Purpose: In 2006 UNOS introduced an electronic notification system known as DonorNet. It allowed electronic transmission of donor offers allowing detailed information about each potential donor to be viewed quickly by transplant centers, including their place on the allocation list (donor sequence number). We sought to examine the utilization of donors based on sequence number and also to assess if higher sequence number resulted in inferior long term survival compared to donors taken more readily at lower sequence number. Methods: A custom data request was made of UNOS to provide the data on transplants since the advent of DonorNet along with sequence number for accepted hearts. Demographics were compared with descriptive statistics and survival post transplant examined with Kaplan-Meier curves. Results: From 5/1/2007 -3/31/2014 there were 13481 adult heart transplants reported to UNOS with donor sequence numbers available. Transplant recipients consisted of 10037 males (74 %) with the majority having Type O or A hearts (38 % O, 41 % A). The mean donor age was 31.7 ± 11.7 years and the mean recipient age 52.6 ± 12.8 years. The mean ischemic time was 3.2 ± 1.1 hours. The mean left ventricular ejection fraction for the donors was 61.6 ± 7.1 %. Only 10 % of donors with an ejection fraction below 50 % were utilized for transplantation. The median donor sequence number was 3 and the 75th percentile for donor sequences was 10. 90 % of all donors in the database were accepted with a sequence number of 27 or less. This indicates that it was rare to transplant using a heart which had been turned down for more than 27 recipients. We analyzed graft survival by sequence number to assess whether this avoidance was warranted. The 5 year survival for 13438 evaluable patients was 74.5 %. When subdivided by donor sequence of 1-10 versus higher than 10, there was no difference (p= 0.21). Similarly, graft survival was similar with a cutpoint of donor sequence 30 or less (p= 0.10 log rank). Conclusion: Relatively few donors are taken with a sequence number greater than 27, yet the survival appears similar. Obviously these data are skewed by selection bias since the analysis only includes donors utilized for transplant. Nevertheless, these data suggest an opportunity to utilize more donors that are currently not being considered.

CI through levels. Following conversion to Tac-ER, even somewhat lesser adaptions of the CI dose to obtain stable immunosuppression were noted (3 vs. 6 in response to 54 through level measurements; p = 0.28). Also, intraindividual deviation of the prescribed CI dose was not increased during the therapy with Tac-ER (0,2±0,3 vs. 0,4±0,5mg). No case of transplant rejection was observed. Conclusion: The results from this small retrospective analysis indicate a promising trend for reduced nephrotoxicity in patients after heart transplantation receiving the calcineurin inhibitor tacrolimus in extended-release form. A conversion to extended-release tacrolimus is safe and feasible requiring no more dose adaptions.

Purpose: Patients supported with left ventricle assist device (LVAD) are at high risk for both bleeding and thrombotic events. In a recent study of a subset of patients enrolled in the IMAGE trial showed significantly decreased activity of 2 platelets activation genes (PF4, C6orf25) and 2 hematopoietic genes (WDR40A, MARCH8) during the first year after transplantation. This study aims to report changes in the GEP of patients supported by LVADs, before and after device implantation. Methods: In this prospective study consecutive patients undergoing LVAD implantation were considered for enrolment. Patients required device exchange, temporary mechanical circulatory support, INTERMACS1, and septic shock were excluded. Blood work including GEP (Allomap® and its genes subset), von Willebrand factor were taken one week prior to LVAD implantation and 1, 3 and 6 months after device implantation. Results: 21 patients, with mean age 54.2±13.7, 72.7% were male were enrolled into the study. There wasn't significant difference in the total GEP score before and after 1 month post implantation (31.7±6.42 vs 32.8±4.63, p= 0.63). Similarly, no significant differences were detected in the platelets regulating genes PF4 (24.9±0.75 vs 25.2±0.87, p= 0.40) and C6orf25 (26.2±1.43 vs 25.9±1.24, p= 0.84). There was no change in the hematopoietic genes WDR40 (27.6±1.27 vs 27.4±1.47, p= 0.75) and MARCH8 levels (28.6±1.08 vs 28.5±1.24, p= 0.88) at 1 month. 90% of the patients developed acquired vonWillebrand disease type 2A 1 month following device implantation.Purpose: Beginning January 2009 to present, all NYHA class IV, and all INTERMACS II patients referred for surgical therapy, had heart transplantation only in presence of LVAD contra indications (severe pulmonary hypertension, apical thrombus, aortic valve incompetence, non compliance) Therefore, all LVAD implanted were classified as destination therapy. Results are here reviewed. Methods: January 2009 to October 2015 90 NYHA class IV pts. (60% males vs 40% females, affected either by DCMP, 45%, or by IHD ,50%, or other, 5%, aged 25 to 73 years, mean 49 y.), had either heart transplant (G 1, 55 pts.) or Heart Mate II type LVAD implanted, (35 pts. ,G2 pts.) Entire population was followed up from 1 to 60 mos. Results: 1 mo. survival was 93% in G1 vs. 96 % in G2, while 60 mos. survival was in G1.69% vs 82% in G2, p.v.:n.s. One mo freedom from RVF was 69% in G1 vs. 79 % in G2, p.v.: n.s. 60 mos freedom from hospital readmission (25% in G1vs. 32% in G2), from infections (G1: 40%, vs. G2 34%), and from renal failure (G1: 52%, vs. G2 82%,) were not significant. Otherwise, freedom from neoplasia (G1: 76%, vs. G2 100 %, from bleeding G1: 89%, vs. G2 25%, 12 mos. and survival on the waiting list gone from 35% in 2009 to 49% i 2015 had .p.v.: < 0.005. Conclusion: Although our experience is still limited, better controlled mortality on the waiting list and acceptable results in terms of survival, and of freedom from main complications seems to indicate that use of LVAD as destination therapy shoul...

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