{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T21:17:35Z","timestamp":1771103855528,"version":"3.50.1"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012513","name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Cardiovasculares","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012513","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008052","name":"Fundaci\u00f3n Alfonso Mart\u00edn Escudero","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008052","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009664","name":"Sociedad Espa\u00f1ola de Cardiolog\u00eda","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Levosimendan, a calcium\u2010sensitizing inotropic agent, is used in patients with advanced heart failure (HF) awaiting heart transplantation (HT). Its prolonged effects, due to an active metabolite, may influence post\u2010transplant vasodilation, particularly when administered shortly before HT. However, its impact on post\u2010HT complications such as vasoplegia and primary graft dysfunction (PGD) remains unclear. This study aimed to evaluate whether preoperative levosimendan affects these outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective, multicenter observational study included adult HT recipients from 2010 to 2022 across three Spanish centers. Patients were grouped based on whether they received levosimendan within 1\u00a0month prior to HT. Main outcomes were post\u2010HT vasoplegia (defined as cardiac index \u22652.5\u00a0L\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      , systemic vascular resistance &lt;1000\u00a0dyn\u00b7s\u00b7cm\n                      <jats:sup>\u22125<\/jats:sup>\n                      , and either a vasoactive\u2010inotropic score (VIS)\u00a0&gt;\u00a020 or norepinephrine administration &gt;0.1\u00a0\u00b5g\/kg\/min at 24\u00a0h post\u2010HT) and severe PGD, as defined by the 2014 ISHLT criteria. Secondary outcomes included all\u2010cause mortality. Subgroup analyses were performed for patients receiving levosimendan within 1\u00a0week of HT and by sex. Statistical analyses included propensity score (PS) matching, Kaplan\u2013Meier curves, and multivariate Cox regression models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 598 HT recipients, 94 (15.7%) received levosimendan preoperatively. After PS adjustment, no significant differences were found in the incidence of vasoplegia (40.0% vs. 39.2%, OR 0.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.98) or severe PGD (10.6% vs. 10.3%, OR 1.25,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.63) between groups. Post\u2010HT mortality was also not different (HR 0.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.37). Vasoplegia did not affect mortality, while severe PGD was linked to higher mortality. Subgroup and sex\u2010based analyses revealed no significant outcome differences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pre\u2010HT levosimendan use was not associated with increased early post\u2010transplant complications and appears to be a safe strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>This study evaluated whether giving levosimendan before HT affects early post\u2010transplant complications. Among 598 patients, 94 received levosimendan within a month before surgery. Results showed no significant differences in rates of vasoplegia, severe primary graft dysfunction, or mortality. Levosimendan use appears safe in the immediate pre\u2010transplant setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70327","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T05:00:16Z","timestamp":1761282016000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Pre\u2010Heart Transplant Levosimendan Administration on Post\u2010Transplant Vasoplegia and Primary Graft Dysfunction"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6064-8683","authenticated-orcid":false,"given":"Joan","family":"Guzman\u2010Bofarull","sequence":"first","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, IDIBAPS  Barcelona Spain"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2375-0643","authenticated-orcid":false,"given":"Alba","family":"Mart\u00edn\u2010Centellas","sequence":"additional","affiliation":[{"name":"Hospital Puerta de Hierro  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1112-4063","authenticated-orcid":false,"given":"David","family":"Couto\u2010Mallon","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario De A Coru\u00f1a (CHUAC), Instituto de Investigaci\u00f3n Biom\u00e9dica De A Coru\u00f1a (INIBIC)  A Coru\u00f1a Spain"},{"name":"Centro De Investigaci\u00f3n Biom\u00e9dica En Red de Enfermedades Cardiovasculares (CIBERCV)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8585-2522","authenticated-orcid":false,"given":"Roger","family":"Borr\u00e0s","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, IDIBAPS  Barcelona Spain"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5313-2379","authenticated-orcid":false,"given":"Andrea","family":"Arenas\u2010Loriente","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, IDIBAPS  Barcelona Spain"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8704-3104","authenticated-orcid":false,"given":"Mercedes","family":"Rivas\u2010Lasarte","sequence":"additional","affiliation":[{"name":"Hospital Puerta de Hierro  Madrid Spain"},{"name":"Centro De Investigaci\u00f3n Biom\u00e9dica En Red de Enfermedades Cardiovasculares (CIBERCV)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5055-3146","authenticated-orcid":false,"given":"Javier","family":"Segovia\u2010Cubero","sequence":"additional","affiliation":[{"name":"Hospital Puerta de Hierro  Madrid Spain"},{"name":"Centro De Investigaci\u00f3n Biom\u00e9dica En Red de Enfermedades Cardiovasculares (CIBERCV)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4886-5615","authenticated-orcid":false,"given":"Mar\u00eda G.","family":"Crespo\u2010Leiro","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario De A Coru\u00f1a (CHUAC), Instituto de Investigaci\u00f3n Biom\u00e9dica De A Coru\u00f1a (INIBIC)  A Coru\u00f1a Spain"},{"name":"Centro De Investigaci\u00f3n Biom\u00e9dica En Red de Enfermedades Cardiovasculares (CIBERCV)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1718-2424","authenticated-orcid":false,"given":"Ana","family":"Garc\u00eda\u2010\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, IDIBAPS  Barcelona Spain"},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona  Barcelona Spain"},{"name":"Centro De Investigaci\u00f3n Biom\u00e9dica En Red de Enfermedades Cardiovasculares (CIBERCV)  Madrid Spain"},{"name":"Centro Nacional de Investigaciones Cardiovasculares  Madrid 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