Search

Background: Recent innovations in temperature‐controlled cardiac transportation allow for static hypothermic preservation of transplant organs during transportation. We assessed differences in donor‐derived cell‐free DNA (dd‐cfDNA) using the SherpaPak cardiac transport system (SCTS) and traditional ice transportation. Methods: Single‐organ heart transplant recipients between January 2020 and January 2022 were included if they had dd‐cfDNA measures ≤6 weeks post‐transplant along with the baseline biopsy at 6 weeks as part of the surveillance protocol and no biopsy‐confirmed rejection ≤90 days. Elevated dd‐cfDNA ≥.20% were compared between groups using logistic regression including a subject effect. Results: Of 65 hearts transplanted, 30 were transported with SCTS and 35 on ice. Recipient characteristics were similar between groups. Donors in the SCTS group were older (34 vs. 40 years, p =.04) with a longer total ischemic time (171 vs. 212 min, p =.002). Recipients in the SCTS group had a greater risk of elevated dd‐cfDNA unadjusted and adjusted for donor age, and prolonged ischemic times > 3.5 h (Unadjusted odds ratio: 4.9, 95%‐CI: 1.08–22.5, p =.039 and Adjusted odds ratio: 5.5, 95%‐CI: 1.03–29.6, p =.046). Primary graft dysfunction rates and 1‐year mortality were comparable between groups. Conclusion: Elevated dd‐cfDNA in patients procured with SCTS may indicate that graft injury was not negated relative to ice transport. However, there were no clinical differences noted in short or long‐term outcomes including mortality despite a longer ischemic time in the SCTS group. [ABSTRACT FROM AUTHOR]

Heart and lung transplant recipients require care provided by clinicians from multiple different specialties, each contributing unique expertise and perspective. The period the patient spends in the intensive care unit is one of the most critical times in the perioperative trajectory. Various organizational models of intensive care exist, including those led by intensivists, surgeons, transplant cardiologists, and pulmonologists. Coordinating timely efficient intensive care is an essential and logistically difficult goal. The present work product of the American Society of Transplantation's Thoracic and Critical Care Community of Practice, Critical Care Task Force outlines operational guidelines and principles that may be applied in different organizational models to optimize the delivery of intensive care for the cardiothoracic organ recipient. [ABSTRACT FROM AUTHOR]

Donor‐derived cell free DNA (dd‐cfDNA) has rapidly become part of rejection surveillance following orthotopic heart transplantation. However, some patients show elevated dd‐cfDNA without clinical evidence of rejection. With the aim to provide a clinical description of this subpopulation, we retrospectively analyzed 35 cardiac transplant recipients at our center who experienced elevated (≥.20%) dd‐cfDNA in the absence of clinical rejection, out of a total 106 recipients who had dd‐cfDNA results available during the first year. The median time to first elevated dd‐cfDNA level was 46 days, and the highest dd‐cfDNA recorded within 1 year was.31% [inter‐quartile range,.23–.45]. Twenty‐two (63%) patients experienced infections (cytomegalovirus (CMV) or other), and 16 (46%) presented with de novo donor‐specific antibodies. Cluster analysis revealed four distinct groups characterized by (a) subclinical rejection with 50% CMV (n = 16), (b) non‐CMV infections and the longest time to first elevated dd‐cfDNA (187 days) (n = 8), (c) right ventricular dysfunction (n = 6), and (d) women who showed the youngest median age (45 years) and highest median dd‐cfDNA (.50%) (n = 5). Continued prospective analysis is needed to determine if these observations warrant changes in patient management to optimize the utilization of this vital non‐invasive graft surveillance tool. [ABSTRACT FROM AUTHOR]