{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:08:30Z","timestamp":1783944510517,"version":"3.55.0"},"reference-count":59,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>En bloc heart\u2010lung transplantation (HLTx) has been utilized for the past 50 years for the treatment of end\u2010stage heart and lung disease, with significant evolution in the field over that time. This is a systematic review of HLTx and a description of the evolution and outcomes in this patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pubmed and Embase were searched for all articles on HLTx from the time of database inception. A total of 1513 articles were screened, and after exclusion, 29 were included in this systematic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Reported cases of HLTx were more common in the early era (before 2000), for the indications of cystic fibrosis, Eisenmenger's syndrome, and pulmonary hypertension. In the contemporary era (2000\u2013present), patients were not as commonly transplanted for cystic fibrosis, with pulmonary hypertension and congenital heart disease comprising the majority of cases. Rates of short\u2010term mortality tended to be lower in more recent studies, with only recent studies reporting long\u2010term survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>HLTx has evolved substantially. In tandem with isolated heart and lung transplantation, the indications for transplant, medical therapy, and outcomes have changed over time. While HLTx is used less frequently in contemporary times compared to the early days of cardiothoracic transplantation, indications for HLTx continue to exist, and the use of HLTx will continue to be indicated. Centers with experience in HLTx should continue to report trends in patient management and outcomes, to continue to guide continued refinement in the field of HLTx.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70270","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T13:54:50Z","timestamp":1754920490000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["En Bloc Heart\u2010Lung Transplantation: Past and Present. A Systematic Review"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7146-4337","authenticated-orcid":false,"given":"Ryaan","family":"EL\u2010Andari","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery Department of Surgery University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7277-6188","authenticated-orcid":false,"given":"Nicholas M.","family":"Fialka","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery Department of Surgery University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abrar","family":"Alam","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isha","family":"Khonde","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery Department of Surgery University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Weatherald","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine Department of Medicine University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"Halloran","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine Department of Medicine University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayan","family":"Nagendran","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery Department of Surgery University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(10)66405-3"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2016.07.015"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-012-0397-2"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-315780"},{"key":"e_1_2_13_6_1","first-page":"275","article-title":"Heart and Heart\u2010Lung Transplantation: The Canadian and World Experience From December 1967 to September 1985","volume":"29","author":"Modry D. 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