims The prognostic value of ‘high dose’ loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). Methods and results All ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into ‘low dose’, ‘intermediate dose’, and ‘high dose’ loop diuretics corresponding to furosemide equivalent doses of ≤40, 40–250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N‐terminal pro‐B‐type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for ‘low dose’, ‘intermediate dose’, and ‘high dose’ patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the ‘high dose’ group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002] and a six‐fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P < 0.001) when compared with the ‘low dose’ group. ‘Intermediate doses’ were not significantly associated with these two outcomes in adjusted models (P > 0.05). Conclusions A ‘high dose’ of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre‐HT patients.

MEETING REPORT Transpl Int, 09 November 2023 https://doi.org/10.3389/ti.2023.11859

Background Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports. Methods We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate. Results Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 11), with a total of 110 patients. A median of 3 (IQR 2–8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 2). The median age at CASH was 57.7 (47.8–63.1) years, with a median time from transplant to CASH of 4.4 (1–9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% (n = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8–14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively. Conclusion Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure.

Purpose Extracorporeal photopheresis (ECP) is recommended by different apheresis and transplant societies based on study results from 1998 and 2006 as an adjunctive therapy in prevention and treatment of acute cellular rejection (ACR) after heart transplantation (HTx). At present, however, it is also used to treat antibody mediated rejection (AMR) with and without (+/-) donor specific antibodies (DSA). The aim of this study was to describe the real-world use of ECP across European heart transplant centres and assess its impact on clinical outcomes in the modern era of heart transplantation. Methods Seven transplant centres located in five European countries participated in this retrospective, explorative, single-arm chart review study of over 90 patients. All included patients received ECP after heart transplant in 2015 or later with a follow-up period of up to two years after the last ECP treatment. Data have been extracted from the medical charts covering patient characteristics, reasons for ECP treatment, ECP treatment schedule and duration, concomitant treatments, clinical outcomes (e.g. graft dysfunctions, rejections, survival, immune system, kidney function) as well as treatment related complications and safety. Endpoints The findings of the full study analysis from the largest known multi-centre study on ECP after HTx, will be presented for ECP treatment overall, and for the three sub-groups ACR, AMR (+/- DSA), and prevention of rejection. Endpoints that will be reported will include graft and overall survival, incidence of rejections, infections and complications, changes in rejection grading, improvements in graft function, and ECP related safety data.

AbstractAimsThe value of Forrester's perfusion/congestion profiles assessed by invasive catheter evaluation in non‐inotrope advanced heart failure patients listed for heart transplant (HT) is unclear. We aimed to assess the value of haemodynamic evaluation according to Forrester's profiles to predict events on the HT waitlist.Methods and resultsAll non‐inotrope patients (n = 837, 79% ambulatory at listing) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 with right heart catheterization (RHC) were included. The primary outcome was a combined criteria of waitlist death, delisting for aggravation, urgent HT or left ventricular assist device implantation. Secondary outcome was waitlist death. The ‘warm‐dry’, ‘cold‐dry’, ‘warm‐wet’, and ‘cold‐wet’ profiles represented 27%, 18%, 27%, and 28% of patients, respectively. At 12 months, the respective rates of primary outcome were 15%, 17%, 25%, and 29% (P = 0.008). Taking the ‘warm‐dry’ category as reference, a significant increase in the risk of primary outcome was observed only in the ‘wet’ categories, irrespectively of ‘warm/cold’ status: hazard ratios, 1.50; 1.06–2.13; P = 0.024 in ‘warm‐wet’ and 1.77; 1. 25–2.49; P = 0.001 in ‘cold‐wet’.ConclusionsHaemodynamic assessment of advanced HF patients using perfusion/congestion profiles predicts the risk of the combine endpoint of waitlist death, delisting for aggravation, urgent heart transplantation, or left ventricular assist device implantation. ‘Wet’ patients had the worst prognosis, independently of perfusion status, thus placing special emphasis on the cardinal prominence of persistent congestion in advanced HF.

Diabetes and impaired glucose tolerance occurring after organ transplantation have been recognized for many years. International consensus guidelines for all types of organs have been published in this journal in 2003.1 Nevertheless, the incidence and burden of this complication in heart transplanted (HT) patients remain approximative, partly due to the limited size of the cohorts described in the literature and heterogenous definitions. A recent large review concluded that posttransplant diabetes mellitus does not affect survival based on a few retrospective studies with small cohorts.2 In a retrospective study based on the Registry of the International Society for Heart and Lung Transplantation data over a cohort of 26 263 HT patients, Vest et al3 show a 21% incidence of new-onset diabetes (NODAT) over the first 5 y following HT associated with a severe negative impact on mortality, retransplantation, and renal dysfunction. Most of the cases occurred during the first year posttransplant. No significant improvement in the incidence has been found between the 2 eras studied (1999–2005 versus 2004–2012). Based on these results, the incidence of NODAT equals the incidence of ≥2R cellular acute rejection, demonstrating the importance of this complication after HT.4 To face this crucial issue, several ways should be explored as actions on modifiable risk factors: Pretransplant and posttransplant rehabilitation and education programs should be proposed to tackle obesity and attenuate posttransplant cardiometabolic risk. Posttransplant screening should be included in our follow-up protocols to obtain early diagnosis of NODAT. In the era of sodium-glucose linked transporter2 inhibitors and glucagon-like peptides 1 receptor antagonist, aggressive protocols using novel antidiabetic drugs should be evaluated. Individualized immunosuppressive protocol targeting diabetes should be proposed. Immunosuppression remains the major modifiable risk factor for the incidence of NODAT. The pathogenesis of immunosuppressive agents and NODAT is not fully elucidated.5 Glucocorticoids are associated with the greatest risk of developing NODAT and their diabetogenic effects are dose dependent. Based on International Society for Heart and Lung Transplantation registry data, >80% HT adult patients are treated with steroids at 1 y. A recent review on steroid-free and steroid withdrawal protocols after HT demonstrated the feasibility of steroids withdrawal with a success rate of 50%–80% with no adverse impact on survival and concluded that the use of steroids for >1 y seems unlikely to provide clinical benefit.6 In the tacrolimus in combination,tacrolimus alone compared trial, steroids were weaned in both groups at 8 wk with <3% incidence of grade 2 or 3 acute cellular rejection.7 Calcineurin inhibitors have also shown diabetogenic effects with probable deleterious consequences on beta-pancreatic cells and insulin metabolism.5 Tacrolimus seems to be more diabetogenic than cyclosporine. A randomized study demonstrated an improvement and even a reversal of diabetes after conversion from tacrolimus to cyclosporine in kidney transplanted patients.8 Several studies have shown that immunosuppressive protocol adaptations aiming to reduce calcineurin inhibitors were reasonable treatment options depending on time from transplant, but the benefit on NODAT has not been clearly evaluated.9 An international consensus meeting on diabetes after kidney transplantation held in Vienna in 2013 recommended to choose and use immunosuppression regimens shown to have the best outcome for patient and graft survival irrespective of posttransplant diabetes mellitus risk.10 Since the article of Vest et al, we urgently need to reevaluate this controversial point for our HT patients.

Introduction: The mitochondrial function of circulating peripheral blood mononuclear cells (PBMCs) is an interesting new approach to cardiac diseases. Thus, PBMC’s mitochondrial respiration decreases in relation to heart failure severity. However, no data are available on heart-transplanted patients (Htx). Population and Methods: We determined PBMCs mitochondrial respiration by high-resolution respirometry (Oroboros Instruments) and superoxide anion production using electron paramagnetic resonance (Bruker-Biospin) in 20 healthy subjects and 20 matched Htx and investigated clinical, biological, echocardiographic, coronarography and biopsy characteristics. Results: PBMCs mitochondrial respiratory chain complex II respiration was decreased in Htx (4.69 ± 0.84 vs. 7.69 ± 1.00 pmol/s/million cell in controls and Htx patients, respectively; p = 0.007) and complex IV respiration was increased (24.58 ± 2.57 vs. 15.68 ± 1.67 pmol/s/million cell; p = 0.0035). Superoxide anion production was also increased in Htx (1.47 ± 0.10 vs. 1.15 ± 0.10 µmol/min; p = 0.041). The leucocyte-to-lymphocyte ratio was increased in Htx, whom complex II correlated with leucocyte number (r = 0.51, p = 0.02) and with the left ventricular posterior wall peak early diastolic myocardial velocity (r = −0.62, p = 0.005). Complex IV was increased in the two patients with acute rejection and correlated negatively with Htx’s isovolumetric relation time (r = −0.45, p = 0.045). Discussion: Although presenting with normal systolic function, Htx demonstrated abnormal PBMC’s mitochondrial respiration. Unlike immunosuppressive therapies, subclinical diastolic dysfunction might be involved in these changes. Additionally, lymphopenia might reduce complex II, and acute rejection enhances complex IV respirations. Conclusion: PBMC’s mitochondrial respiration appears modified in Htx, potentially linked to cellular shift, mild diastolic dysfunction and/or acute rejection.

Abstract Introduction Heart transplantation is a life-saving surgical procedure for patients with end-stage cardiac dysfunction, however, such procedures are usually at risk of rejection due to acute inflammatory activation. While such inflammatory induction leaves the newly transplanted heart at risk of functional and structural remodeling subsequent to oxidative damage, current anti-inflammatory treatment options expose the patient to an elevated risk for adverse reactions in addition to absence of cardio-protective effects. Therefore, novel therapies with anti-inflammatory and cardio-protective dual effects are needed. Recently, our group has reported that low-grade inflammation is associated with upregulation of SGLT1/2 in arteries of human with cardiovascular diseases. Yet, the role and function of SGLT2 in human cardiac tissue remains poorly understood. Aim This study focuses on the expression pattern of SGLT1/2 in cardiac biopsies of heart transplanted patients and aim to identifying their functional impact. Methods Routine endomyocardial Biopsies (23) were performed for the detection of acute rejection heart transplanted patients (less than 2 years) at our University Hospital. Gene expression levels were assessed using RT-qPCR, the in situ tissue localization of proteins by immunofluorescence staining, and the level of oxidative stress by dihydroethidium staining. Results Gene expression analysis revealed strong inflammatory reaction in 5 samples indicated by at least 20-fold higher levels of mRNA of IL1B, IL6, TNFA and CD68 compared to the other 18 samples and concomitant with high expression levels of SLC5A1, SLC5A2, AT1R, CYBA, NCF1, ICAM1, VCAM1, MMP2, MMP9 and TGFB1 in contrast to low levels of NOS3. In addition, increased levels of oxidative stress were observed in the same biopsies, which were diminished by the antioxidant N-acetylcysteine (NAC), NADPH oxidase inhibitor (VAS-2870), TNF-α receptor neutralizing antibody (infliximab), ACE inhibitor (perindoprilat), AT1R antagonist (losartan), dual SGLT1/2 inhibitor (sotagliflozin) and selective SGLT2 inhibitor (empagliflozin) with inhibitory effects reaching up to 80%. Immunofluorescence staining indicated signals for nitro-tyrosine, TNF-alpha, SGLT1 and 2 in several samples. Conclusion These findings indicate that both isoforms SGLT1 and SGLT2 are expressed in the transplanted human heart and suggest a pattern of expression associated with pro-inflammatory response. They further indicate a potential protective effect of SGLT2 inhibitors in transplanted hearts through mitigating oxidative stress and hence providing a possible novel therapy for heart transplantation recipients to preserve the heart function. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim Pharma GmbH & Co. KG

BACKGROUND:The first wave of the Covid-19 pandemic resulted in a drastic reduction in kidney transplantation and a profound change in transplant care in France. It is critical for kidney transplant centers to understand the behaviors, concerns and wishes of transplant recipients and waiting list candidates.METHODS:French kidney patients were contacted to answer an online electronic survey at the end of the lockdown.RESULTS:At the end of the first wave of the pandemic in France (11 May 2020), 2112 kidney transplant recipients and 487 candidates answered the survey. More candidates than recipients left their home during the lockdown, mainly for health care (80.1% vs. 69.4%; P<0.001). More candidates than recipients reported being exposed to Covid-19 patients (2.7% vs. 1.2%; P=0.006). Many recipients and even more candidates felt inadequately informed by their transplant center during the pandemic (19.6% vs. 54%; P<0.001). Among candidates, 71.1% preferred to undergo transplant as soon as possible, 19.5% preferred to wait until Covid-19 had left their community, and 9.4% were not sure what to do.CONCLUSIONS:During the Covid-19 pandemic in France, the majority of candidates wished to receive a transplant as soon as possible without waiting until Covid-19 had left their community. Communication between kidney transplant centers and patients must be improved to better understand and serve patients' needs.

BACKGROUND: Aim of this study was to describe the real-world use of extracorporeal photopheresis (ECP) and assess its impact on clinical outcomes in the modern era of heart transplantation. METHODS: Seven transplant centers from 5 European countries participated in this retrospective, observational, single-arm chart review study. All patients received ECP after heart transplantation in 2015 or later. Data were extracted from medical records between November 2020 and December 2021. RESULTS: Overall, 105 patients were enrolled and followed for an average of 2 years after initiation of ECP. Reasons to start ECP were acute cellular rejection (35.2%), rejection prevention (32.4%), mixed rejection (18.1%), and antibody-mediated rejection (14.3%). Rejection ISHLT grades improved from start to end of ECP treatment in 92% of patients treated with ECP for rejection. Of patients who started ECP to prevent rejection, 88% remained free from any rejection despite a reduction of calcineurin inhibitors. Overall survival was 95%, and no deaths were related to ECP. Safety events occurred in 18 patients, of which 13 experienced complications with venous access. CONCLUSIONS: This study, the largest European ECP study in heart transplantation, demonstrates that ECP can effectively be used to treat different rejection types and to prevent rejection in the modern era of immunosuppression. Patients with rejections who have received ECP have shown high response as measured by histological improvements in ISHLT classification. A high percentage of patients in the prevention group remained free from rejection despite reduction in immunosuppression, in particular calcineurin inhibitors. J Heart Lung Transplant 2023;42:1131-1139 & COPY; 2023 The Author(s). Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

PurposeHeart transplant recipients with SARS-CoV-2 infection are at high risk of poor outcomes. Given the high waitlist mortality in heart transplant candidates, the Agence de la biomedecine after discussion with the French scientific societies decided to pursue the transplant program where transplant's capacity was ensured. This study aimed to assess the impact of COVID-19 on heart recipient mortality in France.MethodsAll heart recipients with SARS-CoV-2 infection reported in the French national registry CRISTAL between February 1st and September 30th 2020 were included in the study (n=86). 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.ResultsOf the 86 patients included (median age (IQR) 59 years (46-67), 69% male gender, median time from transplantation 6.9 years (3.0-15.2)) 77% required hospitalization including 39% in ICU. Twenty patients died (CFR: 23%). No difference in 3-month survival was observed between 2020 and 2019 recipient cohorts (98.8% [98.5%-99.1%] versus 99.0% [98.7%-99.2%], respectively) (Figure 2).ConclusionWhile COVID-19 was associated with high fatality rate in heart transplant recipients, we could not identify an excess mortality in 2020 heart recipient cohort. These findings suggest that continuing heart transplant activity during the COVID-19 pandemic was a reasonable option. Heart transplant recipients with SARS-CoV-2 infection are at high risk of poor outcomes. Given the high waitlist mortality in heart transplant candidates, the Agence de la biomedecine after discussion with the French scientific societies decided to pursue the transplant program where transplant's capacity was ensured. This study aimed to assess the impact of COVID-19 on heart recipient mortality in France. All heart recipients with SARS-CoV-2 infection reported in the French national registry CRISTAL between February 1st and September 30th 2020 were included in the study (n=86). 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. Of the 86 patients included (median age (IQR) 59 years (46-67), 69% male gender, median time from transplantation 6.9 years (3.0-15.2)) 77% required hospitalization including 39% in ICU. Twenty patients died (CFR: 23%). No difference in 3-month survival was observed between 2020 and 2019 recipient cohorts (98.8% [98.5%-99.1%] versus 99.0% [98.7%-99.2%], respectively) (Figure 2). While COVID-19 was associated with high fatality rate in heart transplant recipients, we could not identify an excess mortality in 2020 heart recipient cohort. These findings suggest that continuing heart transplant activity during the COVID-19 pandemic was a reasonable option.

Objectives: To describe the coinfections in invasive aspergillosis (IA), to identify factors associated with coinfections, and to evaluate the impact of coinfection on mortality. Patients and methods: We conducted a monocentric retrospective study of consecutive putative, probable, or proven IA that occurred between 1997 and 2017. All coinfections, with an onset within 7 days before or after the first sign of aspergillosis, were identified. Factors associated with coinfections and mortality were analysed by multivariable analysis. Results: Among the 690 patients with IA included in the study, the median age was 57 years (range 7 days to 90 years). A coinfection was diagnosed in 272/690 patients (39.4%, 95%CI 35.8-43.2). The location of this coinfection was pulmonary only in 131/272 patients (48%), bloodstream only in 66/272 patients (24%) and other/multiple sites in 75/272 patients (28%). Coinfections were bacterial (110/272 patients, 40%), viral (58/272, 21%), fungal (57/272, 21%), parasitic (5/272, 2%) or due to multiple types of pathogens (42/272, 15%). Factors associated with a coinfection in adjusted analysis were: allogeneic haematopoietic stem-cell transplantation (OR 2.3 (1.2-4.4)), other haematological malignancies (OR 2.1 (1.2-3.8)), other underlying diseases (OR 4.3 (1.4-13.6)), lymphopenia (OR 1.7 (1.1-2.5)),C-reactive protein >180 mg/L (OR 1.9 (1.2-3.0)), fever (OR 2.4 (1.5-4.1)), tracheal intubation (OR 2.6 (1.5-4.7)), isolation of two or more different Aspergillus species (OR 2.7 (1.1-6.3)), and the presence of non-nodular lesions on chest computed tomography (OR 2.2 (1.3-3.7) and OR 2.2 (1.2-4.0)). Coinfections were independently associated with a higher mortality at week 12 (adjusted HR 1.5 (1.1-1.9), p < 0.01). Conclusions: Coinfections are frequent in IA patients and are associated with higher mortality. Francois Danion, Clin Microbiol Infect 2021;27:1644 (c) 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.