Aim of this retrospective analysis was to evaluate the effects of ivabradine given primarily as a heart rate-lowering agent on allograft function and cardiopulmonary performance in heart transplant recipients with permanent sinus tachycardia. Starting May 2006, 26 heart transplant recipients with permanent sinus tachycardia received ivabradine (5 mg bid). It was discontinued early in 3 patients (11.5%) due to adverse events. In the remaining 23 patients, resting heart rate (HR) was significantly lowered from 106.3 +/- 9.1 to 82.2 +/- 6.3 bpm after 3 weeks of treatment. The effect remained constant during the remaining treatment period, whereas resting blood pressure was not affected. After 12 weeks of ivabradine treatment, the corrected QT interval was significantly reduced into the range seen in normal individuals. Left ventricular (LV) end-diastolic posterior wall thickness, LV mass and LV mass index were also found to have decreased significantly. There was a trend to improvement of cardiopulmonary performance and LV ejection fraction, both of which did not reach statistical significance, however. It may be concluded that ivabradine successfully reduced the resting HR of heart transplant recipients with sinus tachycardia without negatively influencing the blood pressure. The definitive impact of ivabradine on LV mass regression and cardiopulmonary performance require further prospective, randomized and controlled trials.

Methadone is an effective and sustainable second-line alternative opioid for the treatment of cancer-related pain. The methods of titration are comparable in terms of efficacy, safety, and ease of use.

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In this manuscript, we present the first experience of evaluating donation after circulatory death (DCD) lungs, using the normothermic preservation Organ Care System (OCS) and subsequent successful transplantation. The OCS could be a useful tool for the evaluation of marginal lungs from DCD donors as it allows a proper recruitment and bronchoscopy in such donations in addition to continuous ex-vivo perfusion and assessment and treatment during transport. The OCS could potentially be a standard of care in the evaluation of marginal lungs from DCD.

Ex vivo lung perfusion (EVLP) is being increasingly used as a method of evaluating high-risk lungs for transplantation. Previous reports comparing EVLP outcomes with standard transplantation did not match for recipient and transplant characteristics. We examined the outcomes of a large cohort of patients who received EVLP lungs with a propensity score matched conventional cohort. Methods: Patients (1/06-4/15) who received at least one EVLP lung were included in the study. Of the 958 transplants performed, 133 utilized EVLP lungs. 170 lung blocks were evaluated by EVLP during the same period. Propensity matching (1:1, nearest neighbor) was used to identify a matched cohort of 133 patients from patients receiving a conventional lung. Matching factors included age at transplant, pulmonary disease, cold ischemic time, and single vs double lung transplant. Quantile-quantile plots were used to check balance. Re-transplant, heart-lung transplant, and transplant of patients bridged with extracorporeal life support were excluded. Results: Both groups had similar distributions of propensity scores. The EVLP group had lower donor pO2s (408.3 +/-95.5 mmHg vs 451.3 +/-74.3 mmHg, p< 0.0001), a higher proportion of DCD donors (53 [39.8%] vs 7 [5.2%], p< 0.0001), and a higher number of donor smokers (74 [55.6%] vs 59 [44.4%], p= 0.04). Mean EVLP time was 278 +/-62.9 min. Kaplan-Meier survival was similar between the two groups (p= 0.30, Fig 1). Freedom from PGD2/3 at 72h was better in the EVLP group (110 [82.7%] vs 91 [68.4%], p= 0.01) with a trend towards lower 30-day mortality (4 [3%] EVLP, 9 [6.8%] non-EVLP, p= 0.17). Median [95%CI] ICU stay (4[3-6]days non-EVLP vs 4[3-4]days EVLP, p= 0.83) and median [95%CI] hospital stay were similar between groups (23[20-27] days non-EVLP vs 21[19-23] days EVLP, p= 0.21). Conclusion: EVLP is a reliable technique for selecting lungs suitable for transplantation. Short and long term outcomes are excellent and comparable or superior to conventionally selected and preserved donor lungs.