Marius Berman

Background: False‐positive hepatitis C virus (HCV) (FPHC) serology has been reported with earlier‐generation axial‐flow left ventricular assist devices (LVADs), but its frequency with the magnetically levitated HeartMate 3 and its implications for heart transplant pathways remain unknown. This study describes FPHC serology in HeartMate 3 LVAD recipients and explores associated clinical and immunological features. Methods: A retrospective, single‐center study was conducted at a specialist cardiothoracic center. All adults implanted with a HeartMate 3 LVAD between March 2018 and July 2025 with complete HCV serology before and after implantation were included. Patients developing HCV antibody positivity with negative confirmatory testing were classified as having FPHC serology. Patient demographics, blood product transfusions, liver function tests, lactate dehydrogenase, and human leukocyte antigen (HLA) sensitization were compared between groups. Results: Among 54 HeartMate 3 LVAD recipients, 10 (18.5%) developed FPHC serology after implantation. There were no significant differences between groups in age, sex, liver function tests, or lactate dehydrogenase. The number of fresh frozen plasma units transfused at implantation and the development of anti‐HLA Class I antibodies were associated with FPHC serology ( p = 0.039, p = 0.04, respectively). No significant associations were observed with red blood cell or platelet transfusions. Conclusion: FPHC serology is a clinically important phenomenon in HeartMate 3 LVAD recipients. Clinicians and patients should be aware of this phenomenon to minimize unnecessary investigations and delays to transplant candidacy assessment. Standardized confirmatory testing protocols and multicenter studies are needed to clarify the underlying immune mechanisms and their impact on post‐transplant outcomes.

Heart transplantation is still the definitive therapy for end-stage heart failure, yet the persistent shortage of suitable donor organs limits its application. Traditionally, static cold storage (SCS) has served as an effective standard preservation method, providing safe and adequate protection for preservation times under four hours. Yet, the need to extend this window and the specific metabolic requirements of donation after circulatory death (DCD) hearts have prompted interest in machine perfusion (MP) technologies. This literature review investigates the influence of temperature in ex situ heart perfusion, comparing normothermic (NMP), hypothermic (HMP), and subnormothermic (SNMP) strategies. Evidence from experimental models and emerging clinical studies suggests that MP can prolong preservation times, mitigate ischemic injury, and enable real-time metabolic and viability assessment of donor hearts prior to transplantation. These strategies represent a central trade-off: NMP enables real-time functional assessment of the beating heart, while HMP and SNMP approaches prioritize profound metabolic suppression to mitigate ischemic injury. Nonetheless, current data are limited by high costs, significant resource requirements, variability in perfusion protocols, and the scarcity of randomized controlled trials, particularly for HMP and SNMP. Standardization of methodologies, direct comparative studies, and the adoption of a risk-stratified preservation ecosystem are needed to clarify optimal temperature strategies. However, recent clinical successes with hypothermic strategies in traditionally normothermia-dependent donor types, such as DCD hearts, signal a potential paradigm shift, challenging established value propositions and prompting a critical re-evaluation of optimal preservation strategies.

Objectives: Donation after circulatory-determined death (DCD) heart transplantation has increased the number of hearts available for transplantation by 30%-40%. This may be associated with improved clinical outcomes for patients waiting for transplantation. We compare clinical outcomes from registration on the transplant waiting list before and after establishment of a DCD heart transplant programme. Methods: Observational cohort study of all patients listed for heart transplantation at a single centre for 3 years before (cohort 1) and 3 years after (cohort 2) the start of a DCD heart transplant programme. Outcome measures included heart transplantation, removal from waiting list due to death or deterioration, removal from waiting list due to improvement or patient choice, and need for mechanical circulatory support (MCS) after listing for heart transplantation. Results: One hundred twenty-nine patients were registered on the waiting list in cohort 1 and 146 patients in cohort 2. Patients in cohort 1 underwent 91 donation after brainstem-determined death (DBD) and 12 DCD heart transplants. Patients in cohort 2 underwent 102 DBD and 32 DBD heart transplants. Compared with cohort 1, patients in cohort 2 had a shorter waiting time for transplantation (45 vs 77 days, P = 0.001) and an increased cumulative incidence of transplantation (P < 0.001). When all patients had reached an end-point, patients in cohort 2 had a lower likelihood of death or removal from waiting list due to deterioration (6% vs 18%, P = 0.011) and fewer patients in cohort 2 required MCS after listing (4.1% vs 13.9%, P = 0.007). Conclusions: In a single centre, introduction of a DCD heart transplant programme was associated with shorter waiting times for heart transplantation and a lower likelihood of death/deterioration or requirement for MCS while waiting for heart transplantation.