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Background: The inflammatory response is critically important in ST-segment elevation myocardial infarction (STEMI). The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), novel inflammatory biomarkers, have been linked to the determination of outcomes in various diseases. The aim of the current study was to examine the relation of the SII and SIRI with contrast-induced acute kidney injury (CI-AKI) in elderly subjects with STEMI undergoing primary percutaneous coronary intervention (pPCI). Methods: All patients diagnosed with STEMI between November 2020 and September 2024 were screened, and patients aged over 70 were retrospectively analyzed in the present study. The patients were divided into two groups according to CI-AKI development. The SII and SIRI were calculated based on the peripheral blood counts. A receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of the SII and SIRI in predicting CI-AKI. Additionally, multivariable logistic regression models were employed to investigate the associations between inflammatory indices and the incidence of CI-AKI in elderly patients with STEMI. Results: A total of 263 participants were included (mean age 77.67 ± 6.20, 56% women). Both the SII and SIRI were higher in the CI-AKI group than in the non-CI-AKI group (3252 ± 2257, 1097 ± 991 p < 0.001 for SII; 12.1 ± 4.54, 4.86 ± 2.42 p < 0.006 for SIRI). In the receiver operating characteristic analysis, the SII and SIRI showed the highest area under curve (AUC) compared with other inflammatory parameters. The AUC of the SII and SIRI were 0.903 and 0.867 (p < 0.001). In multivariate logistic regression analysis, the SII and SIRI were found as independent predictors of CI-AKI. Conclusions: The SII and SIRI were found to be important markers for predicting post-procedural CI-AKI in elderly patients with STEMI.

Cold flush and static cold storage is the standard preservation technique for donor lungs before transplantations. Several research groups have assessed normothermic perfusion of donor lungs but all devices investigated were non-portable. We report first-in-man experience of the portable Organ Care System (OCS) Lung device for concomitant preservation, assessment, and transport of donor lungs. Between Feb 18, and July 1, 2011, 12 patients were transplanted at two academic lung transplantation centres in Hanover, Germany and Madrid, Spain. Lungs were perfused with low-potassium dextran solution, explanted, immediately connected to the OCS Lung, perfused with Steen's solution supplemented with two red-cell concentrates. We assessed donor and recipient characteristics and monitored extended criteria donor lung scores; primary graft dysfunction scores at 0, 24, 48, and 72 h; time on mechanical ventilation after surgery; length of stays in hospital and the intensive-care unit after surgery; blood gases; and survival of grafts and patients. Eight donors were female and four were male (mean age 44·5 years, range 14–72). Seven recipients were female and five were male (mean age 50·0 years, range 31–59). The preharvest donor ratio of partial pressure of oxyen (PaO2) to fractional concentration of oxygen in inspired air (FIO2) was 463·9 (SD 91·4). The final ratio of PaO2 to FIO2 measured with the OCS Lung was 471·58 (127·9). The difference between these ratios was not significant (p=0·72). All grafts and patients survived to 30 days; all recipients recovered and were discharged from hospital. Lungs can be safely preserved with the OCS Lung, resulting in complete organ use and successful transplantation in our series of high-risk recipients. In November, 2011, we began recruitment for a prospective, randomised, multicentre trial (INSPIRE) to compare preservation with OCS Lung with standard cold storage. TransMedics and German Federal Ministry of Education and Research.

Objective: Ex vivo organ perfusion is an advanced preservation technique that allows graft assessment and extended ex situ intervals. We hypothesized that its properties might be especially beneficial for high-risk recipients and/or donors with extended criteria. Methods: We reviewed the outcomes of 119 consecutive heart transplant patients, which were divided into two groups: A (OCS) vs. B (conventional). Ex vivo organ perfusion was performed using the Organ Care System (OCS). Indications for OCS-usage were expected ischemic time of >4 h or >2 h plus given extended donor criteria. Results: Both groups included mostly redo cases (A: 89.7% vs. B: 78.4%; p = 0.121). Incidences of donors with previous cardiac arrest (%) (A: 32.4 vs. B: 22.2; p < 0.05) or LV-hypertrophy (%) (A: 19.1 vs. B: 8.3; p = 0.119) were also increased in Group A. Ex situ time (min) was significantly longer in Group A (A: 381 (74) vs. B: 228 (43); p < 0.05). Ventilation time (days) (A: 10.0 (19.9) vs. B: 24.3 (43.2); p = 0.057), postoperative need for ECLS (%) (A: 25.0 vs. B: 39.2; p = 0.112) and postoperative dialysis (chronic) (%) (A: 4.4 vs. B: 27.5; p < 0.001) were numerically better in the OCS group, without any difference in the occurrence of early graft rejection. The 30-d-survival (A: 92.4% vs. B: 90.2%; p = 0.745) and mid-term survival were statistically not different between both groups. Conclusions: OCS heart allowed safe transplantation of surgically complex recipients with excellent one-year outcomes, despite long preservation times and unfavourable donor characteristics. Furthermore, we observed trends towards decreased ventilation times and fewer ECLS treatments. In times of reduced organ availability and increasing recipient complexity, OCS heart is a valuable instrument that enables otherwise infeasible allocations and contributes to increase surgical safety.

Background Stone heart syndrome was first described by Denton Cooley in 1972 and represents an extremely rare but severe complication following cardiac surgery. The condition is characterized by an irreversible, concentric, spastic contracture of the myocardium occurring during reperfusion which does not respond to either pharmacological or mechanical interventions. The underlying pathophysiology remains poorly understood, but an association with suboptimal cardioprotection and prolonged ischemia time has been suggested. Case presentation A 22-year-old otherwise healthy patient was admitted for elective mitral valve surgery due to severe mitral regurgitation caused by bileaflet prolapse and a history of cardiomyopathy of unclear etiology. Upon weaning from cardiopulmonary bypass, the patient developed biventricular heart failure requiring veno-arterial extracorporeal membrane oxygenation. Transesophageal echocardiography showed a stone heart. In the following days, temporary mechanical circulatory support was escalated to veno-arterio-venous extracorporeal membrane oxygenation and Impella. On postoperative day 5, a durable left ventricular assist device was implanted. Due to refractory stone heart syndrome, the patient was evaluated for heart transplantation which was successfully performed on postoperative day 23. The subsequent course was largely uneventful. The patient was discharged to rehabilitation at 6 weeks post transplantation. Conclusion Acute terminal heart failure due to perioperative stone heart is rare. In cases of irreversible global myocardial injury, orthotopic heart transplantation remains the only curative treatment option.

Background Ex vivo lung perfusion (EVLP) is used by an increasing number of transplant centres. It is still controversial whether an acellular or cellular (erythrocyte enriched) perfusate is preferable. The aim of this paper was to evaluate whether acellular (aEVLP) or cellular EVLP (cEVLP) preserves functional lung ultrastructure better and to generate a hypothesis regarding possible underlying mechanisms. Methods Lungs of 20 pigs were assigned to 4 groups: control, ischaemia (24 h), aEVLP and cEVLP (both EVLP groups: 24 h ischaemia + 12 h EVLP). After experimental procedures, whole lungs were perfusion fixed, samples for light and electron microscopic stereology were taken, and ventilation, diffusion and perfusion related parameters were estimated. Results Lung structure was well preserved in all groups. Lungs had less atelectasis and higher air content after EVLP. No significant group differences were found in alveolar septum composition or blood-air barrier thickness. Small amounts of intraalveolar oedema were detected in both EVLP groups but significantly more in aEVLP than in cEVLP. Conclusions Both EVLP protocols supported lungs well for up to 12 h and could largely prevent ischaemia ex vivo reperfusion associated lung injury. In both EVLP groups, oedema volume remained below the level of functional relevance. The group difference in oedema formation was possibly due to inferior septal perfusion in aEVLP.

Low haemocompatibility of left ventricular assist devices (LVAD) surfaces necessitates anticoagulative therapy. Endothelial cell (EC) seeding can support haemocompatibility, however, the availability of autologous ECs is limited. In contrast, allogeneic ECs are readily available in sufficient quantity, but HLA disparities induce harmful immune responses causing EC loss. In this study, we investigated the feasibility of using allogeneic low immunogenic ECs to endothelialize LVAD sintered inflow cannulas (SIC). To reduce the immunogenicity of ECs, we applied an inducible lentiviral vector to deliver short-hairpins RNA to silence HLA class I expression. HLA class I expression on ECs was conditionally silenced by up to 70%. Sufficient and comparable endothelialization rates were achieved with HLA-expressing or HLA-silenced ECs. Cell proliferation was not impaired by cell-to-Sintered Inflow Cannulas (SIC) contact or by silencing HLA expression. The levels of endothelial phenotypic and thrombogenic markers or cytokine secretion profiles remained unaffected. HLA-silenced ECs-coated SIC exhibited reduced thrombogenicity. In contrast to native ECs, HLA-silenced ECs showed lower cell lysis rates when exposed to allogeneic T cells or specific anti-HLA antibodies. Allogeneic HLA-silenced ECs could potentially become a valuable source for LVAD endothelialization to reduce immunogenicity and correspondingly the need for anticoagulative therapy which can entail severe side effects.

Background In spite of renal graft shortage and increasing waiting times for transplant candidates, simultaneous heart and kidney transplantation (HKTx) is an increasingly performed procedure established for patients with combined end-stage cardiac and renal failure. Although data on renal graft outcome in this setting is limited, reports on reduced graft survival in comparison to solitary kidney transplantation (KTx) have led to an ongoing discussion of adequate organ utilization. Methods This retrospective study was conducted to evaluate prognostic factors and outcomes of 27 patients undergoing HKTx in comparison to a matched cohort of 27 patients undergoing solitary KTx between September 1987 and October 2019 in one of Europe’s largest transplant centers. Results Median follow-up was 100.33 (0.46–362.09) months. Despite lower five-year kidney graft survival (62.6% versus 92.1%; 111.73 versus 183.08 months; p  = 0.189), graft function and patient survival (138.90 versus 192.71 months; p  = 0.128) were not significantly inferior after HKTx in general. However, in case of prior cardiac surgery requiring sternotomy we observed significantly reduced early graft and patient survival (57.00 and 94.09 months, respectively) when compared to patients undergoing solitary KTx (183.08 and 192.71 months; p  < 0.001, respectively) or HKTx without prior cardiac surgery (203.22 and 203.22 months; p  = 0.016 and p  = 0.019, respectively), most probably explained by the significantly increased rate of primary nonfunction (33.3%) and in-hospital mortality (25.0%). Conclusions Our data demonstrates the increased rate of early kidney graft loss and thus significantly inferior graft survival in high-risk patients undergoing HKTx. Thus, we advocate for a “kidney-after-heart” program in such patients to ensure responsible and reasonable utilization of scarce resources in times of ongoing organ shortage crisis.

Objective Photon-counting CT (PCCT) combines improved dose efficiency with spectral imaging, enabling dynamic functional imaging at chest CT dose levels. Dual energy CT typically uses perfused blood volume (PBV) as a static perfusion surrogate. This study compared low-dose dynamic PCCT compared with reference-dose PCCT and static PBV imaging. Materials and methods Six minipigs with left lung transplants underwent dynamic perfusion imaging using PCCT at reference and low-dose settings, along with a static PBV scan. Perfusion metrics—Blood Flow Deconvolution (BFD), Mean Transit Time Deconvolution (MTTD), Flow Extraction Product (FEP), and Time to Start Deconvolution (TTSD)—were normalized and analyzed across six lung regions using Kruskal-Wallis tests and Bland-Altman analysis. Results Low-dose and reference-dose dynamic PCCT showed strong agreement across perfusion parameters (BVP bias: 0.03; BVD bias: 0.04), with no significant differences in BVP ( p  = 0.995) or BVD ( p  = 0.374). Kinetic metrics were stable across dose levels (all p  > 0.2). While low-dose imaging showed slightly greater perfusion heterogeneity, BVP remained robust. Static PBV differed significantly from dynamic BVP (reference dose: p  < 0.001; low-dose: p  = 0.04). Left-right perfusion differences were detected in two animals by all methods. Estimated doses were 2.37 mSv (reference-dose) and 1.36 mSv (low-dose), comparable to chest CT (1.49 mSv) and below conventional CT perfusion (3–10 mSv). Conclusion Dynamic PCCT enables quantitative lung perfusion imaging at radiation doses comparable to standard chest CT. Low-dose dynamic PCCT shows strong agreement with reference-dose acquisitions, while dynamic parameters reveal functional differences not captured by static PBV imaging. Relevance statement Dynamic low-dose photon-counting computed tomography enables lung perfusion quantification at radiation doses comparable to standard chest CT, facilitating dose-efficient functional imaging in pulmonary disease. Key Points Low-dose PCCT (~ 1.36 mSv) is feasible, comparable to single chest CT (1.49 mSv). Strong agreement was seen between low- and reference-dose PCCT (BVP bias 0.03; BVD bias 0.04). Kinetic perfusion metrics remained stable across dose levels (all p  > 0.2). Graphical Abstract

PurposesOutcomes following lung transplantation are limited by bronchiolitis obliterans syndrome (BOS). As the number of circulating regulatory T cells (Treg) is lower in lung recipients with BOS than in stable lung recipients, we hypothesized that Treg is also correlated with lung function in the early post-transplantation period.MethodsThis prospective study included 18 consecutive patients whose lung function parameters were recorded 3 weeks and 3 months after transplantation, between February and July 2007. Peripheral blood mononuclear cells were stained with anti-CD3, -CD4, -CD8, -CD19, -CD25, -CD28, -CD45RA, -CD45RO, -CD69, -CD127, -CTLA4, and -Foxp3 antibodies and FACS assays were performed. In addition, intracellular cytokines were stained for FACS.ResultsTreg-specific markers (Foxp3, CD127lo, and CTLA4) in the CD25+CD4+ population were correlated with both forced expiratory volume in 1 s and forced vital capacity. Th1-cytokine secretion was more dominant in CD4+CD25+ T cells than in CD4+CD25− T cells. In contrast, Th2 and Treg cytokine secretion was the dominant response in stable recipients.ConclusionsThe frequency of Treg cells was positively correlated with good lung function in the early period after lung transplantation.

Objective: Acute mesenteric ischemia (AMI) is recognized as a vascular emergency, having high mortality and requiring rapid and efficient and treatment. In this study, we aimed to assess the levels of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in patients with AMI and to search for a relationship between the NLR and PLR values and inhospital mortality of patients with AMI. Methods: In total, one hundred and twenty three patients (67 AMI+ and 56 AMI-) were included in this retrospective study. Sixty seven patients diagnosed as having AMI following computed tomography angiography after presenting to the emergency room were included in AMI (+) group. “Receiver Operating Characteristic” analysis was done to determine the optimal NLR and PLR thresholds in diagnosis and inhospital mortality of AMI. Also, univariate and multivariate analyses were made to evaluate the complete blood count parameters affecting the outcomes of patients with AMI. Results: It was found that AMI+ patients had higher neutrophil count than AMI- patients, while the lymphocyte count was significantly lower (p<0.001 p<0.001, respectively). The NLR and PLR values were significantly higher in AMI+patients than in AMI-patients (p<0.001, p<0.001, respectively). In the multiple logistic regression analysis, only NLR and red cell distribution width were identified as independent predictors of inhospital mortality of patients with AMI [odds ratio (OR)=1.171, 95% confidence interval (CI)=1.020-1.345, p=0.026; OR=1.474, 95% CI=1.028-2.113, p=0.035, respectively]. Although PLR failed to predict inhospital mortality in AMI+ subjects (area under the curve (AUC=0.597, 95% CI=0.459-0.734, p<0.178), NLR level greater than 10.1, measured on admission, predicted inhospital mortality in AMI+ subjects (AUC=0.698, 95% CI=0.570-0.827, p<0.006). Conclusion: Neutrophil-to-lymphocyte ratio is a reliable predictive marker in hospital mortality in patients with AMI.