Survival after single versus bilateral lung transplantation for high-risk patients with pulmonary fibrosis.

Background: Whether single lung transplantation (SLT) or bilateral lung transplantation (BLT) is optimal for patients with severe idiopathic pulmonary fibrosis (IPF) is unknown. We examine a large multi-institutional cohort of high-risk IPF patients to address this question.

Methods: We retrospectively reviewed United Network for Organ Sharing data to identify 1,256 lung transplant (LTx) recipients with IPF between 2005 and 2007.

Quality of life and functional status in patients surviving 12 months after left ventricular assist device implantation.

Background: As left ventricular assist device (LVAD) support duration increases, quality of life (QoL) becomes a concern. We reviewed the QoL in patients on LVAD support for >or=1 year.

Methods: We retrospectively reviewed our prospective database for patients supported >or=1 year by HeartMate pulsatile- (HM1) or continuous-flow (HM2) LVADs from 2000 to 2009.

The impact of donor-recipient sex matching on survival after orthotopic heart transplantation: analysis of 18 000 transplants in the modern era.

Introduction: Single-institution series have suggested that men receiving orthotopic heart transplantation from female donors have decreased survival. No multi-institutional series has comprehensively addressed the issue of donor and recipient sex matching for both male and female orthotopic heart transplantation recipients.

Methods And Results: We used data from the multi-institutional prospectively collected United Network for Organ Sharing open transplantation cohort to review 18 240 adult patients who received orthotopic heart transplantation from 1999 to 2007.

PDE5A inhibitor treatment of persistent pulmonary hypertension after mechanical circulatory support.

Background: Pulmonary hypertension (PH) secondary to left heart failure portends a poor prognosis and is a relative contraindication to heart transplantation at many centers. We tested the hypothesis that when PH persists after adequate left ventricle unloading via recent left ventricular assist device (LVAD) therapy, phosphodiesterase type 5A inhibition would decrease PH in this population.

Methods And Results: We performed an open-label clinical trial using control patients not receiving therapy.

Impact of recipient body mass index on organ allocation and mortality in orthotopic heart transplantation.

Background: It is unknown whether obesity affects organ allocation in orthotopic heart transplantation (OHT). The United Network for Organ Sharing (UNOS) database provides an opportunity to examine this issue.

Methods: We reviewed UNOS data to identify 27,002 OHT candidates placed on the heart transplantation wait list (1998 to 2007).

Impact of donor-recipient race matching on survival after lung transplantation: analysis of over 11,000 patients.

Background: Few studies have examined the effect of race in lung transplantation (LTx). The United Network for Organ Sharing (UNOS) database provides an opportunity to examine outcomes of race matching for a large cohort of patients.

Methods: We retrospectively reviewed UNOS data for 11,323 adults receiving primary LTx (1997 to 2007).

The impact of center volume on survival in lung transplantation: an analysis of more than 10,000 cases.

Background: Whether center volume influences outcomes in lung transplantation is unknown. We reviewed United Network for Organ Sharing data to examine the effect of center volume on short-term mortality.

Methods: We reviewed United Network for Organ Sharing data (1998 through 2007) to identify 10,496 first-time adult lung transplantation recipients at 79 centers.

Heart transplantation for adults with congenital heart disease: analysis of the United network for organ sharing database.

Background: Congenital heart disease (CHD) in the adult is an uncommon indication for heart transplantation but has been increasing. We assessed survival and predictors of death after heart transplantation for adults with CHD.

Methods: Adult primary heart transplant recipients (aged > 17 years) reported to the United Network for Organ Sharing (1987 to 2006) were reviewed and categorized by diagnosis of CHD vs other diagnoses.

Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction.

We report the case of a 67 year-old patient who presented with worsening chest pain and shortness of breath, four days post acute myocardial infarction. Contrast enhanced computed tomography of the chest ruled out a pulmonary embolus but revealed an unexpected small subepicardial aneurysm (SEA) in the lateral left ventricular wall which was confirmed on cardiac magnetic resonance imaging. Intraoperative palpation of the left lateral wall was guided by the cardiac MRI and CT findings and confirmed the presence of focally thinned and weakened myocardium, covered by epicardial fat.

Impact of U.S. Lung Allocation Score on survival after lung transplantation.

Background: The Lung Allocation Score (LAS) dramatically changed organ allocation in lung transplantation. The impact of this change on patient outcomes is unknown. The purpose of the study was to examine early mortality after lung transplantation under the LAS system.

Long-acting oral phosphodiesterase inhibition preconditions against reperfusion injury in an experimental lung transplantation model.

Objectives: Ischemia-reperfusion injury remains a devastating complication of lung transplantation. Phosphodiesterase inhibitors have been shown to precondition tissues against ischemia-reperfusion injury. Little is known, however, about the utility of phosphodiesterase inhibition in reperfusion injury after lung transplantation.

Impact of advanced age in lung transplantation: an analysis of United Network for Organ Sharing data.

Background: Elderly patients are increasingly referred for lung transplantation (LTx) evaluation. Earlier outcomes studies in this cohort are limited by sample size. The United Network for Organ Sharing (UNOS) database provides an opportunity to examine survival in a large cohort of elderly patients.

Lung transplantation in older patients with cystic fibrosis: analysis of UNOS data.

Background: The lifespan for patients with cystic fibrosis (CF) is increasing. As a result, greater numbers of older CF patients are presenting for lung transplantation (LTx). The UNOS database provides an opportunity to examine outcomes for this population.

Elevated pretransplantation soluble CD30 is associated with decreased early allograft function after human lung transplantation.

Early allograft function after lung transplantation is variable. Clinical criteria have limited predictive value for early graft function. Recipient immunologic state before LTx may affect early lung function.

Impact of donor-to-recipient weight ratio on survival after heart transplantation: analysis of the United Network for Organ Sharing Database.

Background: Generally accepted donor criteria for heart transplantation limit allografts from donors within approximately 20% to 30% of the recipient's weight. We analyzed the impact of donor-to-recipient weight ratio on survival after heart transplantation.

Methods And Results: Adult heart transplant recipients reported to the United Network for Organ Sharing from 1999 to 2007 were divided into 3 groups based on donor-to-recipient weight ratio: <0.

Increased mortality at low-volume orthotopic heart transplantation centers: should current standards change?

Background: The Centers for Medicare and Medicaid Services (CMS) mandate that orthotopic heart transplantation (OHT) centers perform 10 transplants per year to qualify for funding. We sought to determine whether this cutoff is meaningful and establish recommendations for optimal center volume using the United Network for Organ Sharing (UNOS) registry.

Methods: We reviewed UNOS data (years 1999 to 2006) identifying 14,401 first-time adult OHTs conducted at 143 centers.

Right heart dysfunction after left ventricular assist device implantation: a comparison of the pulsatile HeartMate I and axial-flow HeartMate II devices.

Background: Right heart dysfunction confers significant morbidity and mortality after left ventricular assist device implantation and historically occurs in as many as a third of patients. It is unknown whether newer axial flow pumps have a different impact on postimplant right heart dysfunction. We compared the incidence of right heart dysfunction after implantation of the pulsatile HeartMate I (XVE) and the continuous flow HeartMate II left ventricular assist device.

The impact of surgical ventricular restoration on mitral valve regurgitation.

Background: Surgical management of functional mitral regurgitation (MR) in ischemic cardiomyopathy is controversial. Surgical ventricular restoration (SVR) decreases left ventricular volume and may improve MR severity. We assessed the impact of SVR on the degree of MR.

Pretransplant panel reactive antibodies in human lung transplantation: an analysis of over 10,000 patients.

Background: The role of panel reactive antibody (PRA) in lung transplant recipients has not been clearly defined in a large population. We sought to determine how panel reactive antibody level affects survival in lung transplant recipients.

Methods: The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research files from 1987 through 2005 were analyzed.

Outcomes in bicaval versus biatrial techniques in heart transplantation: an analysis of the UNOS database.

Background: Despite 40 years of heart transplantation, the optimal atrial anastomotic technique remains unclear. The United Network for Organ Sharing (UNOS) database provides a unique and novel opportunity to address this question by examining survival in a large cohort of patients undergoing orthotopic heart transplantation (OHT). We hypothesized that, when examining the issue on a large scale, no difference in survival would exist between techniques.

Impact of bilateral versus single lung transplantation on survival in recipients 60 years of age and older: analysis of United Network for Organ Sharing database.

Objective: Lung transplantation has been increasingly applied to patients over the age of 60 years. Importantly, the procedure of choice, single versus bilateral lung transplantation, remains unclear. Therefore, the purpose of this study was to examine short- and midterm outcomes in this age group with particular attention to procedure type.

Marginal cardiac allografts do not have increased primary graft dysfunction in alternate list transplantation.

Background: Clinical success with modern heart transplantation (HT) has led to the development of an alternate list (AL) HT strategy, matching marginal cardiac allografts with recipients who do not meet standard criteria for HT. Marginal allografts may be at an increased risk for primary graft dysfunction (PGD), the leading cause of early mortality after HT.(1) The incidence of PGD in AL HT relative to standard list (SL) HT has not been evaluated, and may contribute to the greater mortality associated with AL HT.

Isolated mitral valve repair in patients with depressed left ventricular function.

Background: The utility of mitral valve repair (MV repair) has been well documented in patients with normal left ventricular function. Few studies, however, have specifically examined outcomes of isolated MV repair in patients with decreased left ventricular function. The purpose of the present study is to review a modern experience with isolated MV repair in patients with depressed left ventricular function and to examine intermediate outcomes.