Background: Primary graft dysfunction (PGD) has detrimental effects on recipients following lung transplantation. Here, we determined the contemporary trends of PGD in a national database, factors associated with the development of PGD grade 3 (PGD3) and ex vivo lung perfusion’s (EVLP) effect on this harmful postoperative complication. Methods: The United Network for Organ Sharing database was queried from 2015 to 2023, and recipients were stratified into No-PGD, PGD1/2, or PGD3. The groups were analyzed with comparative statistics, and survival was determined with Kaplan–Meier methods. Multivariable Cox regression was used to determine factors associated with increased mortality. PGD3 recipients were then stratified based on EVLP use prior to transplantation, and a 3:1 propensity match was performed to determine outcomes following transplantation. Finally, logistic regression models based on select criteria were used to determine risk factors associated with the development of PGD3 and mortality within 1 year. Results: A total of 21.4% of patients were identified as having PGD3 following lung transplant. Those with PGD3 suffered significantly worse perioperative morbidity, mortality, and had worse long-term survival. PGD3 was also independently associated with increased mortality. Matched EVLP PGD3 recipients had significantly higher use of ECMO postoperatively; however, they did not suffer other significant morbidity or mortality as compared to PGD3 recipients without EVLP use. Importantly, EVLP use prior to transplantation was significantly associated with decreased likelihood of PGD3 development, while having no significant association with early mortality. Conclusions: EVLP is associated with decreased PGD3 development, and further optimization of this technology is necessary to expand the donor pool.

Previously, limited cumulative experience has been linked to poor transplantation outcomes following ex vivo lung perfusion (EVLP). We sought to determine if EVLP performed at external perfusion centers (EPC) could mitigate this effect. Recipients from the United Network for Organ Sharing Database were stratified into: high-volume transplant program (HV-TP), low-volume transplant program (LV-TP), and EPC, based on who performed EVLP. Comparative statistics and Kaplan-Meier survival analysis were used, with a multivariable Cox regression model identifying independent mortality risk factors. A subgroup analysis compared LV transplant centers using EPCs (LV-EPC) against HV-TP recipients. The LV-TP group had a significantly higher incidence of postoperative ECMO use (20.8%, p = 0.009) and primary graft dysfunction grade 3 (PGD3) (30.1%, p = 0.011). However, survival did not significantly differ between groups, and LV-TP was not independently associated with increased mortality. Subgroup analysis showed that the LV-EPC had significantly shorter hospital stay when compared with HV-TP (20.5 vs. 24 days, p = 0.01) and equivocal rates of PGD3 ( p = 0.204), with no survival or independent mortality difference on multivariable analysis. External perfusion centers can mitigate postoperative complications associated with LV transplant centers. For centers with limited EVLP experience, EPCs offer a viable alternative pathway to expand the donor pool.

Heart transplantation from donors after circulatory death (DCD) has demonstrated increased primary graft dysfunction. Durable mechanical circulatory (MCS) recipients have slightly higher perioperative risk but excellent long‐term survival. We sought to determine if the use of DCD donors impacted outcomes for patients with MCS. The United Network for Organ Sharing database was queried from 2019 to 2023 for all adult recipients who underwent heart transplant with a durable left ventricular assist device (LVAD). Outcomes were compared for recipients of DBD and DCD donors. Kaplan–Meier analysis was used to compare survival. A total of 3449 recipients underwent heart transplant who met the study criteria. The number of DCD and DBD donors was 288 (8.4%) and 3161 (92.6%). There was no difference in the length of stay, postoperative dialysis, pacemaker, stroke rate, or in‐hospital mortality. Recipients with durable LVADs of DCD donors had a higher rate of treatment for rejection within the first year. Overall survival was not different between DBD and DCD donors (p = 0.153). Postoperative and survival outcomes for DCD donation remain similar between patients with and without MCS. These findings may help decrease waitlist time for patients with durable MCS.

Socioeconomic status can affect outcomes following cardiac surgery. The Distressed Communities Index (DCI) is a comprehensive comparative measure for economic well-being. This study aimed to explore the association of DCI scores and outcomes following surgical aortic valve replacement (SAVR). Seven humdred forty-six consecutive patients who underwent SAVR at our Institution from 2012 to 2020 were retrospectively reviewed. These patients were categorized into 2 groups based on their DCI scores: distressed (DCI>80 [n = 144]) and nondistressed (DCI ≤ 80 [n = 602]). Key variables were used for a 1:1 propensity-match, followed by Kaplan-Meier and conditional survival analyses. Multivariable Cox regression models were also constructed in both unmatched and matched cohorts to evaluate the independent association between DCI and survival. Before matching, the distressed group had a significantly lower median age (61.0) as well as a higher median Society of Thoracic Surgeons risk score (2.13%) compared to the nondistressed group (65.0, 1.74%, P = 0.0253, P = 0.0031). Kaplan-Meier estimated mortality was also significantly higher for the distressed group (P = 0.0004). After matching, 144 patients were identified in each group, with all standardized mean differences less than 0.10. Kaplan-Meier estimated mortality remained significantly higher for the distressed group in this matched cohort (P = 0.03). Multivariable Cox regression also confirmed DCI>80 was independently associated with higher mortality in both cohorts. These findings reveal that distressed DCI scores correlate with worse clinical outcomes post-SAVR. These survival disparities highlight a need for improved patient care and suggest that DCI could be a useful tool for better risk stratification and postdischarge planning to improve outcomes for high-risk populations.