Background. The use of extracorporeal membrane oxygenation (ECMO) after transplantation seems to be associated with an increased risk for infectious complications. We assessed the impact of ECMO use on the incidence of infectious diseases in a nationwide cohort of heart transplant recipients. Methods. Patients undergoing heart transplantation between 2008 and 2017 and enrolled in the Swiss Transplant Cohort Study were included. We calculated incidence rates of infection at 1-y posttransplant and used Cox regression to identify infection-associated risk factors according to the pathogen group. Results. We included 306 heart transplant recipients of whom 42 patients (13.7%) received ECMO in the posttransplant period. Incidence rates at 1 y for overall infection were 259 per 100 patient-years in the ECMO group (176 for bacterial, 52 for viral and 36 for fungal infections) and 126 per 100 patient-years in the non-ECMO group (68 for bacterial, 45 for viral and 14 for fungal infections). In the ECMO group, gram-negative bacterial infections predominated over gram-positive pathogens. Use of ECMO was associated with an increased risk of overall infections (hazard ratio 1.81 [95% CI. 1.02-3.19], P = 0.04) and fungal infections (hazard ratio 3.44 [95% CI, 1.33-8.89], P = 0.01). Conclusions. In this nationwide cohort of heart transplant recipients, the use of ECMO was associated with an increased risk for overall and fungal infections. More studies are needed to evaluate whether ECMO is independently associated with infection or a surrogate for a more critical patient condition.

Objective We aimed to evaluate the early and midterm mortality of young patients treated for cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after adult cardiac surgery. Methods Studies reporting the outcome after postcardiotomy VA-ECMO in adult patients were identified through a systematic review of the literature. Individual patient-level data were provided by the authors of 10 studies. Results Data on 1268 patients treated at 25 hospitals were included in this study. Adjusted analysis identified 40 years of age as a cutoff value for in-hospital and mid-term mortality. Patients aged >40 years had significantly greater in-hospital mortality (1129 patients, crude rates 68.8% vs 43.1%, adjusted odds ratio, 3.267; 95% confidence interval, 1.970-5.425) and mortality at 24-month (109 patients, crude rates 73.7% vs 45.0%, adjusted hazard ratio, 3.530, 95% confidence interval, 2.571-4.844). Twelve (11.0%) patients aged ≤40 years received a ventricular assist device and heart transplantation, whereas this strategy was adopted in 33 (2.9%) patients aged >40 years (P < .001). Eventually, 7 (6.4%) patients aged ≤40 years and 12 (1.1%) patients aged >40 years underwent heart transplantation (P < .001). Heart transplantation tended to decrease in-hospital mortality in patients aged ≤40 years (14.3% vs 45.1%, P = .138), whereas this difference reached statistical significance in patients aged >40 years (25.0% vs 69.3%, P = .002). Conclusions The present findings suggest that early and midterm mortality after postcardiotomy VA-ECMO is significantly lower in patients aged ≤40 years compared to older patients. However, mortality remains substantial also among these young patients and heart-replacement therapies are infrequently performed in this subset of patients likely because of severe perioperative complications.

OBJECTIVES:To investigate the optimal duration of venoarterial extracorporeal membrane oxygenation (ECMO) for cardiogenic shock refractory to medical therapies after cardiac surgery and whether its prolonged use is justified. DATA SOURCES:Previously published articles on postcardiotomy venoarterial ECMO. STUDY SELECTION:Articles reporting on the early outcome after postcardiotomy venoarterial ECMO in adult patients were identified through a systematic review of the literature. DATA EXTRACTION:Data on prespecified patients' characteristics, operative variables, and outcomes were provided by the authors of previous studies on this topic. DATA SYNTHESIS:Individual data of 1267 patients treated at 25 hospitals from ten studies were included in this meta-analysis. In-hospital mortality rates were lowest among patients treated 3-6 days with venoarterial ECMO. Multilevel mixed-effects logistic regression considering the cluster effect of the participating hospitals adjusted for individual patient's risk profile and operative variables showed that the risk in-hospital mortality did not significantly increase in patients treated more than 6 days up to 20 days. CONCLUSIONS:The present study demonstrated that prolonged venoarterial ECMO support after adult cardiac surgery may be justified. However, the analysis was limited by the knowledge of only those circumstances known at the start of ECMO.

Purpose: The Transmedics Organ Care System (OCS) allows both the expansion of a transplant program to long-distance brain death donation (DBD) and the use of hearts from donation after circulatory death (DCD). However, the implementation of such a system is complex, and in the context of a modest-sized transplant program such as Switzerland's, (on average, 39 transplants per year), the expected benefit was unknown.

A significant proportion of patients with heart failure (HF) progress to an advanced stage, which is associated with a substantial increase in morbidity and mortality. These patients may be eligible for advanced treatment strategies such as mechanical circulatory support with ventricular assist devices (VAD). Vascular dysfunction is a hallmark of heart failure pathophysiology and prognosis. However, whether and to what degree the hemodynamic benefits of VADs influence vascular function remain unknown. In this study, we evaluated endothelial vascular function with flow-mediated vasodilatation (FMD) and with flicker-light induced retinal vasodilatation (FID). 34 patients with a VAD (age 58 ± 10 years, 85

Purpose:Postoperative delirium (POD) after transcatheter aortic valve implantation (TAVI) is frequent in older adults and associated with multiple negative outcomes including a higher mortality. We aimed to investigate whether a comprehensive geriatric assessment (CGA) prior to TAVI reduces the odds of POD and results in a positive change in self-care ability, intended to lay a foundation for future geriatric comanagement.Patients and methods:We used a retrospective, single-center study with a quasi-experimental design enrolling patients aged 70 years and older undergoing CGA before elective TAVI, and a nonrandomized comparison group without preoperative CGA. Data on POD occurrence during the first 5 days after TAVI (primary outcome) and change in self-care ability index (SPI) between admission and discharge (secondary outcome) were collected from electronic health records and CGA data (exposure) by clinical assessment. To explore associations between (1) CGA and POD, and (2) CGA and SPI, multivariate logistic regression and linear regression models were applied adjusting for age, sex, BMI, and number of medications.Results:Among 435 patients (mean age 81.0 ± 5.6 years, 43.6% women, median [IQR] SPI at baseline 40 [39, 40] points), POD incidence was 14.3% in the CGA group vs 18.8% in the non-CGA group (P 0.219). Undergoing CGA before TAVI was not associated with the odds for POD (OR: 1.15; 95%CI: 0.65-2.04) or improved SPI (P 0.073).Conclusion:We observed no association of CGA prior to TAVI with POD incidence or postoperative self-care, highlighting the need for additional studies investigating the effect of POD preventive measures in older TAVI patients integrated into a comprehensive geriatric comanagement program.

Background: Extracorporeal life support (ECLS) is pivotal for sustaining the function of failing hearts and lungs, and its utilization has risen. In cases where conventional cannulation strategies prove ineffective for providing adequate ECLS support, the implementation of an enhanced system with a third cannula may become necessary. Hybrid ECLS may be warranted in situations characterized by severe hypoxemia of the upper extremity, left ventricular congestion, and dilatation. Additionally, it may also be considered for patients requiring respiratory support or experiencing hemodynamic instability. Method: All hybrid ECLS cases of adults at the University Hospital Zurich, Switzerland, between January 2007 and December 2019 with initial triple cannulation were included. Data were collected via a retrospective review of patient records and direct export of the clinical information system. Results: 28 out of 903 ECLS cases were initially hybrid cannulated (3.1%). The median age was 57 (48.2 to 60.8) years, and the sex was equally distributed. The in-hospital mortality of hybrid ECLS was high (67.9%). In-hospital mortality rates differ depending on the indication (ARDS: 36.4%, refractory cardiogenic shock: 88.9%, cardiopulmonary resuscitation: 100%, post-cardiotomy: 100%, others: 75%). Survivors exhibited a lower SAPS II level compared with non-survivors (20.0 (12.0 to 65.0) vs. 55.0 (45.0 to 73.0)), and the allogenic transfusion of platelet concentrate was observed to be less frequent for survivors (0.0 (0.0) vs. 1.8 (2.5) units). Conclusion: The in-hospital mortality rate for hybrid ECLS was high. Different indications showed varying mortality rates, with survivors having lower SAPS II scores and requiring fewer platelet concentrate transfusions. These findings highlight the complexities of hybrid ECLS outcomes in different clinical scenarios and underline the importance of rigorous patient selection.

The global lack of donor shortage poses a major limitation for heart transplantation. New concepts with expanded donor inclusion criteria comprise extended transport distances and prolonged ischemic times with the aim of reaching a larger number of potential donors. Recent developments in cold storage solutions may allow more donor hearts with prolonged ischemic times to be use for transplantation in the future. We present our experience during a long-distance donor heart procurement with the longest reported transport distance and transport time in the current literature. This was made possible through the use of SherpaPak™, an innovative cold storage system which allows for controlled temperatures during transportation.

Zusammenfassung: Ältere und hochbetagte Patient_innen haben ein erhöhtes Risiko für Komplikationen und nachteilige Behandlungsverläufe bei Operationen, Interventionen und onkologischen Therapien. Gleichzeitig sollte diese Gruppe nicht anhand des chronologischen Alters von potenziell nutzenbringenden medizinischen Verfahren per se ausgeschlossen werden. Geriatrische Syndrome und erhöhte Vulnerabilität durch eine altersmedizinische Abklärung rechtzeitig zu identifizieren wird zunehmend wichtiger und wird in den Richtlinien der Fachgesellschaften mehrerer Spezialdisziplinen bereits heute empfohlen. Nach einer geriatrischen Abklärung sollte jedoch idealerweise ein proaktives Co-Management im Sinn einer integrierten Versorgung erfolgen. Die Etablierung von interdisziplinären Behandlungspfaden für ältere Spitalpatient_innen kann dazu beitragen, Behandlungsergebnisse signifikant zu verbessern. Dieser Ansatz kann neben verbesserten patientenbezogenen Ergebnissen und ansteigenden Qualitätsindikatoren auch positive gesundheitsökonomische Effekte bieten.

BACKGROUND:Despite increasing use and understanding of the process, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy is still associated with considerable mortality. Personalized and quick survival predictions using machine learning methods can assist in clinical decision making before ECMO insertion. METHODS:This is a multicenter study to develop and validate an easy-to-use prognostic model to predict in-hospital mortality of VA-ECMO therapy, using unbiased recursive partitioning with conditional inference trees. We compared two sets with different numbers of variables (small and comprehensive), all of which were available just before ECMO initiation. The area under the curve (AUC), the cross-validated Brier score, and the error rate were applied to assess model performance. Data were collected retrospectively between 2007 and 2019. RESULTS:837 patients were eligible for this study; 679 patients in the derivation cohort (median (IQR) age 60 (49 to 69) years; 187 (28%) female patients) and a total of 158 patients in two external validation cohorts (median (IQR) age 57 (49 to 65) and 70 (63 to 76) years). For the small data set, the model showed a cross-validated error rate of 35.79% and an AUC of 0.70 (95% confidence interval from 0.66 to 0.74). In the comprehensive data set, the error rate was the same with a value of 35.35%, with an AUC of 0.71 (95% confidence interval from 0.67 to 0.75). The mean Brier scores of the two models were 0.210 (small data set) and 0.211 (comprehensive data set). External validation showed an error rate of 43% and AUC of 0.60 (95% confidence interval from 0.52 to 0.69) using the small tree and an error rate of 35% with an AUC of 0.63 (95% confidence interval from 0.54 to 0.72) using the comprehensive tree. There were large differences between the two validation sets. CONCLUSIONS:Conditional inference trees are able to augment prognostic clinical decision making for patients undergoing ECMO treatment. They may provide a degree of accuracy in mortality prediction and prognostic stratification using readily available variables.

Homograft heart valves may have significant advantages and are preferred for the repair of congenital valve malformations, especially in young women of childbearing age, athletes and in patients with active endocarditis. A growing problem, however, is the mismatch between tissue donation and the increasing demand. The aim of this paper is to describe the initiation process of a homograft procurement program to attenuate the shortage of organs. A comprehensive description of the infrastructure and procedural steps required to initiate a cardiac and vascular tissue donation program combined with a prospective follow-up of all homografts explanted at our institution. Between January 2020 and May 2022, 28 hearts and 12 pulmonary bifurcations were harvested at our institution and delivered to the European homograft bank. Twenty-seven valves (19 pulmonary valves, 8 aortic valves) were processed and allocated for implantation. The reasons for discarding a graft were either contamination (n = 14), or morphology (n = 13) or leaflet damage (n = 2). Five homografts (3 PV, 2 AV) have been cryopreserved and stored while awaiting allocation. One pulmonary homograft with a leaflet cut was retrieved by bicuspidization technique and awaits allocation, as a highly requested small diameter graft. The implementation of a tissue donation program in cooperation with a homograft bank can be achieved with reasonable additional efforts at a transplant center with an in-house cardiac surgery department. Challenging situations with a potential risk of tissue injury during procurement include re-operation, harvesting by a non-specialist surgeon and prior central cannulation for mechanical circulatory support.

Benefit of a Geriatric Evaluation before Operations, Interventions and Oncological Therapies Abstract: Older patients face an increased risk of complications and adverse outcomes during and after operations, interventions, and intense oncological therapies. At the same time, this patient group should not be excluded per se from potentially beneficial medical procedures based on chronological age alone. The timely identification of geriatric syndromes and increased vulnerability by means of comprehensive geriatric assessment is becoming increasingly important and is already recommended in the guidelines of professional societies of several medical disciplines. Nonetheless, the geriatric assessment should ideally be followed by proactive co-management in the sense of integrated care. The establishment of interdisciplinary and integrated care pathways for older hospital patients can contribute to significantly improved treatment outcomes. In addition to better patient-related outcomes and rising quality indicators, this approach may also offer positive health economic effects.

Background: The use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) has rapidly increased in recent years. Today, applications of V-V ECMO include a variety of clinical conditions such as acute respiratory distress syndrome (ARDS), bridge to lung transplantation and primary graft dysfunction after lung transplantation. The purpose of the present study was to investigate in-hospital mortality of adult patients undergoing V-V ECMO therapy and to determine independent predictors associated with mortality.Methods: This retrospective study was conducted at the University Hospital Zurich, a designated ECMO center in Switzerland. Data was analyzed of all adult V-V ECMO cases from 2007 to 2019.Results: In total, 221 patients required V-V ECMO support (median age 50 years, 38.9% female). In-hospital mortality was 37.6% and did not statistically vary significantly between indications (P=0.61): 25.0% (1/4) for primary graft dysfunction after lung transplantation, 29.4% (5/17) for bridge to lung transplantation, 36.2% (50/138) for ARDS and 43.5% (27/62) for other pulmonary disease indications. Cubic spline interpolation showed no effect of time on mortality over the study period of 13 years. Multiple logistic regression modelling identified significant predictor variables associated with mortality: age [odds ratio (OR), 1.05; 95% confidence interval (CI): 1.02-1.07; P=0.001], newly detected liver failure (OR, 4.83; 95% CI: 1.27-20.3; P=0.02), red blood cell transfusion (OR, 1.91; 95% CI: 1.39-2.74; P<0.001) and platelet concentrate transfusion (OR, 1.93; 95% CI: 1.28-3.15; P=0.004).Conclusions: In-hospital mortality of patients receiving V-V ECMO therapy remains relatively high. Patients' outcomes have not improved significantly in the observed period. We identified age, newly detected liver failure, red blood cell transfusion and platelet concentrate transfusion as independent predictors associated with in-hospital mortality. Incorporating such mortality predictors into decision making with regards to V-V ECMO use may increase its effectiveness and safety and may translate into better outcomes.

Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO. Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching. Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients’ risk profile. Conclusions: In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.

Objectives Left ventricular assist devices (LVADs) have been established as alternative to heart transplantation for patients with end-stage heart failure refractory to medical therapy. Right heart failure (RHF) after LVAD implantation is associated with inferior outcome. Its preoperative anticipation may influence the selection between a pure left ventricular and a biventricular device type and, thus, improve outcomes. Reliable algorithms to predict RHF are missing. Methods A numerical model was used for simulation of a cardiovascular circulation. The LVAD was placed as parallel circuit between left ventricle and aorta. In contrast to other studies, the dynamic hydraulic behavior of a pulsatile LVAD was replaced by that of a continuous LVAD. A variety of hemodynamic states was tested mimicking different right heart conditions. Adjustable parameters included heart rate (HR), pulmonary vascular resistance (PVR), tricuspid regurgitation (TR), right ventricular contractility (RVC) and pump speed. Outcome parameters comprised central venous pressure (CVP), mean pulmonary artery pressure (mPAP), cardiac output (CO) and occurrence of suction. Results Alteration of HR, PVR, TR, RVC and pump speed resulted in diverse effects on CO, CVP and mPAP, resulting in improvement, impairment or no change of the circulation, depending on the degree of alteration. Conclusions The numerical simulation model allows prediction of circulatory changes and LVAD behaviour following variation of hemodynamic parameters. Such a prediction may be of particular advantage to anticipate RHF after LVAD implantation. It may help preoperatively to choose the appropriate strategy of only left ventricular or both left and right ventricular support.

BACKGROUND:Extracorporeal life support (ECLS) is a salvage treatment for acute circulatory failure. Our high-volume tertiary centre performs more than 100 implants annually and provides ECLS-transports. With this study, we aimed to analyze the incidence and risk factors of limb ischemia depending on the vascular access.METHODS:Between January 1, 2007, and December 31, 2018, 937 patients received an ECLS. Preoperative, intraoperative, in-hospital and up to 5 years follow-up data were collected. Outcome measures were limb ischemia and survival.RESULTS:In total, 402 femoro-femoral veno-arterial ECLS patients were identified. Mean age was 56 ± 16.7 years, 26.9% were female, 7.9% had a history of peripheral vascular disease. Cannulation was performed percutaneously in 82.1% (n = 330), surgically in 5.7% (n = 23) and combined in 12.2% (n = 49). Mortality was not significantly different between the groups (51.1% percutaneous, 43.5% surgical, 44.9% combined [p = 0.89]). There was no significant difference in limb ischemia either, but a trend toward an increased frequency in the percutaneous group (p = 0.0501). No amputation was necessary. Limb ischemia slightly increased in-hospital mortality (54.6%) but did not affect long-term survival beyond 30 days. Univariate analysis adjusted for cannulation methods revealed younger age and female gender as risk factors of limb ischemia and younger age for limb ischemia after percutaneous cannulation.CONCLUSIONS:Our study shows that percutaneous, surgical, and combined vascular access techniques for ECLS implantation are associated with comparable and low incidence of limb ischemia which slightly increases in-hospital mortality. Special precaution has to be taken in young and female patients.

Background: Extracorporeal life support (ECLS) therapy is increasingly used for cardiac and respiratory support postcardiotomy, in refractory cardiogenic shock and in cardiopulmonary resuscitation. This study aims to describe in-hospital mortality of patients requiring ECLS, to identify independent predictors associated with mortality and to analyze changes of mortality over time. Methods: This retrospective study includes all adult ECLS cases at the University Hospital Zurich, a designated ECLS center in Switzerland, in the period 2007 to 2019. Results: ECLS therapy was required in 679 patients (median age 60 years, 27.5% female). In-hospital mortality was 55.5%. Cubic spline interpolation did not detect evidence for a change in mortality over the whole period of 13 years. In-hospital mortality significantly varied between ECLS indications: 70.7% (152/215) for postcardiotomy, 67.9% (108/159) for cardiopulmonary resuscitation, 47.0% (110/234) for refractory cardiogenic shock, and 9.9% (7/71) for lung transplantation and expansive thoracic surgery (P<0.001). Logistic regression modelling showed excellent discrimination in the receiver operating characteristic (ROC) area under the curve (AUC) of 0.89 [95% confidence interval (CI): 0.87-0.92] and identified significant mortality predictors: age, simplified acute physiology score (SAPS) II, as well as new liver failure and each allogenic blood transfusion unit given per day. ECLS after cardiopulmonary resuscitation was associated with significantly higher mortality compared to ECLS for refractory cardiogenic shock. Conclusions: In-hospital mortality of patients treated with ECLS therapy is high. Outcomes have not changed significantly in the observed period. We identified age, SAPS II, and each allogenic blood transfusion unit given per day as independent mortality predictors. Knowledge of predictors strongly associated with in-hospital mortality may affect future decisions about ECLS indications and the respective management to use this elaborate therapy more effectively.

Background: It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. Results: The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08–1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04–1.76, I2 21%). Conclusions: Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO.

Background Transplant-related surgical site infections (SSI) pose a relevant threat for heart (HTx) and lung transplant recipients (LuTx). Considering the paucity of data, we analyzed HTx and LuTx within the Swiss Transplant Cohort Study (STCS). Methods The STCS dataset was used to identify adult HTx and LuTx with a follow-up of at least 90 days post-transplant between 2008 and 2020. Risk factors for SSIs were investigated with logistic regression. Cox proportional hazard models, one model starting from transplantation with 365 days follow-up and one model starting 90 days post-transplant with unrestricted follow-up, were applied to address the impact of SSIs on patient and graft survival. Results Of 356 HTx 31 (8.7%) and of 450 LuTx 21 (4.7%) individuals experienced SSIs. In both HTx and LuTx, the majority of SSIs were caused by bacteria, most frequently coagulase-negative staphylococci and Enterococcus spp.. In HTx, diabetes mellitus (multivariable OR 2.4, 95%CI 1.02-5.8, P=0.04) and maintenance immunosuppression without calcineurin or mTOR inhibitor in the first week post-transplant (multivariable OR 3.9, 95%CI 1.3-11.4, P=0.01) were independent risk factors for SSIs. In multivariable Cox proportional hazard models, SSIs were associated with reduced patient and graft survival in LuTx (365-day model: HR 5.0, 95%CI 1.9-13.0; P=0.009; 90-day baseline model: HR 2.2, 95%CI 1.2-4.1, P=0.02), whilst we did not detect an association in HTx. Conclusions Gram-positive bacteria predominated in SSIs after both HTx and LuTx. LuTx with SSI had impaired failure-free survival as compared to those without SSI.