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Purpose Cardiac allograft vasculopathy (CAV) represents a relevant issue after Heart Transplantation (HTx), affecting mid and long-term outcomes. Coronary artery disease (CAD) of the donor graft has been implicated in the pathogenesis and progression of CAV. Although definitive data are still lacking, CAD of the donor graft represents an exclusion criteria in many transplant Units. We analyzed the outcomes of patients who underwent HTx from donor hearts affected by no-severe CAD. Methods Patients who received a graft, evaluated with coronary angiogram before the retrieval, were divided into two groups according to the presence or not of no-severe CAD (with lesions ≤50%) of the donor graft (groups CAD and NCAD, respectively). The outcomes analyzed were survival and freedom from grade ≥2 CAV. The study period was between 1990 and 2018. Median follow up was 86 months (range 0.3-317). Results There were differences between CAD and NCAD groups according to the baseline characteristics, as reported in Table 1. Survival and Freedom from grade ≥2 CAV were similar between the two groups at mid term (p=0.47 and p=0.66, Figure 1). At adjusted multivariate analysis for both survival and freedom from grade ≥2 CAV, donor CAD was not considered a significant risk factor. Conclusion Coronary angiogram plays a reliable role in identifying suitable organs, even those affected by CAD. In fact, no-severe donor CAD does not seem to affect survival and development of high grade CAV, more likely due to immunological factors. If confirmed by larger studies, these finding could encourage the employment of donor hearts affected by CAD.

Purpose The Organ Care System (OCS) Heart® is non-inferior to standard cold storage for preservation of donor hearts. We hypothesized that its properties for prolonged heart preservation might be especially beneficial for extended criteria donor (ECD) hearts. Methods Patients transplanted with ECD hearts preserved using the OCS Heart® at two German and one Italian centers between 11/2011 and 10/2019 were prospectively followed and included into the study. ECD were defined as fulfilling at least one of the following criteria: age between 45 and 55 years without coronary angiography; age >55 years; echocardiographic evidence of left ventricular hypertrophy (LVH); need for cardiopulmonary resuscitation (CPR) longer than 20 minutes; left ventricular ejection fraction (LVEF) Results During the study period, the OCS Heart® was employed in 122 patients transplanted at the three institutions. Among these 122 patients, 82 (67%) patients were transplanted with an ECD heart, as defined by the aforementioned criteria (median donor age, 48 years; LVH, n=17; CPR, n=28; mild CAD, n=5; LVEF 60% in echocardiography. At 2-year follow-up, survival and freedom from biopsy-confirmed rejection (ISHLT grade >1R) were 78% and 86%, respectively. Conclusion OCS Heart® allowed safe transplantation of extended criteria donor hearts. Despite out-of-body time was longer than 6 hours, patient and graft outcomes were favorable.

Purpose Heart transplantation (HTx) is the best therapeutic option for patients suffering from end-stage heart failure, but the shortage of donor hearts still represents a crucial problem. Methods Since 1985 to December 2017, a total of 611 HTx in 600 patients have been transplanted at our Centre. The aim of the study is to analyze the short- and long-term results of HTx in patients with older donor age, comparing the Results The mean age at HTx was 55±11.1 years. Of these, 561 (91%) received a donor heart Recipients transplanted with donors Conclusion In the older donor groups, the incidence mortality is highest in the first month from HTx; conversely, it appears similar at 1-year between donor

Purpose Increasing recipient (RA) and donor age (DA) are independently associated with mortality after Heart Transplantation (HT). The aim of this study was to analyse the impact of age-matching on HT survival. Methods 485 recipients who underwent HT between 1990 and 2018 in our Institution were divided into 4 groups: RA 50 (Group 2), RA>60-DA 60-DA>50 (Group 4), and their outcomes were compared. Emergency HT, bridge with MCS and re-HT were excluded. Mean follow-up was 109 ± 84 months. Results Preoperative data reported in Table 1. 30-day mortality across the groups was 4.9%, 9.8%, 8.1%, 9.2% from Group 1 to 4 (p=0,4). The survival of Group 1 was significantly higher than that of other groups (p=0,001), figure 1. The outcome of young recipients receiving older donor grafts did not significantly differ from that of older recipients. At multivariate analysis , donor age (HR 1,02; 95%CI:1,007-1,04) and recipient age (HR 1,05;95%CI:1,02-1,09) correlated with long-term mortality. Conclusion In this study, the use of hearts from older donors did not affect survival of older recipients; conversely, in young recipients it increased the risk of mortality. Older donor organs employment is advisable to expand the donor pool, but donor-recipient age matching should be taken into account to improve long-term outcomes.

Therapeutic drug monitoring (TDM) is essential to maintain the efficacy of many immunosuppressant drugs while minimizing their toxicity. TDM of mycophenolate mofetil requires area under the curve AUC determinations but appears laborious, costly, and clinically impractical. To overcome these problems, limited sampling strategies (LSS) have been proposed in adult and pediatric renal transplant patients. The purpose of this study was to develop an LSS in heart transplant patients. Forty-four mycophenolic acid (MPA) full AUC(0-12h) profiles were generated by high-performance liquid chromatography in nine heart transplant patients during the first 12 weeks posttransplant. Each patient received concomitant cyclosporine and prednisone therapy. Multiple stepwise regression analysis was used to define the time points of MPA levels to explain the MPA AUC(0-12h). Agreement between abbreviated AUC and the full AUC(0-12h) was tested by means of a Bland and Altman analysis. The highest coefficient of determination r(2) among MPA AUC and single concentrations (r(2) = .610) was observed with C(2), while C(12) provided the lowest one (r(2) = .003). Stepwise linear regression showed that the minimal model with the best estimation of MPA AUC(0-12h) was obtained at timed values of 1.25, 2, and 6 hours. The corresponding estimated model was AUC = 5.568 + 0.902 * C(1.25) + 2.022 * C(2) + 4.594 * C(6) (r(2) = .926). Bland and Altman analysis revealed good agreement between predicted AUC and full AUC. A further interesting model equation obtained by four samples was AUC = 3.800 + 1.015 * C(1.25) + 1.819 * C(2) + 1.566 * C(4) + 3.479 * C(6) (r(2) = .948).

THE presence or history of neoplastic disease was a traditional contraindication to heart transplantation (HTx), because of the fear of increased risk of tumor recurrence and lymphoproliferative disorders with chronic immunosuppression. More recently, recipient selection criteria have been extended both in kidney and in HTx, including patients (pts) cured for neoplastic disease and without recurrence for at least 2 years. Here we report our 12-year experience of HTx in pts with heart disease and a history of cancer involving other organs, and in those in whom chemotherapy for cancer resulted in heart failure due to toxic cardiomyopathy.