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Introduction: Heart transplantation has become an acceptable treatment in pediatric patients with end-stage heart disease and complex congenital heart disease. The liberalization of recipient eligibility criteria, mainly age, along with the expansion of the donor pool has resulted in the acceptable transplantation of older recipients.Methods: Between July 1994 and June 1998, 39 pediatric patients aged 16 days to 17.6 years (median 6.68 years) and 123 elderly patients aged 60 to 74.8 years (median 64.1 years) were transplanted at our institution. In the pediatric group, 19 had idiopathic dilated cardiomyopathy (DCM) (46 %), 14 had congenital heart disease (34 %), 4 had other etiologies of cardiomyopathy (10 %), 2 had transplant coronary artery disease (TCAD) (5 %), and 1 each had acute rejection and graft failure. In the elderly group, 71 had ischemic cardiomyopathy (58 %), 38 had DCM (31 %), 9 had other forms of cardiomyopathy (7 %), and 5 had TCAD (4 %).Results: Thirty-day, 1-year, and 4-year survival was 97.4 %, 87.2 %, and 70.9 % for the pediatric group and 92.7 %, 81.3 %, and 79.3 % for the elderly group. One and 4-year freedom from TCAD was 100.0 % and 85.3 % for the pediatric group and 91.9 % and 83.3 % for the elderly group.Conclusions: [emsp3 ]Orthotopic heart transplantation is effective for the treatment of irreparable congenital and end-stage heart disease. It provides excellent long-term results in both the very young and elderly. [ABSTRACT FROM AUTHOR]

Transplantation from donors with HCV-viremia to recipients without HCV-viremia (HCV D+/R-) is common, but no data exist for recipients with HIV or donors with HCV/HIV co-infection. We assessed outcomes of HCV D+/R- transplants within three HIV Organ Policy Equity Act studies of HIV+ abdominal transplantation to recipients with HIV between 2017-2023. Eighteen kidney and 6 liver HIV+ transplant recipients received organs from 19 donors with HCV viremia, including 7 with HCV/HIV co-infection. Median recipient age was 58 years, 96% were male, and median waitlist time was one year. All recipients had undetectable HIV RNA at time of transplant with median CD4 count 499 cells/mm 3 . HCV/HIV co-infected donors had median CD4 count 210 cells/mm 3 and 4/7 had detectable HIV RNA. HCV treatment with direct acting antivirals was initiated at median 33 days post-transplant and sustained virologic response was achieved in 23/23 treated recipients without HCV-related adverse events; data unavailable for one participant. Kaplan-Meier survival analysis demonstrated 100% one-year and 96% three-year survival. Graft survival was 96% at one and three years. HCV D+/R- abdominal transplantation, including donors with HCV/HIV co-infection, demonstrates favorable patient and graft survival in recipients with HIV and is a viable strategy to increase organ utilization., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Christine Durand reports a relationship with Gilead Sciences Inc that includes: funding grants. Dorry Segev reports a relationship with AstraZeneca Pharmaceuticals LP that includes: consulting or advisory and speaking and lecture fees. Dorry Segev reports a relationship with CareDx Inc that includes: consulting or advisory and speaking and lecture fees. Dorry Segev reports a relationship with Moderna Inc that includes: consulting or advisory. Dorry Segev reports a relationship with Novavax Inc that includes: consulting or advisory. Dorry Segev reports a relationship with Regeneron Pharmaceuticals Inc that includes: consulting or advisory. Dorry Segev reports a relationship with Springer Publishing Company LLC that includes: consulting or advisory. Dorry Segev reports a relationship with Vertex that includes: consulting or advisory. Dorry Segev reports a relationship with Houston Methodist Hospital that includes: speaking and lecture fees. Dorry Segev reports a relationship with Northwell Health that includes: speaking and lecture fees. Dorry Segev reports a relationship with Optum Health Education that includes: speaking and lecture fees. Dorry Segev reports a relationship with Sanofi that includes: speaking and lecture fees. Dorry Segev reports a relationship with WebMd that includes: speaking and lecture fees. Editor, Springer Publishing - Dorry Segev, co-author If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Inc.)

Background: Kidney transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV is an emerging practice. It has been performed since 2016 under the U.S. congressional HIV Organ Policy Equity Act and is currently approved for research only. The Department of Health and Human Services is considering expanding the procedure to clinical practice, but data are limited to small case series that did not include donors without HIV as controls., Methods: In an observational study conducted at 26 U.S. centers, we compared transplantation of kidneys from deceased donors with HIV and donors without HIV to recipients with HIV. The primary outcome was a safety event (a composite of death from any cause, graft loss, serious adverse event, HIV breakthrough infection, persistent failure of HIV treatment, or opportunistic infection), assessed for noninferiority (margin for the upper bound of the 95% confidence interval, 3.00). Secondary outcomes included overall survival, survival without graft loss, rejection, infection, cancer, and HIV superinfection., Results: We enrolled 408 transplantation candidates, of whom 198 received a kidney from a deceased donor; 99 received a kidney from a donor with HIV and 99 from a donor without HIV. The adjusted hazard ratio for the composite primary outcome was 1.00 (95% confidence interval [CI], 0.73 to 1.38), which showed noninferiority. The following secondary outcomes were similar whether the donor had HIV or not: overall survival at 1 year (94% vs. 95%) and 3 years (85% vs. 87%), survival without graft loss at 1 year (93% vs. 90%) and 3 years (84% vs. 81%), and rejection at 1 year (13% vs. 21%) and 3 years (21% vs. 24%). The incidence of serious adverse events, infections, surgical or vascular complications, and cancer was similar in the groups. The incidence of HIV breakthrough infection was higher among recipients of kidneys from donors with HIV (incidence rate ratio, 3.14; 95%, CI, 1.02 to 9.63), with one potential HIV superinfection among the 58 recipients in this group with sequence data and no persistent failures of HIV treatment., Conclusions: In this observational study of kidney transplantation in persons with HIV, transplantation from donors with HIV appeared to be noninferior to that from donors without HIV. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT03500315.)., (Copyright © 2024 Massachusetts Medical Society.)

Mouse models have been instrumental in understanding mechanisms of transplant rejection and tolerance, but cross-study reproducibility and translation of experimental findings into effective clinical therapies are issues of concern. The Mouse Models in Transplantation symposium gathered scientists and physician-scientists involved in basic and clinical research in transplantation to discuss the strengths and limitations of mouse transplant models and strategies to enhance their utility. Participants recognized that increased procedure standardization, including the use of prespecified, defined endpoints, and statistical power analyses, would benefit the field. They also discussed the generation of new models that incorporate environmental and genetic variables affecting clinical outcomes as potentially important. If implemented, these strategies are expected to improve the reproducibility of mouse studies and increase their translation to clinical trials and, ideally, new Food and Drug Administration-approved drugs., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose, as described by the American Journal of Transplantation., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Xenotransplantation offers the potential to meet the critical need for heart and lung transplantation presently constrained by the current human donor organ supply. Much was learned over the past decades regarding gene editing to prevent the immune activation and inflammation that cause early organ injury, and strategies for maintenance of immunosuppression to promote longer-term xenograft survival. However, many scientific questions remain regarding further requirements for genetic modification of donor organs, appropriate contexts for xenotransplantation research (including nonhuman primates, recently deceased humans, and living human recipients), and risk of xenozoonotic disease transmission. Related ethical questions include the appropriate selection of clinical trial participants, challenges with obtaining informed consent, animal rights and welfare considerations, and cost. Research involving recently deceased humans has also emerged as a potentially novel way to understand how xeno-organs will impact the human body. Clinical xenotransplantation and research involving decedents also raise ethical questions and will require consensus regarding regulatory oversight and protocol review. These considerations and the related opportunities for xenotransplantation research were discussed in a workshop sponsored by the National Heart, Lung, and Blood Institute, and are summarized in this meeting report., Competing Interests: Declaration of competing interest The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Kiran K. Khush: recipient of NHLBI research grant on donor heart evaluation for transplantation (R01HL125303). Brendan Parent: recipient of Applebaum Foundation grant to study ethics of xenotransplantation. Karen J. Maschke and Michael Gusmano: recipients of NCATS research grant on ethical translation of xenotransplantation clinical trials (1R01TR003844-0). The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)