{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:28:51Z","timestamp":1783211331489,"version":"3.54.6"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>To evaluate differences in post-transplant outcomes by pre-transplant urgency status, focusing on early post-transplant infection and its contribution to mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed 801 adult heart transplant recipients enrolled in the Korea Organ Transplant Registry (April 2014\u2013December 2021). Recipients were classified as Status 0 (highest urgency; n = 287) and Status 1\u20133 (n = 514). Outcomes included all-cause mortality, post-transplant infection, acute allograft rejection, and cardiac allograft vasculopathy (CAV) up to 5 years. Mediation, landmark, and multivariable time-dependent Cox models assessed the impact and determinants of infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 5-year follow-up, 128 recipients (16.0%) died. Status 0 recipients had higher mortality than Status 1\u20133 recipients (28.0% vs. 13.5%; P &amp;lt; .001). Infection was the leading cause of death and was more frequent in Status 0 recipients at 1 and 6 months, whereas rejection and CAV rates were similar between groups. Infection at 1, 6, and 12 months was strongly associated with mortality and mediated the association between urgency status and mortality, accounting for 47.4%, 34.9%, and 34.2% of total effect, respectively. After adjustment for pre- and post-transplant organ support, urgency status was no longer independently associated with infection risk, whereas prolonged mechanical ventilation (&amp;gt;24\u2005h) remained the strongest predictor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Status 0 heart transplant recipients had higher mortality and early post-transplant infection risk than Status 1\u20133 recipients. Early infection, largely associated with greater clinical severity and prolonged mechanical ventilation, may explain the excess mortality in this high-urgency group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag167","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:30:14Z","timestamp":1781004614000},"source":"Crossref","is-referenced-by-count":1,"title":["High-urgency heart transplantation and outcome trade-offs: early post-transplant infection and mortality"],"prefix":"10.1093","volume":"13","author":[{"given":"Kyu-Sun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Division of Cardiology, Eulji University Hospital and Eulji University School of Medicine , Daejeon ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3284-0904","authenticated-orcid":false,"given":"Darae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Oh","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hae-Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myoung Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyungseop","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Keimyung University Dongsan Medical Center , Daegu ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong-Ju","family":"Choi","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7290-2463","authenticated-orcid":false,"given":"Sang Eun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9856-9227","authenticated-orcid":false,"given":"Seok-Min","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2616-1294","authenticated-orcid":false,"given":"Soo Yong","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital , Yangsan ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2779-4037","authenticated-orcid":false,"given":"Hyun-Jai","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"KOTRY study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheol","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaewon","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Joo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Ho","family":"Ju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Ho","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Ae","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeehoon","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeongsu","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junho","family":"Hyun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi Hee","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minjae","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam Hee","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun Hwa","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"2026062515414432900_xvag167-B1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.124.012272","article-title":"Review of the global activity of heart transplant","volume":"18","author":"El Rafei","year":"2025","journal-title":"Circ Heart Fail"},{"key":"2026062515414432900_xvag167-B2","doi-asserted-by":"publisher","first-page":"565","DOI":"10.4070\/kcj.2018.0189","article-title":"The past, present and future of heart transplantation","volume":"48","author":"Kim","year":"2018","journal-title":"Korean Circ J"},{"key":"2026062515414432900_xvag167-B3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1038\/s41569-023-00902-1","article-title":"Heart transplantation: advances in expanding the donor pool and xenotransplantation","volume":"21","author":"Jou","year":"2024","journal-title":"Nat Rev Cardiol"},{"key":"2026062515414432900_xvag167-B4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.005795","article-title":"Changes in the United States adult heart allocation policy: challenges and opportunities","volume":"13","author":"Shore","year":"2020","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2026062515414432900_xvag167-B5","author":"Eurotransplant International Foundation"},{"key":"2026062515414432900_xvag167-B6","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.jchf.2023.01.009","article-title":"Impact of the 2018 UNOS heart transplant policy changes on patient outcomes","volume":"11","author":"Maitra","year":"2023","journal-title":"JACC Heart Fail"},{"key":"2026062515414432900_xvag167-B7","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1001\/jamacardio.2020.4909","article-title":"Evolving trends in adult heart transplant with the 2018 heart allocation policy change","volume":"6","author":"Kilic","year":"2021","journal-title":"JAMA Cardiol"},{"key":"2026062515414432900_xvag167-B8","doi-asserted-by":"publisher","first-page":"2624","DOI":"10.1093\/cvr\/cvab259","article-title":"Cardiac allograft vasculopathy: current review and future research directions","volume":"117","author":"Pober","year":"2021","journal-title":"Cardiovasc Res"},{"key":"2026062515414432900_xvag167-B9","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1161\/CIRCULATIONAHA.117.029753","article-title":"Honoring 50 years of clinical heart transplantation in circulation: in-depth state-of-the-art review","volume":"137","author":"Stehlik","year":"2018","journal-title":"Circulation"},{"key":"2026062515414432900_xvag167-B10","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.healun.2007.03.005","article-title":"Prevention of acute rejection and allograft vasculopathy by everolimus in cardiac transplants recipients: a 24-month analysis","volume":"26","author":"Vigano","year":"2007","journal-title":"J Heart Lung Transplant"},{"key":"2026062515414432900_xvag167-B11","doi-asserted-by":"publisher","first-page":"868","DOI":"10.4070\/kcj.2016.0403","article-title":"Initial report of the Korean Organ Transplant Registry (KOTRY): heart transplantation","volume":"47","author":"Lee","year":"2017","journal-title":"Korean Circ J"},{"key":"2026062515414432900_xvag167-B12","doi-asserted-by":"publisher","first-page":"724","DOI":"10.4070\/kcj.2018.0392","article-title":"The Korean Organ Transplant Registry (KOTRY): second official adult heart transplant report","volume":"49","author":"Kim","year":"2019","journal-title":"Korean Circ J"},{"key":"2026062515414432900_xvag167-B13","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.healun.2022.10.015","article-title":"The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients","volume":"42","author":"Velleca","year":"2023","journal-title":"J Heart Lung Transplant"},{"key":"2026062515414432900_xvag167-B14","volume-title":"Explanation in Causal Inference: Methods for Mediation and Interaction","author":"VanderWeele","year":"2015"},{"key":"2026062515414432900_xvag167-B15","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1097\/MCA.0000000000000911","article-title":"Mediation analysis for the relationship between dyslipidemia and coronary artery disease via hypersensitive C-reactive protein in a case-control study","volume":"31","author":"He","year":"2020","journal-title":"Coron Artery Dis"},{"key":"2026062515414432900_xvag167-B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2023.100747","article-title":"FGF-23, left ventricular hypertrophy, and mortality in patients with CKD: a revisit with mediation analysis","volume":"3","author":"Hidaka","year":"2024","journal-title":"JACC Adv"},{"key":"2026062515414432900_xvag167-B17","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1016\/j.healun.2019.04.003","article-title":"Post-transplant outcome in patients bridged to transplant with temporary mechanical circulatory support devices","volume":"38","author":"Yin","year":"2019","journal-title":"J Heart Lung Transplant"},{"key":"2026062515414432900_xvag167-B18","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.healun.2016.10.008","article-title":"Extracorporeal membrane oxygenation support and post-heart transplant outcomes among United States adults","volume":"36","author":"Zalawadiya","year":"2017","journal-title":"J Heart Lung Transplant"},{"key":"2026062515414432900_xvag167-B19","doi-asserted-by":"publisher","first-page":"79","DOI":"10.4070\/kcj.2024.0176","article-title":"The Korean Organ Transplant Registry (KOTRY): third official adult heart transplant report","volume":"55","author":"Choi","year":"2025","journal-title":"Korean Circ J"},{"key":"2026062515414432900_xvag167-B20","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1093\/ehjacc\/zuab063","article-title":"Mechanical ventilation at the time of heart transplantation and associations with clinical outcomes","volume":"10","author":"Miller","year":"2021","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026062515414432900_xvag167-B21","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.healun.2007.11.566","article-title":"Outcomes in patients older than 60 years of age undergoing orthotopic heart transplantation: an analysis of the UNOS database","volume":"27","author":"Weiss","year":"2008","journal-title":"J Heart Lung Transplant"},{"key":"2026062515414432900_xvag167-B22","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/j.healun.2016.08.008","article-title":"Association of recipient age and causes of heart transplant mortality: implications for personalization of post-transplant management-an analysis of the International Society for Heart and Lung Transplantation Registry","volume":"36","author":"Wever-Pinzon","year":"2017","journal-title":"J Heart Lung Transplant"},{"key":"2026062515414432900_xvag167-B23","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14460","article-title":"Impact of diabetes mellitus on clinical outcomes after heart transplantation","volume":"35","author":"Feng","year":"2021","journal-title":"Clin Transplant"},{"key":"2026062515414432900_xvag167-B24","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1016\/j.healun.2024.03.004","article-title":"The International Society for Heart and Lung Transplantation (ISHLT): 2024 infection definitions for durable and acute mechanical circulatory support devices","volume":"43","author":"Aslam","year":"2024","journal-title":"J Heart Lung Transplant"},{"key":"2026062515414432900_xvag167-B25","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1093\/cid\/ciae120","article-title":"Nosocomial infections in adults receiving extracorporeal membrane oxygenation: a review for infectious diseases clinicians","volume":"79","author":"Marcus","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2026062515414432900_xvag167-B26","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1007\/s001340101029","article-title":"Nosocomial infections during extracorporeal membrane oxygenation","volume":"27","author":"O'Neill","year":"2001","journal-title":"Intensive Care Med"},{"key":"2026062515414432900_xvag167-B27","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1097\/MAT.0000000000000771","article-title":"Cannula-related infection in patients supported by peripheral ECMO: clinical and microbiological characteristics","volume":"65","author":"Allou","year":"2019","journal-title":"ASAIO J."},{"key":"2026062515414432900_xvag167-B28","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1111\/ajt.14208","article-title":"Infection in organ transplantation","volume":"17","author":"Fishman","year":"2017","journal-title":"Am J Transplant"},{"key":"2026062515414432900_xvag167-B29","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2024.11878","article-title":"Impact of everolimus initiation and corticosteroid weaning during acute phase after heart transplantation on clinical outcome: data from the Korean Organ Transplant Registry (KOTRY)","volume":"37","author":"Lee","year":"2024","journal-title":"Transpl Int"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article-pdf\/doi\/10.1093\/eschf\/xvag167\/68504116\/xvag167.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/13\/3\/xvag167\/68504116\/xvag167.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/13\/3\/xvag167\/68504116\/xvag167.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T19:41:48Z","timestamp":1782416508000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/doi\/10.1093\/eschf\/xvag167\/8705098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6,10]]},"published-print":{"date-parts":[[2026,5,5]]}},"URL":"https:\/\/doi.org\/10.1093\/eschf\/xvag167","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,5]]},"article-number":"xvag167"}}