Renal dysfunction caused by calcineurin inhibitor (CNI) nephrotoxicity occurs often and contributes significantly to late mortality after heart transplantation (HTx). Over the last decades, this has prompted many clinical studies in an effort to develop kidney-protecting immunosuppressive strategies including delayed CNI start, minimization, withdrawal, or even de novo CNI avoidance. In the past, these strategies often failed due to the lack of efficacy. Since 2009, novel CNI-reducing strategies have been under investigation. These strategies minimize renal damage using induction agents such as antithymocyte globulin and alternative immunosuppressive agents such as the mechanistic target of rapamycin inhibitors (sirolimus or everolimus) or mycophenolate.This review outlines the recent results of using these renal protection strategies including their drawbacks. We also discuss alternative approaches to optimize individual immunosuppressive therapies after HTx. K E Y W O R D Scalcineurin inhibitors, heart transplantation, immunosuppression, mechanistic target of rapamycin inhibitors, nephrotoxicity, renal protecting strategies

In Middle Europe, closed and open MVCs are now rarely performed, but the ultra-long-term results are excellent and serve as a standard for the now-established balloon valvuloplasty. MVCs remain an option for pregnant women. In third world clinical conditions, closed MVC remains a less expensive alternative.

Purpose: The shortage of suitable donor organs is a problem in lung transplantation. This dilemma is even worse in recipients with small chest cavities. In order to exploit a larger donor pool, we electively accepted bigger organs for small patients and performed lobar lung transplants. We further compared this patient group with patients receiving regular bilateral lung transplantation concerning survival and lung function. Methods: In our lung transplant program 10 patients (8 women and 2 men, 45.9±12.2 years old) received elective lobar lung transplantation between March 2009 and August 2014 with a mean waiting time of 227±163 days. The underlying diseases were IPF (n= 6), CF (n= 3) and PHT (n= 1). The mean recipient height was 164±8 cm and their calculated total lung capacity (TLC) was 5.3±1.0 L. Results: Donor lungs from 9 males and 1 female with a calculated TLC of 7.7±0.3 L and 5.3 L and a donor height of 185±4 cm and 165 cm respectively were accepted. Mean donor age was 44.9±7.2 years. All recipients were successfully transplanted via bilateral anterior or clamshell incisions using intraoperative ECMO support. In 5 cases, we transplanted a right upper (RUL) + right middle lobe (RML) and a left upper lobe (LUL). The remaining patients received RUL and LUL (n= 2), RLL and LLL (n= 2), and RML + RLL and LLL (n= 1). There were no postoperative complications needing further interventions. The 30-day survival was 90 %. The one year survival was 72.7 %. All other patients are still alive in 11/2015 at 49.3 (±25.3) months. The Kaplan-Meier curve is slightly better compared to our patients, who received regular bilateral lung transplantation (n= 49). Cause of death (n= 3) during the first year were graft failure (day 11), encephalopathy (day 77) and sepsis (day 134), respectively. Further complications have been BOS at stage III in one patient and 10 hospitalizations due to infections at some point. Their last measured VC and FEV1 was 64.7±18.7% and 58.3±11.3%, respectively. This is again comparable to our results after regular lung transplants. Conclusion: In this study it is shown that elective lobar lung transplantation can be performed safely with similar overall results as regular lung transplantation. It is an option for mainly female patients with small thoraces. ( 855) 10 Year Survival After Lung Transplantation: A Single Center Experience

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