{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T10:09:11Z","timestamp":1771409351674,"version":"3.50.1"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":175,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Heart\u2013lung transplantation (HLTx) remains a life-saving intervention for patients with end-stage cardiopulmonary failure. We retrospectively analysed long-term HLTx outcomes at our centre to assess survival trends and evaluate the impact of evolving immunosuppressive, surgical and perioperative strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This single-centre retrospective cohort study included 80 patients who underwent HLTx between 1983\u20131995 (Era 1) and 1996\u20132010 (Era 2), with follow-up through June 2024. All patients had severe cardiorespiratory failure. The primary endpoint was all-cause mortality. Secondary endpoints included early and late post-transplant outcomes. Overall survival at 1, 5 and 10 years post-transplant was 60 \u00b1 6%, 46 \u00b1 6% and 35 \u00b1 6%, respectively. Survival improved significantly between Era 1 (46 \u00b1 10%, 18 \u00b1 9% and 9 \u00b1 6%) and Era 2 (66 \u00b1 7%, 5 \u00b1 7% and 45 \u00b1 7%) (P &amp;lt; 0.001), correlating with advancements in immunosuppression, organ preservation and perioperative care. Univariable risk factors for increased mortality included Euro Collins versus Perfadex lung preservation (P &amp;lt; 0.001), University of Wisconsin (UW2) versus Histidine-Tryptophan-Ketoglutarate (HTK) solution cardioplegia (P &amp;lt; 0.001), and Epstein\u2013Barr virus infection (P = 0.036). Heart failure: OR 4.557 (95% CI: 1.057\u201319.648, P = 0.042) and gastrointestinal bleeding: OR 2.739 (95% CI: 1.310\u20135.726, P = 0.016) were identified as risks for mortality. These factors remained significant in multivariable analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HLTx outcomes at our centre are consistent with international benchmarks. Survival has improved in Era 2, likely due to individualised immunosuppressive regimens, novel organ preservation techniques and enhanced surveillance. These results support ongoing optimisation of multidisciplinary care for complex cardiopulmonary failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15411","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:55:26Z","timestamp":1756288526000},"page":"3899-3909","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Four Decades of Heart\u2013Lung Transplantation: Milestones and Outcomes in Advanced Cardiorespiratory Failure"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-8655","authenticated-orcid":false,"given":"L. Lily","family":"Rosenthal","sequence":"first","affiliation":[{"name":"Division of Paediatric and Congenital Heart Surgery, LMU University Hospital Munich , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Maria","family":"M\u00fchlbauer","sequence":"additional","affiliation":[{"name":"Division of Paediatric and Congenital Heart Surgery, LMU University Hospital Munich , Munich ,","place":["Germany"]},{"name":"Department of Cardiac Surgery, LMU University Hospital Munich , Munich ,","place":["Germany"]},{"name":"Department of Internal Medicine, Clinic Bogen , Bogen ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carola","family":"Grinninger","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital Munich , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaus A.","family":"Haas","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology and Intensive Care, LMU University Hospital Munich , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinrich","family":"Netz","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology and Intensive Care, LMU University Hospital Munich , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert Dalla","family":"Pozza","sequence":"additional","affiliation":[{"name":"Division of Paediatric Cardiology and Intensive Care, LMU University Hospital Munich , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"H\u00f6rer","sequence":"additional","affiliation":[{"name":"Division of Paediatric and Congenital Heart Surgery, LMU University Hospital Munich , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Michel","sequence":"additional","affiliation":[{"name":"Division of Paediatric and Congenital Heart Surgery, LMU University Hospital Munich , Munich ,","place":["Germany"]},{"name":"Department of Cardiovascular Diseases, Munich Heart Alliance (MHA) \u2013 German Centre for Cardiovascular Research (DZHK), LMU University Hospital Munich , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Schramm","sequence":"additional","affiliation":[{"name":"Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine-Westphalia (HDZ NRW) , Bad Oeynhausen ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Graetz","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital Munich , Munich ,","place":["Germany"]},{"name":"Clinic Gauting, Department of Intensive Care, Sleep and Respiratory Medicine , Gauting ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Hagl","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital Munich , Munich ,","place":["Germany"]},{"name":"Department of Cardiovascular Diseases, Munich Heart Alliance (MHA) \u2013 German Centre for Cardiovascular Research (DZHK), LMU University Hospital Munich , Munich ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"2026021804150265700_ehf215411-bib-0001","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1136\/thx.24.4.383","article-title":"Transplantation of the heart and both lungs. 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