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\begin{document}

\title{Heart transplantation in the new era of extended donor criteria}



\author[1]{Antonio Piperata}%
\author[2]{Raphael Caraffa}%
\author[1]{olimpia bifulco}%
\author[3]{Martina Avesani}%
\author[1]{Gino Gerosa}%
\author[4]{Tomaso Bottio}%
\affil[1]{Affiliation not available}%
\affil[2]{University of Padua}%
\affil[3]{Universita degli Studi di Padova Dipartimento di Medicina}%
\affil[4]{University of Padua Medical School,}%


\vspace{-1em}



  
  \date{May 08, 2024}


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\begin{abstract}
The heart transplantation (HT) is undoubtedly the best treatment for
end-stage heart failure patients (2). However, the organ shortage
remains a major challenge in cardiac surgery. Facing this problem, the
medical community starts to extend the donor criteria to select more
suitable organs for HT. The use of ECDs is still controversial, since it
is associated with a high incidence of primary graft failure (3), and
although it guarantees longer survival than without transplantation,
there is still some hesitation in accepting this practice.%
\end{abstract}%



\sloppy


\textbf{Heart transplantation in the new era of extended donor
criteria.}

Antonio Piperata\textsuperscript{1}, MD; Raphael
Caraffa\textsuperscript{2}, MD; Olimpia Bifulco\textsuperscript{2}, MD;
Martina Avesani\textsuperscript{1}, MD; Gino Gerosa\textsuperscript{2},
MD, Tomaso Bottio\textsuperscript{2}, MD, PhD.

\textsuperscript{1}Department of Cardiology and Cardio-Vascular Surgery,
H\selectlanguage{ngerman}ôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital,
33604, France

\textsuperscript{2}Department of Cardiac, Thoracic, Vascular Sciences
and Public Health, University of Padua, via N. Giustiniani, 2, 35128
Padova, Italy

Corresponding Author: Antonio Piperata,

Avenue Magellan,33600, Pessac, FR

Phone: +33 771768872

E-mail:\emph{a.piperata88@gmail.com}

Keywords: Heart transplantation, marginal donors.

\textbf{Word count} :~ 448

Keyword: transplant

\textbf{The authors do not have any conflict of interest to declare.}

We carefully read the recent paper by N.R. Hess et al. on the use of
extended criteria donors (ECDs) to increase the organ offers (1).

The heart transplantation (HT) is undoubtedly the best treatment for
end-stage heart failure patients (2). However, the organ shortage
remains a major challenge in cardiac surgery.

Facing this problem, the medical community starts to extend the donor
criteria to select more suitable organs for HT. The use of ECDs is still
controversial, since it is associated with a high incidence of primary
graft failure (3), and although it guarantees longer survival than
without transplantation, there is still some hesitation in accepting
this practice.

After a careful analysis of the characteristics of organ donors and the
acceptance criteria used by the various centres, the authors concluded
that the use of ECDs increases the number of HT without major impact on
outcomes. We believe that this article gives a big boost in the debate
on the use of ECDs for HT.

This is the latest demonstration that the use of ECDs in selected
scenarios is safe and can be applied without increasing the mortality.
This may be the results of an increased effort to improve the
association between recipients and donors. In fact, it has been shown
that recipient's conditions have more impact on HT outcomes than those
of the donors. This strategy allows to improve the post-transplant
survival at 1 and 5 years, matching high-risk organs with low-risk
recipients (4).

In this context, we can also include in the ECDs group the hearts
affected by coronary arteries and valvular disease, or congenital heart
defects. This group of organs can successfully be transplanted with
additional procedures at the time of HT. This strategy aims to optimize
the performance of hearts that otherwise would not be used and that can
represent the only chance for patients awaiting transplant.

We have recently published a literature review regarding the use of ECDs
and concomitant procedure to increase the organ availability (5). All
these experiences suggest few more considerations.

Firstly: the use of ECDs is a fundamental resource for addressing the
shortage of organs.

Secondly: the profile of the recipients is constantly changing thanks to
the use of mechanical circulatory supports.

Thirdly: the HT with ECDs certainly ensure better hope for patients than
the absence of a transplantation.

Fourth: simple procedures including heart valve replacement or repair,
coronary artery bypass grafting, or congenital heart defect repair can
be successfully combined with the HT to improve the performance of these
organs.

However, we strongly believe that the use of ECDs should be
progressively considered by the future international recommendations and
guidelines to reduce the waiting lists of patients needing HT.

REFERENCES

\begin{enumerate}
\tightlist
\item
  Hess NR, Seese LM, Sultan I, Wang Y, Thoma F, Kilic A. Impact of
  center donor acceptance patterns on utilization of extended-criteria
  donors and outcomes. J Card Surg. 2021 Aug 8.
\item
  Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update
  of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A
  Report of the American College of Cardiology/American Heart
  Association Task Force on Clinical Practice Guidelines and the Heart
  Failure Society of America. \emph{Circulation} .
  2017;136(6):e137-e161.
\item
  Felker GM, Milano CA, Yager JE, et al. Outcomes with an alternate list
  strategy for heart transplantation. \emph{J Heart Lung Transplant} .
  2005;24(11):1781-1786.
\item
  Trivedi JR, Cheng A, Ising M, Lenneman A, Birks E, Slaughter MS. Heart
  Transplant Survival Based on Recipient and Donor Risk Scoring: A UNOS
  Database Analysis. \emph{ASAIO J} . 2016;62(3):297-301.
\item
  Piperata A, Caraffa R, Bifulco O, Avesani M, Apostolo A, Gerosa G,
  Bottio T. Marginal donors and organ shortness: concomitant surgical
  procedures during heart transplantation: a literature review. J
  Cardiovasc Med (Hagerstown). 2021 Aug 20.
\end{enumerate}

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