Post-transplant lymphoproliferative disorder (PTLD) involving the central nervous system (CNS) is a rare but serious life-threatening complication seen in recipients of solid organ transplant. Primary CNS encompasses 5–15% of all types of PTLD diagnoses, and heart transplant recipients represent 3–5% of those reported cases. Diagnosis is often delayed due to the highly variable presentation, with some cases remaining undiagnosed for years. Multidisciplinary collaboration is crucial for early diagnosis and management. A 53-year-old woman patient presented with altered mental status. MRI revealed nodular ventriculitis and bilateral periventricular hyperdense infiltrates. CSF studies demonstrated lymphocytic pleocytosis, elevated protein, and EBV-PCR-positive results. A stereotactic brain needle biopsy confirmed the presence of EBV-positive diffuse large B-cell lymphoma, consistent with primary CNS PTLD, 14 months after her heart transplant. Despite appropriate management, the patient experienced progressive neurological decline and ultimately suffered a fatal intracerebral hemorrhage. We demonstrate the importance of the early diagnosis and variable presentation of post-heart-transplant PTLD. The importance of surveillance regardless of EBV status and close monitoring of disease progression due to potential life-threatening complications, such as fatal hemorrhages. Therefore, primary CNS-PTLD remains a challenging disease and is being increasingly recognized with improved transplant recipient survival and prolonged exposure to chronic immunosuppression.

Background: We report a case to demonstrate that targeted eosinophil depletion with Benralizumab (anti-IL-5 receptor α therapy) can induce the complete functional and structural reversal of advanced EGPA-associated cardiomyopathy. Case Presentation: A 56-year-old woman with a decade-long history of EGPA presented with progressive nonischemic dilated cardiomyopathy and a nadir ejection fraction of 25–30%. Cardiac MRI demonstrated diffuse nonischemic late gadolinium enhancement consistent with eosinophil-mediated myocardial injury. Despite the optimization of guideline-directed medical therapy, complete recovery was not achieved until benralizumab was initiated. Following biologic therapy, the ejection fraction recovered to 50% and severe mitral regurgitation regressed to mild. The exercise capacity was preserved throughout, with a peak VO₂ of 117% and 111% of predicted before and after biologic therapy, respectively. The patient remains in NYHA Class I at the one-year follow-up. Discussion: We describe a case with EGPA-associated non-ischemic cardiomyopathy treated with benralizumab achieving the complete recovery of ventricular function and achieving the complete independence of steroid therapy. Conclusions: This case emphasizes the importance of identifying the inflammatory etiology of cardiomyopathy, optimizing GDMT systematically, and considering targeted biologic therapy directed at the underlying disease.

Cardiac allograft vasculopathy (CAV) remains a leading cause of graft failure after heart transplantation, yet an early, non-invasive risk stratification tool is not available. Artificial intelligence electrocardiography (AI-ECG) can estimate biological heart age, and it has been associated with cardiovascular risk. Its deviation with chronological age, called delta age, and its utility in the prediction of CAV has never been explored. We conducted a retrospective single-center study for heart transplant recipients bridged with Impella 5.5 (Abiomed, Danvers, MA, USA) at Mayo Clinic Florida (2020–2023). ΔAge was calculated at discharge and 1-year post-transplant. The primary outcome was confirmed CAV at 1 year. Univariate and multivariable logistic regression models were used to assess the independent association between the ΔAge and the development of CAV, with discrimination evaluated by AUC and internally validated via bootstrap resampling (2000 iterations). Fifty patients were reviewed. CAV developed in 13 (26%) patients in 3 years. CAV+ patients had a significantly higher ΔAge at discharge compared to CAV- patients (median −1.0 vs. −11.0 years, p = 0.0023) and at 1 year (median +7.0 vs. −4.0 years, p = 0.0080). On univariate analysis, ΔAge at discharge was a significant predictor of the development of CAV (OR 1.084 per year, AUC 0.788). On multivariable adjustment, ΔAge at discharge remained an independent predictor (adjusted OR 1.138, 95% CI 1.023–1.265, p = 0.018, and model AUC 0.859). ΔAge at discharge is a novel and potential predictor of the development of CAV within 3 years. These findings support the integration of AI-ECG into post-transplant surveillance as a scalable, low-cost tool.

Introduction: The 2018 revision of the United Network for Organ Sharing (UNOS) heart allocation system has shifted clinical practice toward increased use of temporary mechanical circulatory support (tMCS) as a bridge to transplantation (BTT). However, comparative outcomes between temporary and durable MCS strategies remain incompletely defined, particularly from a strategy-level perspective. We aim to compare clinical and peri-transplant outcomes between temporary and durable mechanical circulatory support strategies in patients undergoing heart transplantation. Methods: We conducted a single-center retrospective cohort study of consecutive adult patients who underwent orthotopic heart transplantation between October 2018 and October 2020. Patients were categorized according to MCS strategy as temporary (Impella 5.5 or axillary intra-aortic balloon pump) or durable left ventricular assist device (LVAD). Primary outcomes included device-to-transplant time, cardiopulmonary bypass time, and post-transplant ICU length of stay (LOS). Kaplan–Meier analysis and multivariable linear regression were used to evaluate outcomes and predictors. Results: A total of 26 patients were included, of whom 17 (65.4%) received tMCS and 9 (34.6%) durable LVAD support. Temporary MCS was associated with significantly shorter waitlist time (median 27.5–34 vs. 606 days, p = 0.002) and device-to-transplant time (7–13 vs. 572 days, p = 0.001). Kaplan–Meier analysis demonstrated significantly shorter time to transplantation with tMCS (log-rank χ² = 18.98, p < 0.001). In multivariable analysis, tMCS remained independently associated with shorter device-to-transplant time (B = −495.23; 95% CI −714.38 to −276.08; p = 0.001) and shorter cardiopulmonary bypass time (B = −88.85; 95% CI −126.32 to −51.38; p = 0.001). No statistically significant differences in post-transplant ICU LOS or other early post-transplant outcomes were detected between groups. Conclusions: In this single-center cohort, temporary MCS was associated with significantly shorter time to transplantation and shorter cardiopulmonary bypass times compared with durable LVAD support, while no statistically significant differences in early post-transplant outcomes were detected between groups.