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Clinical Updates in Heart Transplantation

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Dear Colleagues,

Heart transplantation remains the gold standard therapy for end-stage heart failure, yet numerous challenges persist in expanding donor availability, optimizing recipient outcomes, and personalizing care. This Special Issue in the Journal of Clinical Medicine aims to highlight recent advances and emerging strategies across the full spectrum of heart transplantation. We welcome original research articles and comprehensive reviews addressing innovative approaches in donor pool expansion (ex vivo perfusion, DCD donors, and xenotransplantation), novel immunosuppressive regimens, mechanical circulatory support as a bridge to transplantation, and non-invasive rejection monitoring techniques. Additionally, we seek contributions exploring quality of life outcomes, psychological adaptation, and rehabilitation strategies following transplantation.

Of particular interest are manuscripts addressing unique challenges in complex cardiac pathologies beyond dilated cardiomyopathy, including restrictive cardiomyopathy, adult congenital heart disease, cardiac amyloidosis, and failed Fontan circulation. We also encourage submissions on precision medicine approaches to transplantation, including biomarker-guided immunosuppression and AI applications in donor-recipient matching.

This Special Issue will provide a platform for multidisciplinary perspectives from cardiac surgeons, transplant cardiologists, immunologists, anesthesiologists, psychologists, and rehabilitation specialists to advance the field of heart transplantation and improve patient outcomes.

Dr. Giacomo Bianchi
Guest Editor

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15 pages, 474 KB

Open AccessArticle

Pre-Transplant Heavy Smoking Is Associated with Reduced Survival After Heart Transplantation Due to Infection and Malignancy

by Karsten M. Heil, Rasmus Rivinius, Matthias Helmschrott, Ann-Kathrin Rahm, Philipp Ehlermann, Norbert Frey and Fabrice F. Darche

J. Clin. Med. 2025, 14(17), 6024; https://doi.org/10.3390/jcm14176024 - 26 Aug 2025

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Abstract

Background: Tobacco smoking is a known risk factor for adverse cardiovascular events. Many patients after heart transplantation (HTX) have a history of smoking, but the prognostic role of pre-transplant smoking remains uncertain. We thus investigated the effects of pre-transplant heavy smoking (≥20 pack-years) on outcomes after HTX. Methods: This observational retrospective single-centre study included 639 patients receiving HTX at Heidelberg Heart Center between 1989 and 2019. Patients were stratified by intensity of pre-transplant smoking (<20 pack-years or ≥20 pack-years). Analysis covered donor and recipient demographics, post-transplant medications, mortality including causes of death after HTX, and early post-transplant atrial fibrillation (AF) after HTX. Results: A total of 219 of the 639 HTX recipients (34.3%) had a pre-transplant history of heavy smoking (≥20 pack-years). These patients showed an increased 5-year post-transplant mortality (44.3% versus 28.6%, p < 0.001) and had a higher percentage of death due to infection/sepsis (21.5% versus 12.1%, p = 0.002) as well as due to malignancy (5.5% versus 1.7%, p = 0.007). Multivariate analysis demonstrated pre-transplant heavy smoking (≥20 pack-years) as an independent risk factor for five-year mortality after HTX (HR: 2.173, 95% CI: 1.601–2.950, p < 0.001). Analysis of secondary outcomes also showed a significantly higher rate of 30-day post-transplant AF (17.8% versus 11.7%, p = 0.032) in patients with a pre-transplant history of heavy smoking (≥20 pack-years). Conclusions: Pre-transplant heavy smoking is associated with early post-transplant AF, lung cancer, infection, and reduced survival after HTX. Full article

(This article belongs to the Special Issue Clinical Updates in Heart Transplantation)

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14 pages, 661 KB

Open AccessArticle

Comparative Analysis of Multi-Organ Failure Trajectories Following Heart Transplantation and HeartMate 3 Implantation: A 1-Year Postprocedural Follow-Up Study Utilizing the MELD-XI Scale

by Mateusz Sokolski, Jakub Ptak, Małgorzata Makieła, Maciej Szwajkowski, Mateusz Waloszczyk, Kacper Wiśniewski, Joanna Gontarczyk, Paulina Makowska, Dominik Krupka, Natalia Sitko, Magdalena Cielecka, Mateusz Rakowski, Maciej Bochenek, Roman Przybylski and Michał Zakliczyński

J. Clin. Med. 2025, 14(17), 5933; https://doi.org/10.3390/jcm14175933 - 22 Aug 2025

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Abstract

Background: Multi-organ failure (MOF) is a common complication of advanced heart failure (HF), significantly influencing patient prognosis. This study aimed to assess and compare the impact of orthotopic heart transplantation (HTx) and left ventricular assist device (LVAD) implantation on the severity of MOF, as measured by the model for end-stage liver disease excluding INR (MELD-XI) score. Methods: Data from 1 month before to 1 year after HTx or LVAD implantation were analysed. The MELD-XI score was calculated using average bilirubin and creatinine values. Comparative assessments of MELD-XI scores were performed within the HTx and LVAD groups at various time points pre- and post-procedure. Results: The analysis included 107 HTx patients and 30 LVAD patients. The median MELD-XI score 1 month pre-procedure was 11.7 (9.4–16.7) in all patients. There were no significant differences in MELD-XI scores between the groups at 3-, 6-, and 12-month follow-ups. However, a significant difference was observed 1 month post-procedure [HTx: 14.8 (9.4–17.7) vs. LVAD: 11.2 (7.3–14.9), p = 0.02]. In the LVAD group, a significant decrease in MELD-XI score was noted for 3 months post-procedure compared to 1 month pre-procedure (p < 0.001), whereas at 6- and 12-month follow-ups the score did not differ from pre-procedural scores. In the HTx group, significant decreases in MELD-XI scores were observed from 3 months, 6 months, and 1 year post-procedure compared to 1 month pre-procedure (p < 0.002). Conclusions: The MELD-XI scale reveals different MOF trajectories between HTx and LVAD recipients. Both interventions lead to early improvements in liver and kidney function, with sustained benefits in HTx patients, highlighting the distinct impacts on organ function. Full article

(This article belongs to the Special Issue Clinical Updates in Heart Transplantation)

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