Purpose: Hemodymamics is not included in the standard evaluation of graft function after heart transplantation (HT). We routinely perform right heart catheterization (RHC) at every endomyocardial biopsy (EMB). We sought to describe the potential longitudinal trajectories of hemodynamics through the first year after HT and analyze their relationship with subsequent cardiovascular outcomes.

Purpose: The prognostic relevance of antibody-mediated rejection (AMR) has been widely demonstrated. Nevertheless, there are conflicting data about the correct therapeutic approach: there is urgent need for an individual risk stratification tool aimed at guiding immunosuppressive therapies. The purpose of this study was to identify the predictive variables independently associated with poor prognosis after a biopsy-proven AMR episode.

Abstract Background Advanced heart failure (HF) is associated with dismal prognosis despite optimal medical therapy. Invasive assessment with right heart catheterization (RHC) is a valuable tool to assess transplant candidates and hemodynamic profiling is crucial to stratify prognosis and select patients for advanced therapies. Purpose This study aims to examine the relationship between hemodynamic profiles based on cardiac index (CI) and filling pressures and survival in ambulatory patients with advanced HF evaluated for heart replacement therapy (HRT) such as heart transplantation (HT) and left ventricular assist device (LVAD) implant. Methods We analyzed adult ambulatory advanced HF patients evaluated for HRT with an available baseline RHC from 2003 to 2022. Hemodynamic data were classified using a CI < 2.2 l/min/m2 as marker of reduced cardiac output ("cold" profile opposed to the "warm" profile) and increased filling pressure, defined as right atrial pressure ≥ 10 mmHg and/or pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg as a marker for congestion ("wet" profile opposed to the "dry" profile). Study endpoint was death or urgent HT or LVAD implant at 5 years. Results Study population included 610 patients (mean age 53±10 years, 79% males). According to hemodynamic criteria, 332 patients (55%) exhibited a "wet cold" hemodynamic profile, 117 (19%) a "cold dry", 91 (15%) a "warm wet" and 66 (11%) a "warm dry" phenotype. The "wet" patients showed a significantly higher prevalence of pulmonary hypertension (96% wet cold, 94% wet warm vs 21% dry warm, 19% dry cold; p<0,001), a lower pulmonary artery pulsatility index (4,0 wet cold, 4,1 wet warm vs 7,4 dry warm, 6,9 dry cold; p<0,001). No differences were found in etiology of HF. Both reduced CI [OR 1,6 (1-2,4), p=0.003] and increased filling pressures [OR 1,9, (1,2-2,8) p=0.007] were associated with worse outcomes. Survival differed significantly among hemodynamic profiles, with a survival rate of 48% in the "cold wet" profile compared to 68% in the "cold dry" [OR 1,9 (1,2-3,1) p=0,007] and 65% in the "warm dry" [OR 2,2 (1,1-4,2), p=0.01]. The difference between "cold wet" and "warm wet" was borderline significant (p=0.07). Further stratification between right and left ventricular filling pressures showed that isolated right ventricular congestion was rare and associated with low event rate, while in patients with preserved CI, biventricular congestion was associated with borderline worse survival as compared to isolated left ventricular increased filling pressures (p=0.06). Conclusions Hemodynamic profiles assessed with RHC stratify prognosis in ambulatory patients with advanced HF referred for HRT. Evaluation of hemodynamic phenotype may help identify subgroups of patients at high risk and guide therapeutic decisions. Further studies are needed to confirm these findings and develop personalized management strategies to improve clinical outcomes in this population.Survival-hemodynamic phenotypeSurvival-filling pressures

Purpose: The determination of epitopes mismatch (EpMM) load on HLA antigens has been recently suggested as a potential tool to stratify the risk of rejection and it seems to provide insights into alloreactivity more accurately than HLA allele mismatches. However, there are few published data in adult heart transplantation (HT). This study aims to investigate the role of EpMM through the use of the Predicted Indirectly Recognizable HLA Epitopes (PIRCHE-II) score on the risk of rejection and on long-term outcomes.

Purpose: Missing self (MS), the inability of donor endothelial cells to deliver HLA I-mediated signals to inhibitory killer cell Ig-like receptors (KIRs) on recipient natural killer (NK) cells, can lead to microvascular inflammation (MVI) in kidney transplantation, independently of donor-specific anti-HLA antibodies (DSA). The clinical significance of MS in heart transplantation is unknown. We aimed to evaluate the role of innate rejection mediated by NK cells in heart transplanted (HT) patients.

Abstract Background Patients (pts) with advanced heart failure (HF) are poorly tolerant to GDMT, frequently hospitalized and are often carriers of implantable cardioverter-defibrillators (ICD) or of cardiac resynchronization therapy (CRT-D). These devices allow HF centers to remotely monitor the occurrence of arrhythmic events and of ICD interventions, such as anti-tachycardia pacing (ATP) bursts or DC-shocks. While HF hospitalizations are an established prognostic marker, the role of remote monitoring in a context of pts referred for heart transplantation (HT) is poorly explored. Purpose In this retrospective monocentric study we aim to evaluate the prognostic value of remotely-transmitted information from ICD/CRT in pts with advanced HF followed in a tertiary Center dedicated to HF and HT. Methods We included all adult pts with a remotely transmitting device followed by both Electrophysiology and Heart Failure Teams in our Center between September 2016 and January 2023. We collected data about heart disease, medical therapy, echocardiography, device-delivered therapies, and hospital admissions for any cause. The outcome was the combined incidence of death from any cause or urgent heart transplantation. Results 123 pts were enrolled ( 57±10 yrs, 75% males, LVEF 34%±10%). 68 had an ICD, 55 CRT-D. 50 pts (41%) received at least one device-delivered therapy (34 pts had at least one ATP; 29 pts had at least one DC-shock, of whom 26 were appropriate). During a mean follow-up of 29 months, we recorded 121 hospitalizations (53% for arrhythmias, 47% for acute HF) in 44 pts. The endpoint occurred in 14 pts : 12 (9.8%) died, 2 (1.6%) underwent to urgent HT; overall, 12 pts (9.8%) were transplanted. Pts with arrhythmic events had more frequently a spontaneous QRS >120ms (60% vs. 40%, p=0.04) and a trend towards more hospitalizations for heart failure (64% vs. 35%, p=0.059). The predictor of the combined endpoint of death or urgent transplant was hospitalization for HF (RR: 4.2, p<0.01); ATP and/or DC-shocks (RR 7.3) and intolerance to vasodilators (ACE-I, ARB, ARNI), (RR (1.5) showed a borderline statistical significance (p=0.06 for both). However, in the subgroup of patients without any HF hospitalization, device-delivered therapies from ICDs and CRT-D carried an higher risk of death and urgent HT (p=0.03), see Figure . Conclusion In a population of patients with advanced HF, while confirming the known prognostic role of HF hospitalization, we found that remote monitoring of ICD shocks/ATP in patients not hospitalized for HF identifies a subgroup of patients at high risk of death or urgent HT. These results underscore the importance of considering these patients for advanced HF therapies and of an integrated approach between electrophysiologists and HF specialists.

Purpose: We assess the diagnostic performance of the Molecular Microscope Diagnostic System (MMDx) and the AlloSure donor-derived cellfree DNA Fraction (dd-cfDNA%) in diagnosing heart transplant (HT) rejection compared to the gold standard of histopathology (HP).Methods: We reviewed biopsies from HT patients at Houston Methodist Hospital who had MMDx, HP and peripheral blood sample of donorderived cell-free DNA (dd-cfDNA) drawn at the same time point as the endomyocardial biopsy (EMBx).We evaluated the additive performance of MMDx combined with elevated dd-cfDNA% in diagnosing rejection in HT patients with elevated dd-cfDNA% when compared to EMBx HP.Results: We included 113 biopsies from 54 HT patients.The median time of biopsy post-transplantation was 108.0 (IQR 29.0, 307.0) days.Median age was 57.0 (IQR 48.0, 63.0) years and 38/54 (70.4%) were males.Rejection was classified on EMBx in 16 specimens (n=13 ACR ≥ 2R, n=3 AMR ≥ 50% C4d) and on MMDx in 18 specimens (n=9 ACR, n=8 AMR, n=1 ACR+AMR).The AlloSure dd-cfDNA was ≥0.12% in n=48 (42.5%) biopsies and out of these 11 (9 ACR, 2 AMR) had HP rejection on EMBx and 13/48 had rejection on MMDx (7 AMR, 5ACR and 1 mixed rejection) The diagnostic performance of MMDx to predict rejection showed high specificity and negative predictive value (NPV) compared to sensitivity and positive predictive value (PPV).When testing the additive effect of Allo-Sure to MMDx in diagnostic performance to predict rejection compared with HP, MMDx alone showed higher specificity compared to AlloSure ≥0.12% alone.Although the addition of AlloSure to MMDx does not increases the sensitivity, it appears to increase the specificity (Table 1).Conclusion: MMDx and blood-based dd-cfDNA add diagnostic value to the histopathological diagnosis of rejection in HT recipients.

AutoAbs (>3, range = 4 -17) and HLA donor-specific antibody (DSA) was significantly associated with an augmented risk of CLAD [HR = 25.09(5.52 -114.04)], that was higher than patients with only DSA ] or only AutoAb [HR = 4.88 (2.16 -11.00)] (Figure 1, lower panel). Conclusion:The presence of AutoAbs (>3) in circulation was independently associated with a higher risk for CLAD.Furthermore, when AutoAbs and DSA were detected concomitantly, it significantly increased the risk for CLAD.These findings suggest that both allo-and auto-immunity may contribute to CLAD and should be targeted to improve lung allograft outcomes.

our single center experience of heart transplant recipients infected with COVID-19 in whom IS was maintained.Methods: Retrospective analysis from June 2020 to February 2022 of heart transplant recipients followed at our center that tested positive for COVID-19.Patient demographics, comorbidities, baseline IS, hospitalization, ICU need, O2 requirement, mechanical support requirement and mortality were recorded.Results: During the study period, 581 transplants were followed at our center, we documented 65 cases of COVID-19 (Table 1).The average age was 58 years, 75% male, 51% Caucasian.50% had DM, 69% HTN and 48% CKD.Median time since OHT was 4.6 years.71% of the patients were on dual IS.All patients remained on their baseline immunosuppression.Of the 65 patients, 37% required hospitalization, 9% ICU-level of care.Median LOS was 5.5 days.Mortality was 8%, there were no events of rejection or allograph dysfunction.Conclusion: Our data suggest that maintenance of therapeutical levels of IS in patients with COVID-19 is safe in heart transplant recipients.Our outcomes were comparable to those of the existing literature.Larger studies are needed to further validate our results.

Purpose To evaluate the impact of recipients pre-operative right ventricular dysfunction on heart transplantation (Htx) outcomes. Methods We retrospectively analyzed 517 consecutive adult patients who underwent Htx between January 2000 and December 2020, focusing on right heart catheter hemodynamic data, mostly. Results In-hospital mortality was 8%. Severe Early Graft Failure (EGF) occurred in 6.6% of patients. Right ventricular function and pulmonary circulation hemodynamic variables were weighted in terms of influence on in-hospital mortality: Central Venous Pressure (CVP) [OR 1.09 (1.03;1.15), p=0.004], Pulmonary Artery Systolic Pressure (PASP) [OR 1.02 (1.00;1.04), p=0.05], CVP/ Pulmonary Capillary Wedge Pressure (PCWP) ratio [OR 2.78 (1.14;6.80), p=0.025], Pulmonary Vascular Resistance (PVR) [OR 1.15 (1.01;1.32), p=0.042], Trans-Pulmonary Gradient (TPG) [OR 1.11 (1.03;1.18), p=0.003] and Diastolic Trans-Pulmonary Gradient (DPG) [OR 1.10 (1.02;1.20), p=0.015]. Thereafter, PASP [OR 1.03 (1.00;1.05), p=0.016] and TPG [OR 1.08 (1.01;1.17), p=0.03] did impact negatively on the occurrence of EGF. Preoperative right ventricular dysfunction did not result to influence on follow-up (FU) mortality. On the multivariable analysis, CVP and TPG resulted to be independent predictors of in-hospital mortality while TPG of EGF. By spitting patients population into 4 hemodynamic profiles in terms of pulsatile load, focusing on Pulmonary Artery Compliance (PACi), and right ventricle hemodynamic response to load, focusing on CVP:PCWP ratio, we resulted to have a high PACi/high PVC:PCWP profile with a higher risk of in-hospital mortality [OR 2.40 (1.04;5.54), p=0.05] and EGF [OR 3.40 (1.32;7.28), p=0.01]. Overall survival at 1, 5 and 10 years was 89.4%, 80.8% and 66.4%, respectively. By analyzing the four hemodynamic profiles, patients with low PACi/high PVC:PCWP showed the worst survival (Log-rank=0.045). Conclusion In our patients population, CVP and TPG resulted to be independent risk factors of in-hospital mortality while TPG of EGF. Thus, the detection of pre-operative right ventricular dysfunction in potential heart transplant recipients should be managed early and treated properly in terms of preoperative clinical optimization to improve the postoperative outcomes.

Purpose Analyze the characteristic of donors and recipients in our center and the results of heart transplantations for the two different levels of priority according to Italian previous allocation system, urgent patients and elective ones. Methods From 2006 to August 2020, 306 heart transplantations were performed at our institution. Of them 54 (17.6%) in urgency. Reasons for urgency were: 24 patients on ECMO support, 8 on IABP and 13 on intravenous inotropes, 4 arrhythmic storms and 5 complicated LVAD. Results In the urgent population, recipients were predominantly male (68.5 % vs 77.4 % in the elective p=0.17) and significantly younger (46.4 vs 52.2 years, p=0.001). More patients were on ECMO support (42.6% vs 1.7% p=0.000), IABP (42.6 vs 6.7% p=0.000) and mechanically ventilated (46.2% vs 6% p=0.000) pre transplant. The donors of urgent patients were younger than donors of the elective ones (38.9 vs 42.4 years (p=0.06). Donor's gender (68% males) and cause of brain death (brain trauma 44,4%, and cerebral hemorrhage 35,2%) were comparable in the two groups. Mean ischemic time was longer in urgent cases (211 vs 191 minutes, p=0.01) as donations came from across the whole country. Severe Early Graft Failure (EGF) requiring ECMO occurred in 9.4% of patients in the urgent population vs 3.6% in the elective with no significant difference (p=0.076), as well as in hospital mortality that was 11.5% in urgent vs 8.3% (p=0.429). Recipients' risk factors for in-hospital mortality were age [OR 1.05 (1.01;1.09), p=0.028] and Glomerular Filtration Rate (GFR) < 40 ml/min [2.68 (1.04;6.92), p=0.047]. No donors' variable resulted to be a risk factor for in-hospital mortality. Episodes and grade of rejection did not diverge between groups, and so did follow up mortality (16.7% in urgent vs 22.4% in electives p=0.444) Mean follow up time for urgent population was shorter (53.6 vs 75.6 months (p=0.007). Overall 5 and 10 years' mortality was 79.7% and 62% vs 88.1% and 72.8% for urgent and elective patients respectively (p=0.721). Conclusion This retrospective analysis of our transplantation activity with the different priority regimen shows little differences in terms of mortality and complications. Despite the worse clinical characteristics of the urgent recipients and the longer ischemic time, results do not significantly differ from the elective population, underlying the importance of donation quality.

Purpose The evaluation of graft function after heart transplantation (HT) is made by echo and endomyocardial biopsies (EMB). In our Center, we regularly perform right heart catheterization (RHC) at every EMB, until 5 years after HT. The aim of this study is to investigate the role of RHC for defining graft function. Methods We included in this study all patients (pts) undergoing to a EMB after the first month from HT for standard monitoring or for symptoms after 5 yrs from HT in our Center in 2016-17. Data were collected at every EMB. The endpoints were the interplay between RHC, LVEF and biopsy, and the impact of RHC on 2-yrs MACE occurrence. The follow up was started after the first abnormal RHC or, if no abnormal values were found, after the last RHC performed in the observation period. Results 586 EMBs were performed in 113 pts (56.6% <1yr, 38.6% 1-5 yrs, 4.8% for symptoms >5 yrs from HT). In the routine EMBs, 3A CMR and pAMR-2 were more frequent in the first year (18.4% vs 5.8%, 2.4% vs 0.4%, p<0.05); in the unscheduled EMBs, only 10.7% were 3A while 29% were p-AMR+ (25% pAMR-1+, 4% pAMR-2). LVEF did not differ according to distance from HT, routine vs unplanned EMB or CMR grading, but it was more frequently lower in pAMR+ (65% vs 7%) (p<0.01) .RHC better correlated with EMB results, being more frequently pathologic in 1B vs 3A/3B and other grades (46% vs 39% vs 32% respectively, p=0.06) and in AMR (32% vs 51% vs 93%, p-AMR 0 vs 1 vs 2, p<0.01). LVEF was less frequently normal in pts with abnormal RHC, but 82% of pts with a pathologic RHC had normal LVEF. We established three hemodynamic phenotypes: diastolic dysfunction (high filling pressures, normal cardiac index); low cardiac index; normal values. Diastolic dysfunction was more frequent according to pAMR grading (9% vs 29% vs 50%, p=0.01); low CI was more frequent in pAMR+ vs pAMR- (12% vs 8%, p=0.01); no specific hemodynamic pattern was associated with CAV. The incidence of MACE was highest in pts with a pathologic RHC and a 1B/3A/3B, lowest in those with normal RHC and EMBs positive and intermediate in those with a negative biopsy, regardless of RHC values (37.0± 11% vs 16.5±4% vs 0%). Conclusion Hemodynamics better correlates to histology than LVEF and helps in stratifying prognosis in patients with rejection; 1B and >3A CMR can both impact prognosis; assessment of diastolic dysfunction may help in suspecting latent pAMR. Our results support the use of RHC in the complex assessment of graft function. The evaluation of graft function after heart transplantation (HT) is made by echo and endomyocardial biopsies (EMB). In our Center, we regularly perform right heart catheterization (RHC) at every EMB, until 5 years after HT. The aim of this study is to investigate the role of RHC for defining graft function. We included in this study all patients (pts) undergoing to a EMB after the first month from HT for standard monitoring or for symptoms after 5 yrs from HT in our Center in 2016-17. Data were collected at every EMB. The endpoints were the interplay between RHC, LVEF and biopsy, and the impact of RHC on 2-yrs MACE occurrence. The follow up was started after the first abnormal RHC or, if no abnormal values were found, after the last RHC performed in the observation period. 586 EMBs were performed in 113 pts (56.6% <1yr, 38.6% 1-5 yrs, 4.8% for symptoms >5 yrs from HT). In the routine EMBs, 3A CMR and pAMR-2 were more frequent in the first year (18.4% vs 5.8%, 2.4% vs 0.4%, p<0.05); in the unscheduled EMBs, only 10.7% were 3A while 29% were p-AMR+ (25% pAMR-1+, 4% pAMR-2). LVEF did not differ according to distance from HT, routine vs unplanned EMB or CMR grading, but it was more frequently lower in pAMR+ (65% vs 7%) (p<0.01) .RHC better correlated with EMB results, being more frequently pathologic in 1B vs 3A/3B and other grades (46% vs 39% vs 32% respectively, p=0.06) and in AMR (32% vs 51% vs 93%, p-AMR 0 vs 1 vs 2, p<0.01). LVEF was less frequently normal in pts with abnormal RHC, but 82% of pts with a pathologic RHC had normal LVEF. We established three hemodynamic phenotypes: diastolic dysfunction (high filling pressures, normal cardiac index); low cardiac index; normal values. Diastolic dysfunction was more frequent according to pAMR grading (9% vs 29% vs 50%, p=0.01); low CI was more frequent in pAMR+ vs pAMR- (12% vs 8%, p=0.01); no specific hemodynamic pattern was associated with CAV. The incidence of MACE was highest in pts with a pathologic RHC and a 1B/3A/3B, lowest in those with normal RHC and EMBs positive and intermediate in those with a negative biopsy, regardless of RHC values (37.0± 11% vs 16.5±4% vs 0%). Hemodynamics better correlates to histology than LVEF and helps in stratifying prognosis in patients with rejection; 1B and >3A CMR can both impact prognosis; assessment of diastolic dysfunction may help in suspecting latent pAMR. Our results support the use of RHC in the complex assessment of graft function.

Introduction: After the first consensus meeting on the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) published in 2016, several modifications of the original technique have been proposed to reduce the high mortality/morbidity rates. The primary endpoint was to analyze the trend and surgical outcomes of ALPPS over a 9-year period within the series of a prospective national registry. Methods: Patients submitted to ALPPS between 2012 and 2021 were included in the ALPPS Italian Registry and divided into 2 eras: 2012-2016 and 2017-2021. Results: Over a 9-year period, ALPPS (n=249) was used less frequently to treat Klatskin tumor (10.6% vs. 6.1%, p=0.220). An increased use of portal vein embolization (9.1% vs. 30.6%, p<0.001) and partial parenchymal transection (18.9% vs. 45.9%, p<0.001) was observed. There was a significantly increased adoption of minimally invasive (MI) techniques to approach stage 1 (5.5% vs. 28.7%, p<0.001) as well as stage 2 (0% vs. 18.3%, p<0.001). Completion rate was not significantly different between the 2 groups (94.5% vs. 89.3%, p=0.135). There was a significantly reduced rate of major complications in the second era (41.1% vs. 28.7%, p<0.001) whereas incidence of post-hepatectomy liver failure (PHLF) grade B/C did not reach statistical significance (p=0.170) despite an increased use of hepatobiliary scintigraphy in the interstage (1.6% vs. 31.4%, p<0.001). Ninety-day mortality decreased (15% vs. 9%, p=0.150). Conclusions: There have been significant changes in ALPPS strategy and improvement of outcomes over time, with more frequent use of MI techniques and methods of prevention of PHLF.

Purpose Vaccines against COVID-19 have a lower efficacy in HT patients (pts); factors influencing their immunogenicity are unknown. The aim of this study is to investigate the role of immunosuppression on mRNA vaccines efficacy. Methods We included all HT pts followed in our Center completing the vaccine cycle (03-06/21), for whom levels of IgG anti-RBD after the second dose were known, excluding those with a previous COVID infection. Demography, immunosuppression (drugs and trough blood level), lymphocyte count, previous rejection episodes were collected before the first dose. The endpoint was vaccine-induced immunization after the second dose according to our laboratory's threshold of IgG anti-RBD. Results Among 201 vaccinated, IgG anti-RBD values were available for 63 pts at 2± 1 months after the second dose (22±3 days after the first; 89% BNT162b2; 60±11 yrs, 5±1 yrs from HT, 75% males, 3 with rejection > 1R in the previous 6 months). All pts were on CNI-inhibitors (35% tacrolimus, TAC, 65% cyclosporine, CyA), 57% on MMF, 23% mTOR, 69% steroids (CS). 41.7% had no response to vaccine. At univariate analysis the predictors of lack of response to vaccine were: MMF (43% vs 71%), TAC vs CSA (27% vs 73%), steroids (46% vs 76%), steroid dose > 5mg, lymphocytes <18% of leukocytes (both identified by ROC), more than 5 years from HT; mTOR was more likely associated with protection (80% vs 49%), p<0.05 all. Importantly, age was not predictive of immunogenicity. At stepwise multivariate analysis all these factors maintained statistical significance (p<0.05 all). IgG anti-RBD values were influenced by low lymphocytes, steroids and TAC trough levels (p< 0.05 all).Response to vaccine was the lowest for MMF+TAC+CS (23.1%), intermediate for MMF+CyA+CS (53.3%) and steroid-free regimens (68.7%), highest (87.5%) for mTOR+CNI+CS (20%,23%,24%,23% of pts, p=0.01). No rejection episodes were registered 3 months after the second dose of vaccine. Conclusion While confirming a low response to COVID-19 vaccines a in HT pts, our study underscores the negative effect of immunosuppression, particularly of MMF, high doses of steroids and TAC. Given that MMF is a cornerstone of most protocols, from these results it arises the hypothesis (to be tested in larger studies) if switching stable patients from TAC to Cya or to lower steroid doses may favor the attempts to increase the response to vaccines.

transplant activity for each financial year up to April 2020 and our activity between Jan -27 th May 2020 (the first UK pandemic peak) comparing this to the same period over the last five years.This allowed us to directly compare the effect of COVID with previous years activity.Results: A total of 19 heart patients died during Jan to 27 th May 2020.Out of the total deaths 4 were from paediatric group, 11 were post-transplant and 5 on the active list.There were no cardiac deaths related to COVID 19.The total deaths during the same period were 19, 24, 20 and 32 in the years 2019, 2018, 2017 and 2016 respectively.A total of 41 lung patients died during Jan to 27 th May 2020.Out of the total 11 were on the active list awaiting transplant and 19 were post-transplant deaths.Of these 2 were COVID deaths.The corresponding deaths during year 2019, 2018, 2017 and 2016 were 46, 51, 49 and 46 respectively.Transplant activity from Jan to 27 th May in 2016-19 averaged 32 (16 hearts,16 lungs); activity during the same time period in 2020 was 4 lungs and 13 hearts, clearly affected by reduced activity due to COVID19.Conclusion: This audit does not suggest a significant rise in mortality due to the COVID 19 pandemic in vulnerable patients either pre or post-transplantation. Measures such as shielding were highly effective in this population.Transplant activity for the year was affected.

PT-INR data before and after the event, and interruption period in each group were shown in the table.The level of PT-INR after the reversal of anticoagulation therapy was significantly different in the severity of bleeding.There were no thromboembolism events relating to reversal and interruption, as well as de novo bleeding after the resumption.Conclusion: This result suggested that proper evaluation and classification of hemorrhage events may contribute to the appropriate reversal or interruption of antithrombotic therapy for VAD-related hemorrhage.