Objective To investigate whether predicted heart mass (PHM) ratio can predict the prognosis of adult heart transplant patients. MethodsClinical data of 309 heart transplant patients in the 7th People’s Hospital of Zhengzhou from May 2018 to July 2024 were retrospectively analysed. The cut-off value of the PHM ratio was calculated, grouping was conducted according to the cut-off value, and the baseline data and prognosis data of the two groups were compared. ResultsA total of 249 adult heart transplant recipients were included in this study according to the inclusion and exclusion criteria. Cut-off value of the PHM ratio was –0.01. There were 63 patients in the PHM ratio>–0.01 group and 186 patients in the PHM ratio≤–0.01 group. The results of univariate analysis revealed that there were statistically significant differences between the two groups in terms of recipient gender, age, physical indicators, donor gender, and several other aspects (all P<0.05). There was no statistical difference in primary disease, recipient blood type, infectious disease, emergency status, preoperative intra-aortic balloon pump (IABP), preoperative extracorporeal membrane oxygenation (ECMO), preoperative continuous renal replacement therapy, preoperative mechanical ventilation, and preoperative blood creatinine (P>0.05). In terms of prognosis, there were statistical differences between the two groups in postoperative ECMO (P=0.048), and postoperative IABP (P=0.027). Survival rate was significantly lower in the PHM ratio≤–0.01 group than that in the PHM ratio>–0.01 group (HR=1.748 0, 95%CI 1.007 0-3.035 0, P=0.047). Multifactorial Cox regression showed that PHM ratio was significantly associated with survival after heart transplantation (HR=0.000 3, 95%CI 0.000 1-0.001 2, P<0.001); recipient sex, donor sex, donor BMI, donor BSA, recipient BMI, recipient BSA did not significantly correlate with post cardiac transplantation survival. ConclusionPHM ratios can predict the prognosis of adult heart transplantation, and donor hearts with PHM ratios>–0.01 should be selected as much as possible when performing heart donor evaluation.
ObjectiveTo analyze the risk factors for pediatric heart transplantation at a single center and its impact on short-term prognosis, providing experience and reference for pediatric heart transplantation. MethodsThe children who underwent heart transplantation from May 2022 to May 2024 at the Seventh Medical Center of Chinese PLA General Hospital were included in this study. We conducted a retrospective analysis of the clinical data of donors and recipients, perioperative conditions, and postoperative complications. The double-lumen venoplasty technique was used for all surgeries. Basiliximab was applied for immune induction during and after the operation (on the 4th day). Tacrolimus+mycophenolate mofetil+prednisolone acetate was used for postoperative immunosuppressive maintenance treatment. According to whether patients had a history of extracorporeal membrane oxygenation (ECMO) installation before surgery, they were divided into an ECMO group and a non-ECMO group. The postoperative ICU stay time, postoperative ventilator assistance time, aortic clamping time, cardiopulmonary bypass time, recipient body surface area, left ventricular ejection fraction, X-ray cardiothoracic ratio, donor heart cold ischemia time, and the weight ratio between donor and recipient were compared between the two groups, and correlation analysis was performed. ResultsA total of 17 children were included, with 10 (58.8%) males and 7 (41.2%) females. Their ages ranged from 7 months to 16 years, with a median age of 11.0 (10.0, 13.0) years. Their weights ranged from 7.0 to 67.5 kg, with an average weight of (41.6±16.7) kg. Of the 17 children, 16 survived post-operation, and 1 died 5 days after the operation. Five patients were ABO incompatible heart transplantations, and 11 patients had a history of ECMO installation before surgery. The left ventricular ejection fraction of the non-ECMO group was higher than that of the ECMO group (t=2.188, P=0.045). The postoperative ICU stay time and postoperative ventilator assistance time (r=0.599, P=0.011), and cardiopulmonary bypass time (r=0.667, P=0.003) were positively correlated. The cardiothoracic ratio was negatively correlated with the postoperative ventilator assistance time (r=?0.527, P=0.030). ConclusionPediatric heart transplantation is an effective treatment method for children with end-stage heart failure. The left ventricular ejection fraction of the recipient may be a predictive factor indicating that the child needs ECMO assistance. Longer extracorporeal circulation time and larger recipient body surface area may affect the surgical process and perioperative prognosis.
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
Objective To investigate the causes and management strategies for lower limb ischemic necrosis following xenogeneic heterotopic heart transplantation from a multigene-edited pig to a rhesus monkey. Methods A xenogeneic heterotopic heart transplantation was performed on December 16, 2023, at the Institute of Experimental Animals of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, using a quintuple-gene-edited pig as the donor and a rhesus monkey as the recipient. On postoperative day (POD) 9, the recipient monkey underwent left lower limb amputation due to ischemic necrosis. Blood samples were collected at various time points after transplantation for analysis of hematologic parameters, liver and renal function, myocardial enzymes, and coagulation profiles. Ultrasound and computed tomography (CT) were used to evaluate anastomotic patency and cardiac structure. Immunological assays, including complement-dependent cytotoxicity (CDC) and IgG/IgM antibody detection, combined with clinical observations, were employed to assess rejection type and therapeutic response. Results The recipient monkey survived for 46 days after transplantation. Echocardiography demonstrated preserved biventricular systolic function in the recipient’s native heart, with left ventricular ejection fraction (LVEF) consistently exceeding 50%. In the donor pig heart, left ventricular endocardial thickening was noted on POD 9, followed by right ventricular endocardial thickening on POD 24, while LVEF remained around 35%. No hyperacute or acute rejection was detected immunologically. CDC positivity ranged between 3.4% and 5.1%, with IgG/IgM antibody binding trends consistent with CDC results. Following amputation, the recipient exhibited elevated inflammatory markers, coagulopathy, and reactive thrombocytosis, which later normalized. Immunohistochemical staining of the necrotic limb revealed arterial and venous thrombosis; however, no T-cell or B-cell infiltration was observed in vascular structures, thrombi, nerves, muscles, fascia, or skin tissues, with CD3 and CD20 staining both negative. Conclusion Limb ischemia after xenogeneic heart transplantation may be associated with lower extremity vascular thrombosis triggered by local trauma in the context of transplantation-induced inflammatory activation and coagulation dysfunction. While no clear lymphocyte-mediated rejection was observed, further studies are needed to explore the potential role of non-lymphocyte-mediated immune mechanisms.
In recent years, breakthroughs in genetic engineering (GE) and cloning technology have led to the successful cultivation of “designated pathogen free (DPF) xenotransplantation (XENO) medical (M) pigs” (hereinafter referred to as GE-DPF-XENO-M pigs). Based on GE-DPF-XENO-M pigs, a large number of xenotransplantation experiments with non-human primates (NHPs) as recipients basically answered the most concerned questions: overcoming hyperacute rejection and cross species infection. These achievements directly accelerate to the emergence of a new “xenotransplantation subclinical research model”. At the end of 2021, Montgomery and Porrett teams in the United States successively transplanted GE pig kidney into the remains of 3 brain dead cases, no hyperacute rejection occurred after 48–72 hours. These three subclinical studies provide a scientific basis for xenotransplantation into clinical research. On January 7, 2022, Griffith, Maryland, USA, etc. transplanted a GE pig heart to a patient with severe heart failure and survived for 59 days. The above progress shows that xenotransplantation has taken a key step towards the stage of clinical research, which is worthy of our peers’ attention and reference.
ObjectiveTo explore the learning process, critical steps and complication prevention of heterotopic abdominal heart transplantation (HAHT) model in rats,and effectively improve the learning process and shorten the learning curve. MethodsSurgical experience of 146 rats of HAHT from October 2012 to January 2013 was summarized. Operation time,successful rate and failure reasons were analyzed. ResultsA training time of 140-150 hours was needed to successfully master surgical skills of HAHT in rats. Average operation time was 83±27 minutes. There were 105 successful HAHT rats (72%) and 41 failed HAHT rats(28%) among 146 HAHT rats. Major failure reasons included hemorrhagic shock (16 rats,39%) grafted heart rebeating failure (7 rats,17%) and anastomotic stenosis (7 rats,17%). ConclusionVascular anastomosis is the key procedure for the establishment of HAHT model in rats.
Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. MethodsThe Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the Stata 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.
ObjectiveTo compare the perioperative renal function changes in patients undergoing heart transplantation (HT) and left ventricular assist device (LVAD) implantation. MethodsPatients with end-stage heart failure who underwent surgical treatment at Beijing Anzhen Hospital, Capital Medical University from January 2019 to April 2024 were included. According to the surgical method, patients were divided into a HT group and a LVAD group, and the estimated glomerular filtration rate (eGFR) of patients before surgery and postoperative 1, 7, 30, 60 days was compared between the two groups. The patients with preoperative renal dysfunction were subdivided into subgroups for comparison of eGFR changes before surgery and 30 days after surgery between the two groups. ResultsA total of 112 patients were enrolled. There were 78 patients in the HT group, including 61 males and 17 females, aged (44.42±18.51) years. There were 34 patients in the LVAD group, including 30 males and 4 females, aged (54.94±11.37) years. Compared with the HT group, the average age of patients in the LVAD group was greater (P<0.001), body mass index was higher (P=0.008), preoperative eGFR was lower (P=0.009), and the proportions of smokers (P=0.017), alcohol drinkers (P=0.041), and diabetes mellitus (P=0.028) patients were higher. Among patients with preoperative renal dysfunction [eGFR<90 mL/(min·1.73 m2)], compared with the HT group, the postoperative eGFR of the LVAD group was significantly higher than that of the HT group, and it was significantly increased compared with that before surgery; the postoperative eGFR of the HT group was comparable to that before surgery, and more than half of the patients had a lower eGFR than before surgery. Among patients with preoperative renal dysfunction, 11 patients in the HT group received continuous renal replacement therapy, and 8 died early; 2 patients in the LVAD group received continuous renal replacement therapy, and 1 died early. ConclusionFor end-stage heart failure patients with combined renal dysfunction, compared with HT, LVAD implantation enables patients to obtain better renal function benefits.
ObjectiveTo analyze the clinical effects of allograft orthotopic heart transplantation.MethodsThe clinical data of 36 patients with allograft orthotopic heart transplantation performed in the Heart Centre of Nanjing First Hospital from January 1, 2014 to January 1, 2019 were retrospectively analyzed. There were 31 males and 5 females, aged 23-65 (46.2±8.8) years. Protopathy diseases of recipients included dilated cardiomyopathy in 33 patients, end-stage coronary heart disease in 2 patients, and end-stage valvular heart disease in 1 patient. Heart transplantations were performed through double vena cava anastomosis. Immune induction during operations was treated with a combination therapy of both bariximab and methylprednisolone. Postoperatively, all patients were treated with a new triple immunosuppression protocol: FK506+cellcept+prednisone.ResultsDuring the perioperative period, 1 patient died of severe infection. For 8 patients with heart failure, after adjustment and intra-aortic balloon pump, the cardiac function of all the 8 patients improved. For 5 patients with renal failure, after continuous renal replacement therapy, the renal function of all the patients returned to normal. One patient died of graft failure after 1 year of follow-up. The follow-up time for each patient postoperatively differed from 3 to 49 months with an average time of 16±4 months while the 1-year survival rate was 97.1% (34/35). Among them, 10 patients were marginal donors, with no significant differences between conventional donors and them. Conclusion For end-stage heart diseases, heart transplantation is one of the effective treatment methods in China with fine early- and middle-term curative effects. Reasonable application of intra-aortic balloon pump, continuous renal replacement therapy and other adjuvant treatments and the new triple immunosuppression protocol can significantly improve the success rate of heart transplantation, reduce the occurrence of acute and chronic rejections. The application of marginal donors can alleviate the current situation of shortage of donors to some extent.
ObjectiveTo provide a practical reference for optimizing pediatric heart transplantation protocols in China by summarizing the perioperative management and short-term outcomes of pediatric heart transplant recipients at our center. MethodsWe retrospectively analyzed the medical records of all pediatric heart transplant patients performed at the Heart Center of the Children's Hospital, Zhejiang University School of Medicine, between June 2023 and September 2025. Data on donor and recipient demographics, indications for transplantation, use of mechanical circulatory support (MCS) as a bridge to transplant, perioperative clinical parameters, postoperative complications, immunosuppressive regimens, and follow-up outcomes were collected and analyzed. ResultsA total of 12 pediatric patients were enrolled, including 5 females and 7 males, with a median age of 9.7 (7.0, 13.0) years, all diagnosed with cardiomyopathy. MCS was used as a bridge to transplant in 58.33% of patients, including extracorporeal membrane oxygenation in 41.67% and a left ventricular assist device in 16.67%. The median donor heart cold ischemic time was 355 (306, 376) minutes. The most common postoperative complications were acute kidney injury (58.3%) and infection (58.3%). One week postoperatively, the median left ventricular ejection fraction recovered to 67.2% (61.8%, 71.0%). At discharge, 10 patients were in New York Heart Association (NYHA) functional class Ⅰ and 2 patients were in class Ⅱ. Over a follow-up period of 1 to 27 months, all patients survived with good cardiac function. ConclusionOur single-center experience demonstrates satisfactory short-term survival and cardiac function recovery in pediatric heart transplantation. Key areas requiring optimization include strategies for MCS bridging, management of prolonged donor heart cold ischemic time, and individualization of immunosuppressive regimens. Future development of a multi-center registry and genomics-guided precise immunosuppression strategies holds the potential to further improve long-term outcomes.