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Older heart donors (D) are associated to decreased survival after heart transplant (HT) both in older and younger recipients (R). However, the effect of age mismatched D-R pair on late-term survival is still a matter of debate. The aim of this study is to analyze late outcomes after HT in age mismatched D-R pairs compared to equal age matched pairs. We retrospectively analyzed all patients who underwent HT at our center between November 1985-September 2022. Long-term survival was compared among 4 subgroups matched according to their D-R age (D<50years-R>50years, Group 1; D>50years-R>50years, Group 2; D<50years-R<50years, Group 3; D>50years-R<50years, Group 4). Of 1058 patients enrolled during the study period, Group 1,2,3 and 4 included 417 (male D/R 65%/83%, median age D/R 35/58 years), 245 (male D/R 47%/82%, mean age D/R 58/62 years), 356 (male D/R 66%/80%, mean age D/R 22/38 years) and 40 (male D/R 38%/62%, mean age D/R 56/42 years) patients, respectively. 30-day mortality was not different among the 4 groups (p=0.487). At 37-year follow-up, Group 4 showed similar overall survival compared to Group 3 (p=0.324); Group 1 showed better survival compared to Group 2 (p=0.018). Regardless of recipient age, older donors were associated to similar late outcomes (Group 2 vs 4, p=0.676), whereas younger donors showed better late outcomes in younger recipients (Group 3 vs 1, p<0.001) (Figure 1). Severe cardiac allograft vasculopathy did not differ among the 4 groups (p=0.270) at the same follow-up time. Our experience suggests that D-R age mismatch does not affect early survival. At long-term follow-up, regardless of donor age, young recipients show similar long-term survival, whereas older recipients show better survival when receiving young donors. This study highlights the concept that additional unknown biological aging-related D-R factors might influence donor graft durability. [ABSTRACT FROM AUTHOR]

DCD heart procurement is an emerging strategy to expand cardiac donor pool, but the effect of prolonged warm ischemia times on heart transplant (HT) late outcomes is not clearly known. Uncontrolled cardiac arrest of the cardiac graft before DBD might be a useful model to assess post-transplant outcomes after prolonged warm ischemia. Aim of this study is to evaluate the impact of cardiac arrest before DBD on late clinical outcomes in HT recipients. We retrospectively analyzed and compared early and late outcomes of all subjects ≥18 years of age who underwent HT at our Center between November 1985-September 2022 and with cardiac arrest before DBD (Group 1) or without (Group 2). Of 990 enrolled HT within the study period, 104 (10.5%) (male 65, X age 36±2 years) were included in Group 1 (mean time of cardiac arrest 15.0±14.0 minutes, range 0.5-90.0 minutes, cardiac arrest >20 minutes in 19 cases). Group 1 was associated to donor age <50 years (p=0.023), h/o tobacco (p=0.006), alcohol (p=0.007) or substance abuse (p<0.001), suicide or multiple trauma-related death (p<0.001). It was not associated to EF <55% (p=0.367), coronary disease (p=0.922), valve disease (p=0.327) or a specific recipient gender or age. Cardiac arrest <20 and >20 minutes were not associated to increased 30-day mortality compared to Group 2 (8.7% vs 8.5%, p=0.613, and 5.3% vs 8.5%, p=0.816, respectively). At 37-year follow-up, we did not find any significant difference in terms of overall survival (p=0.259) or severe CAV (p=0.54) between the two groups (Figure 1). Cardiac arrest of the donor heart does not affect early and late mortality neither the risk of severe CAV. According to these data, cardiocirculatory arrest of the donor graft might not be a contraindication to its use for HT also at longer warm ischemia times before donation, confirming DCD HT as a potential source of donor hearts, with similar results to DBD also in the long-term. [ABSTRACT FROM AUTHOR]

The purpose of this study is to assess the prevalence and determinants of workplace violence and the sociodemographic risk factors associated. This was a multicenter cross-sectional study. The study was performed using self-compiled Italian version of the World Health Organization's questionnaire on workplace violence online by filling in a Google form. The survey was opened from May 2018 to March 2020 and lasted 5–10 min. The sample consists of 3659 healthcare workers, of which 2525 (69%) are females, 1446 (39.5%) are nurses, and 2029 (55.5%) are health workers from northern Italy. The most frequent age group of the sample is 50–54 years (16.7%). A total of 366 (10%) healthcare workers are victims of physical aggression at work in the last 12 months, of which 6.3% with a weapon. The risk of being a victim of physical aggression at work in the last 12 months is significantly associated with the following independent variables: male gender (odds ratio [OR] 1.72, 95% confidence interval [CI]: 1.36–2.17), work in southern Italy (OR 1.59, 95% CI: 1.10–2.28), and being a nurse (OR 2.56, 95% CI: 2.01–3.25). The risk of being a victim of physical aggression at work with a weapon in the last 12 months is significantly associated with work in southern Italy (OR 9.33, 95% CI: 3.83–22.73). A total of 1723 (47.1%) of healthcare workers declare to be a victim of verbal aggression at work in the last 12 months. The risk of being a victim of verbal aggression at work in the last 12 months is significantly associated with the following independent variables: work in northern Italy (adjusted OR [aOR] 1.54, 95% CI: 1.32–1.81), work in southern Italy (aOR 3.68, 95% CI: 2.90–4.68), and be more than 55 years old (aOR 0.73, 95% CI: 0.63–0.85). The study underlines that the problem of verbal and physical aggression against healthcare workers is still central and is a further starting point for research. The prevalence of violence is difficult to assess because violent incidents are underreported or unreported. The results of the study suggest that increased awareness is needed to develop effective control strategies at the individual, hospital, and national levels to prevent aggression and improve the conditions of victims. [ABSTRACT FROM AUTHOR]