Drug use disorders (DUDs) represent a major global health challenge, leading to substantial morbidity and mortality, while also being compounded by social and structural barriers. In this study, we examined global epidemiological trends in DUDs over the past three decades to inform clinical and public health responses. We extracted data on the incidence, deaths, and disability-adjusted life years (DALYs) attributable to DUDs from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study between 1990 and 2021. Age-standardized incidence (ASIR), mortality (ASMR), and DALY rates per 100,000 population were calculated. The analysis focused on four DUDs—opioid, amphetamine, cocaine, and cannabis use disorders—and further stratified rates by sex, Socio-demographic Index (SDI), countries, and world regions. In 2021, there were 13.6 (95% UI, 11.6–15.7) million new cases, 137,278 (95% UI, 129,269–146,181) deaths, and 15.6 (95% UI, 12.8–18.1) million DALYs attributed to DUDs. Between 1990 and 2021, the ASIR decreased by 8.1%, while the ASMR and DALY rates rose by 30.8% and 14.8%, respectively. Opioid use disorder accounted for the highest ASIR (169.4 [95% UI, 145.1–195.0] per 100,000), ASMR (1.7 [95% UI, 1.6–1.8] per 100,000), and age-standardized DALY rate (191.0 [95% UI, 156.1–222.8] per 100,000) in 2021. Sex and geographical variations were notable, with males and world regions like high-income North America, Australasia, and Eastern/Western Europe showing disproportionately higher rates. Overall, these findings highlight rising mortality and morbidity rates despite a modest decline in incidence, underscoring the need for tailored public health interventions, advancing harm reduction programs, and expanding access to treatment.

Background.: On March 9, 2023, the Composite Allocation Score (CAS) was introduced for all lung transplantation (LT) candidates. We analyzed waitlist and posttransplant outcomes after CAS implementation. Methods.: Using the United Network for Organ Sharing registry (2022–2024), adult patients listed for isolated LT were divided into 2 eras: era 1 (pre-CAS: March 1, 2022–March 8, 2023) and era 2 (post-CAS: March 9, 2023–September 30, 2024). Competing risk regression analyzed waitlist events. Recipient/donor characteristics and mortality risk factors were assessed with Cox models. Survival was evaluated with Kaplan-Meier analysis. Results.: Among 6398 LTs, 2598 (40.6%) occurred in era 2. More Black patients (16.9% versus 15%, P = 0.04) and those with a high school education (35.4% versus 33.4%, P = 0.0003) were transplanted. ABO type O patients were less likely to undergo LT (42.5% versus 46.6%, P = 0.04). Era 2 had longer transport distances (231 versus 202 miles, P < 0.0001), ischemic times (5.1 versus 4.9 h, P < 0.0001), and increased use of flights (79.1% versus 72.8%, P < 0.0001). Donation after circulatory death (9.4% versus 6.2%, P < 0.0001) and normothermic regional perfusion (2.2% versus 1.2%, P = 0.02) usage rose. Waitlist times decreased (29 versus 31 d, P = 0.009), with improved outcomes (sub-hazard ratio, 0.70; P < 0.0001). Era 2 showed superior 6-mo and 1-y survival (P < 0.0001) and reduced rejection treatment (2.6% versus 14.5%, P < 0.0001). Conclusions.: The implementation of CAS was associated with reduced waitlist mortality, improved access for marginalized groups, and enhanced survival. Lungs were procured from greater distances with an increased use of donation after circulatory death with normothermic regional perfusion or ex vivo perfusion. Disparities remain for ABO type O patients, warranting closer follow-up.

Background: Primary graft dysfunction (PGD) represents a leading cause of mortality in patients undergoing donation after brain death (DBD) orthotopic heart transplantation (OHT), requiring timely escalation to mechanical circulatory support. There is a lack of nationwide data regarding PGD after donation after circulatory death (DCD). Here, we evaluated the incidence and short‐term outcomes of PGD following DCD.Methods: Using the UNOS registry between 9/2023 and 9/2024, we identified all adult (≥18 years) recipients of OHT. The incidence and outcomes of moderate‐severe PGD (24‐ and 72‐h post‐transplant) were compared between DCD and DBD. Predictors for mortality after PGD were analyzed using Cox proportional hazard models. 30‐day survival was analyzed using the Kaplan‐Meier method.Results: A total of 5017 patients underwent first‐time OHT, among whom 762 (15.2%) received DCD hearts. DCD had a significantly higher incidence of PGD at 24‐ (7.9% vs. 4.8%; p = 0.001) and 72‐h (5.9% vs. 3.3%; p = 0.001) compared to DBD. 30‐day (p = 0.3068) survival was not different between DCD and DBD patients with PGD. Similarly, for recipients with PGD at 72 h, 30‐day (p = 0.327) survival was comparable. At 72 h, DCD recipients were more likely to be supported on ECMO (p = 0.016). Transplanting DCD organs did not impact PGD‐associated mortality at 24‐ (HR 0.72, p = 0.442) and 72‐h (HR 0.74, p = 0.457). Postoperative ECMO was associated with decreased risk of PGD‐associated mortality in DCD recipients at 24‐ (p < 0.0001) and 72‐h (p < 0.0001).Conclusions: While PGD rates appear higher in DCD, the associated mortality remains comparable to that of DBD. Early support on ECMO may confer survival benefits in DCD recipients with PGD.

Combined heart-liver transplantation (CHLT) is a complex procedure with rising demand and is subject to ongoing assessment. Here, we provide an update on indications, patient outcomes, and risk factors. This retrospective study utilized CHLT data from the United Network for Organ Sharing registry between 1990 and 2023. Recipient and donor characteristics, and risk factors for mortality were analyzed using Cox regression hazard models. Recipient and graft survival at 30 days, 1 year, and 5 years were analyzed using the Kaplan-Meier method. This cohort included 532 patients with median survival of 16.9 years (SD: 1.09). The most common indications for CHLT were congenital heart disease (36%) and dilated cardiomyopathy (31%). Patient survival at 30 days, 1 year, and 5 years were 94%, 85%, and 77%, respectively. Combined heart-liver graft survival was 93%, 85%, and 77%, respectively. Diabetes (hazard ratio [HR]: 1.74; p = 0.04) was associated with multigraft failure and mortality in multivariate analysis. Compared to congenital heart disease, dilated (HR: 0.55; p = 0.03) and restrictive myopathies (HR: 0.5; p = 0.03) were associated with improved graft and overall survival. Higher donor left ventricular ejection fraction (EF) was also associated with improved graft and overall survival (HR: 0.96; p = 0.008). CHLTs are being performed at increasingly higher rates with comparable survival to single-organ transplants. Diabetes was associated with increased mortality. Recipient dilated or restrictive myopathies and higher donor EF were correlated with improved survival compared to congenital heart disease. Further studies are needed to better understand these observations.

Background: In donation after circulatory death (DCD) heart transplants, choosing an optimal procurement method between normothermic regional perfusion (NRP) and direct procurement and preservation on the TransMedics Organ Care System (OCS) remains an important consideration. Thus, we aimed to evaluate long-term outcomes between NRP and OCS in DCD heart transplants. Methods: Using the UNOS registry, we queried all adults (≥18 years old) undergoing DCD and donation after brain death (DBD) heart transplantation between December 2019 and September 2023. TransMedics OCS donors were defined by time from death to clamp ≤30 minutes. Comparatively, NRP donors were defined by time from death to clamp >30 minutes. Kaplan–Meier recipient and graft survival analyses were conducted. Multivariate Cox proportional hazard models were used to identify independent predictors of mortality. Results: We identified 11,767 DBD transplants, 507 OCS, and 265 NRP recipients. Acute rejection rates were not significantly different between groups (p = 0.42). However, significant differences in overall survival were identified between DBD, OCS, and NRP (p = 0.019). Nonetheless, this difference may be attributed to a significant decline in survival for OCS recipients at 3 years (60.7% vs. 78.8% for DBD vs. 83.3% for NRP). Moreover, there were significant differences in graft survival (p = 0.02), with NRP demonstrating superior outcomes at 3 years (83.3%) compared to 60.7% for OCS and 80.0% for DBD. Conclusion: Both procurement methods demonstrate comparable short-term survival and graft function. However, long-term outcomes are more favorable among NRP recipients than OCS and conventional DBD methods. Nevertheless, continued investigation is needed to understand why this mortality difference exists.