Publications

Yasuhiro Shudo, MD, PhD
Clinical Associate Professor, Cardiothoracic Surgery

Publications

  • Pick Your Perfusion: National Outcomes of Normothermic Regional Perfusion versus Direct Procurement and Perfusion in Donation After Circulatory Death Cardiac Transplants. The Journal of thoracic and cardiovascular surgery Shou, B. L., Goerlich, C. E., Zhou, A. L., Ruaengsri, C., Shudo, Y., Hiesinger, W. 2026

    Abstract

    Donation after circulatory death (DCD) cardiac transplantation has substantially expanded the donor pool; however, the optimal procurement strategy - direct procurement and perfusion (DPP) or normothermic regional perfusion (NRP) - remains actively debated. We compared contemporary national outcomes of NRP versus DPP using the United Network for Organ Sharing (UNOS) registry.We analyzed first-time, isolated adult DCD heart transplants performed in the United States between January 1, 2019, and March 31, 2026, using the UNOS Standard Transplant Analysis and Research database. DPP and NRP were defined as a death-to-cross-clamp interval ≤30 and >30 minutes, respectively. Primary outcomes were 1-month, 1-year, and 3-year all-cause mortality. One-to-one propensity score matching (PSM) was performed to compare differences in outcomes between DPP and NRP.The analytic cohort comprised 2,831 DCD heart transplant recipients: 1,737 (61.4%) DPP and 1,094 (38.6%) NRP. DCD comprised 24.6% of all adult heart transplants performed in the United States. After propensity score matching, 939 DPP-NRP pairs were identified. In the matched cohort, survival was lower after DPP than after NRP at 1-month (95.8% vs 97.9%; p=0.01), one year (90% vs 92%, p=0.05), and three years (83.5% vs 86.9%, p=0.04). One year survival was similar on those surviving the first month (94.0% for both groups), as was three year survival conditional on surviving one year (92.7% vs 94.4%, p=0.52).NRP was associated with a modest short-term perioperative survival benefit compared to DPP. Among recipients who survived the first month, one and three year survival was equivalent.

    View details for DOI 10.1016/j.jtcvs.2026.08.001

    View details for PubMedID 42595217

  • Heart-lung transplantation using temperature- and airway pressure-controlled donor organ preservation system. JTCVS techniques Duda, M. M., Elde, S., Pelletier, G. J., Leon, M., Verdi, K. G., Ruaengsri, C., Woo, Y. J., Shudo, Y. 2026; 38: 102404

    View details for DOI 10.1016/j.xjtc.2026.102404

    View details for PubMedID 42577010

    View details for PubMedCentralID PMC13453641

  • Topical vascular organoid therapy promotes microvascular regeneration and functional recovery in porcine ischemic cardiomyopathy. Stem cell reports Farag, J. A., Yajima, S., Kawai, Y., Kawago, K., Pfrender, E., Syed, U., Lyons, J. K., Ueyama, T., Takashima, H., Matsuura, Y., Ikeda, G., Liu, Y., Zhu, Y., Elde, S., Yang, P. C., Woo, Y. J., Shudo, Y. 2026: 102999

    Abstract

    Ischemic heart disease (IHD) often progresses to heart failure due to persistent microvascular dysfunction not corrected by conventional epicardial revascularization. We developed a scaffold-free vascular organoid composed of human endothelial progenitor cells (EPCs) and mesenchymal stem cell-derived smooth muscle cells (SMCs) and evaluated its therapeutic potential in a porcine IHD model. Fourteen days after ischemia induction, bilayer EPC-SMC organoids were transplanted onto the left ventricular surface, and animals were followed for four weeks. Cardiac MRI demonstrated the preservation of left ventricular ejection fraction and modest improvement in regional function compared with controls. Histological and immunohistochemical analyses revealed the migration of transplanted cells into host myocardium, increased vascular density, and enhanced vessel maturation, while gene expression profiling showed the upregulation of angiogenesis-related genes. These findings demonstrate that scaffold-free EPC-SMC vascular organoids can engraft, promote microvascular remodeling, and preserve cardiac function after ischemic injury.

    View details for DOI 10.1016/j.stemcr.2026.102999

    View details for PubMedID 42425089

  • Impact of Donor/Recipient Predicted Heart Mass Ratio on Primary Graft Dysfunction: Organ Heart Perfusion Registry Report Farr, M., Schroder, J. N., Milano, C., D'Alessandro, D., Anyanwu, A., Shudo, Y., Sareyyupoglu, B., Pal, J., Couper, G., Lozonschi, L., Kai, M., Taked, K., Daneshmand, M., Peltz, M., Kaczorowski, D., Goldstein, D., Spielvogel, D., Villavicencio, M., Barrus, B., Kearns, M., Meyer, D., Kilic, A., Sun, B., Haft, J., Pinney, S., Stehlik, J. ELSEVIER SCIENCE INC. 2026: S418

    View details for Web of Science ID 001810046700024

  • Preservation Strategy and Sex-Specific Risk of Severe Primary Graft Dysfunction After Heart Transplantation: A GUARDIAN-Heart Analysis. ASAIO journal (American Society for Artificial Internal Organs : 1992) DeFilippis, E. M., Rodrigo, M. E., Loyaga-Rendon, R., Shudo, Y., Uriel, N., Takeda, K., D'Alessandro, D. A., Fiedler, A. 2026

    Abstract

    Static controlled hypothermic donor heart transportation (SCTS) has been shown to improve survival and lower rates of severe primary graft dysfunction (PGD) after heart transplantation (HT) as compared to ice. The current study examined preservation strategy and sex-specific risk of PGD in the GUARDIAN-Heart registry. Adult HT recipients from October 2015 through July 2025 were included. A propensity-matched cohort was fit using nearest-neighbor matching to compare clinical outcomes by sex and preservation method. A total of 1,723 (29% women) HT recipients were included. In the propensity-matched cohort, rates of severe PGD in the SCTS group were comparable to ice despite significantly longer distance traveled and ischemic times in the SCTS group in both men and women. Women-SCTS experienced significantly lower rates of severe right ventricular (RV) dysfunction at 24 hours compared to the women-ICE group (1% vs. 14%, p < 0.001). One year survival was similar between ice and SCTS in men (92% vs. 95%, p = 0.15) and in women (96% vs. 94%, p = 0.54). Despite longer ischemic times and travel distances, the women-SCTS group had similar outcomes to the women-ice (NCT04141605).

    View details for DOI 10.1097/MAT.0000000000002736

    View details for PubMedID 42127213

  • Association of Controlled Moderate Hypothermic Donor Heart Preservation with Subsequent Allograft Rejection and Non-Invasive Surveillance Testing Khush, K., DeVore, A., Schroder, J., Uriel, N., Takeda, K., Urban, M., Rodrigo, M., D'Alessandro, D., Zuckermann, A., Shudo, Y., Teuteberg, J. ELSEVIER SCIENCE INC. 2026: 130

    View details for Web of Science ID 001762495500010

  • Outcomes with Extended Criteria Donor Hearts When Preserved at 4-8°C Compared to Normothermic Preservation Schroder, J., Urban, M., Couper, G., DeVore, A., Lerman, J., Goldstein, D., Madan, S., Klein, L., Shudo, Y., Silvestry, S., D'Alessandro., D. ELSEVIER SCIENCE INC. 2026: 297-298

    View details for Web of Science ID 001761994900090

  • Hypothermic Oxygenated Perfusion of Extended-Criteria Donor Hearts in Human Transplantation (PRESERVE): A Prospective, Multi-Center, Single-Arm, Open-Label Study Pretorius, V., Ardehali, A., Daneshmand, M., Urban, M., Takeda, K., Schroder, J., Peltz, M., Bryner, B., Esmailian, F., Kearns, M., Shudo, Y., Pal, J., Moazami, N., Kaczorowski, D., Shah, A. ELSEVIER SCIENCE INC. 2026: 7

    View details for Web of Science ID 001761735800016

  • Assessing Donor Obesity in Donation After Circulatory Death Heart Transplantation: TransMedics® Organ Care System Heart Perfusion (OHP) Registry Analysis Schaffer, E., Potel, K., Nguyen, S., Weiner, B., D'Alessandro, D., Anyanwu, A., Loebe, M., Lozonschi, L., Meyer, D., Schroder, J., Shudo, Y., Skipper, E., Sareyyupoglu, B., Arabia, F., Hooker, R., Daneshmand, M., Durham, L., Villavicencio, M., Kilic, A., Goldstein, D., Pham, D., Couper, G., Haft, J., Kaczorowski, D., Spielvogel, D., Stehlik, J., Farr, M., Milano, C., Pinney, S., Shaffer, A. ELSEVIER SCIENCE INC. 2026: 304-305

    View details for Web of Science ID 001761994900100

  • Analysis of Donor-Derived Cell-Free DNA Value and Risk of Infection After Heart Transplant Henricksen, E., Pak, J., Subramanian, A., Dieringer, T., Torres, M., Demir, K., Padilla, C., Teuteberg, J., Hanson, P., Lee, R., Le, T., Vu, A., Skoda, A., Moayedi, Y., Shudo, Y., Khush, K. ELSEVIER SCIENCE INC. 2026: 669-670

    View details for Web of Science ID 001761674500114

  • Dual-Positive Molecular Surveillance and Post-Transplant Outcomes in Heart Transplant Recipients Unni, A., Henricksen, E., Shudo, Y., Skoda, A., Pak, J., Teuteberg, J., Khush, K. ELSEVIER SCIENCE INC. 2026: 621-622

    View details for Web of Science ID 001761674500005

  • Impact of Low Donor/Recipient Predicted Heart Mass Ratio on PGD and Survival: A Report from the Organ Heart Perfusion Registry Farr, M., Schroder, J., D'Alessandro, D., Anyanwu, A., Pal, J., Villavicencio, M., Shudo, Y., Sareyyupoglu, B., Patel, P., Couper, G., Lozonschi, L., Kai, M., Anwer, M., Daneshmand, M., Chan, J., Pretorius, V., Spielvogel, D., Skipper, E., Loebe, M., Takeda, K., Klein, L., Hooker, R., Haft, J., Meyer, D., Goldstein, D., Peltz, M., Kaczorowski, D., Kearns, M., Sun, B., Selzman, C., Ohira, S., Kilic, A., Merlo, A., Williams, C., Esmailian, F., Shaffer, A., Sulemanjee, N., Durham, L., Dowling, R., Barrus, B., Pham, D., Funamoto, M., Itoh, A., Quader, M., Pinney, S., Milano, C., Stehlik., J. ELSEVIER SCIENCE INC. 2026: 749-750

    View details for Web of Science ID 001761712600005

  • Heart Transplantation from Donation After Circulatory Death Donors: Comparison of Heart Preservation Approaches D'Alessandro, D., Schroder, J., Shudo, Y., Pal, J., Esmailian, F., Patel, P., Couper, G., Takeda, K., Skipper, E., Lozonschi, L., Anyanwu, A., Daneshmand, M., Anwer, M., Peltz, M., Dowling, R., Kaczorowski, D., Hooker, R., Kearns, M., Itoh, A., Goldstein, D., Villavicencio, M., Klein, L., Loebe, M., Kilic, A., Meyer, D., Hoffman, J., Haft, J., Sun, B., Pham, D., Barrus, B., Kai, M., Salerno, C., Arabia, F., Funamoto, M., Shaffer, A., Spielvogel, D., Selzman, C., Durham, L., Sulemanjee, N., Quader, M., Pinney, S., Farr, M., Milano, C., Stehlik, J. ELSEVIER SCIENCE INC. 2026: 62

    View details for Web of Science ID 001761688100008

  • Association of Non-English Language Proficiency Status with Heart Transplant Recipient Outcomes McMullen, H., Henricksen, E., Khush, K., Teuteberg, J., Moayedi, Y., Pak, J., Subramanian, A., Dieringer, T., Zimmet, A., Padilla, C., Martin, B., Shudo, Y. ELSEVIER SCIENCE INC. 2026: 449

    View details for Web of Science ID 001762496900024

  • Survival Benefit of Heart-Kidney Versus Heart Transplant With or Without Delayed Kidney Transplant. Journal of the American Heart Association Yajima, S., He, H., Elde, S., Zhu, Y., Woo, Y. J., Shudo, Y. 2026: e043669

    Abstract

    Simultaneous heart-kidney transplantation (SHKT) or isolated heart transplantation (IHT) benefits patients with end-stage heart disease and kidney dysfunction. Understanding the outcomes, risk factors for post-IHT kidney transplantation, and survival benefits of SHKT compared with those of IHT and kidney-after-heart transplantation can guide clinical decision-making. This study aimed to evaluate IHT outcomes, identify risk factors for post-IHT isolated kidney transplantation, and compare the survival benefits of IHT, SHKT, and kidney-after-heart transplantation.This retrospective study analyzed data from the United Network for Organ Sharing database, spanning 2000 to 2022. Adult patients (aged ≥18 years) who underwent their first IHT (n=48 069) or SHKT (n=2345) were included. Among patients undergoing IHT, 667 (1.4%) subsequently received isolated kidney transplantation. The primary outcome was patient survival, which was visualized by Kaplan-Meier analysis and assessed using the shared-frailty Cox proportional hazards model. Survival rates were compared among IHT, SHKT, and kidney-after-heart transplantation recipients. Logistic regression analysis identified risk factors for post-IHT isolated kidney transplantation.The recipient's age, body mass index, pre-IHT diabetes, prior dialysis, and estimated glomerular filtration rate were significant risk factors for post-IHT isolated kidney transplantation. Kaplan-Meier analysis showed significantly higher survival with SHKT than with IHT (1-year: 88.0% versus 85.7%; 5-year: 70.5% versus 64.1%; 10-year: 38.1% versus 30.3%; overall P=0.005). Compared with kidney-after-heart transplantation, SHKT tended to show lower short-term survival but higher long-term survival (5-year: 72.1% versus 61.9%, P=0.047; 10-year: 42.9% versus 15.8%, P<0.001).Selected patients with end-stage heart disease and kidney dysfunction derive more long-term survival benefit from SHKT than from IHT.

    View details for DOI 10.1161/JAHA.125.043669

    View details for PubMedID 41778597

  • Beating heart transplantation: A single center's initial experience and propensity-matched analysis against national registry data. JHLT open Choi, A. Y., Kapula, N., He, H., Degife, E., Krishnan, A., Ashrafi, R., Han, B., Pines, K., Henricksen, E., Elde, S., Fawad, M., Teuteberg, J. J., Khush, K. K., Luikart, H., Ruaengsri, C., Shudo, Y., MacArthur, J. W., Hiesinger, W., Woo, Y. J., Guenthart, B. A. 2026; 11: 100455

    Abstract

    Beating heart transplantation (BHT) was adopted to avoid an additional episode of cardioplegic arrest and reperfusion and reduce allograft ischemia-reperfusion injury. We sought to establish a direct comparison of outcomes between the first cohort of BHT recipients at our center and standard DCD recipients across the US.The UNOS registry was queried to identify adult recipients who underwent first-time isolated DCD HT between 12/2019-12/2023 (before the first BHT was performed outside of our center). All adult patients who underwent first-time isolated DCD BHT between 10/2022-9/2024 at our center were included. Nearest neighbor propensity-score matching was performed and groups were compared for 30-day survival, need for post-transplant mechanical circulatory support, major complications, length of stay, and 1-year survival.A total of 1083 standard DCD recipients and 31 BHT recipients were identified. Before matching, more BHT recipients required pre-transplant IABP (29% vs 9.8%, p=0.003) and ECMO (6.5% vs 0.7%, p=0.029), had higher status on the waitlist (Status 1-3; 97.5% vs. 62%, p<0.001), and spent fewer days waiting [7(5,14) vs 30(9149) days, p<0.001). After matching, BHT recipients demonstrated similar 30-day survival (100% vs 98.3%, p>0.9) and improved 1-year graft survival (100% vs 83.9%, p<0.001) compared to standard DCD recipients.Despite BHT recipients being sicker than standard DCD recipients pre-transplant, their matched survival at 30-days was similar and graft survival was improved at 1-year post-transplant. While BHT may confer excellent early post-transplant outcomes, a larger sample size and longer-term follow-up are needed to confirm the survival benefit associated with BHT.

    View details for DOI 10.1016/j.jhlto.2025.100455

    View details for PubMedID 41658237

    View details for PubMedCentralID PMC12882298

  • Heart-lung transplantation using temperature- and airway pressure-controlled donor organ preservation system JTCVS Techniques Duda, M. M., Elde, S., Pelletier, G. J., Leon, M., Verdi, K. G., Ruaengsri, C., Woo, Y., Shudo, Y. 2026

    View details for DOI 10.1016/j.xjtc.2026.102404

  • Ex Vivo Heart Perfusion Offsets Ischemic Penalties with ≥6-Hour Preservation in Adult Donation-After-Brain-Death Heart Transplantation. The Journal of thoracic and cardiovascular surgery Berg, A. R., Krishnan, A., Heng, E. E., Choi, A. Y., Zhou, A., Alnasir, D. I., Ruaengsri, Y. C., Shudo, Y., Woo, Y. J., MacArthur, J. W. 2025

    Abstract

    The 2018 UNOS allocation revision broadened sharing and lengthened preservation. Survival declines after four hours of cold ischemia, with sharper losses beyond six. Ex vivo heart perfusion (EVHP) may mitigate this risk, but real-world effectiveness in the United States is uncertain.We analyzed adult heart transplants in UNOS (January 1st, 2019- April 1st, 2025). We studied DBD hearts with preservation ≥6 hours, comparing EVHP with a No-EVHP group (pooled static and hypothermic cold storage). The primary outcome was one-year mortality; secondary outcomes were 90-day and three-year mortality, postoperative complications, and cause of death. Analyses included Kaplan-Meier estimates, Cox regression, restricted cubic splines, and 1:1 propensity matching.Of 16,859 DBD recipients, 546 had preservation ≥6 hours (EVHP n=320; No EVHP group n=226). One-year survival was higher with EVHP (92.5% vs 86.3%, p=0.029) and at three years (90.9% vs 79.6%, p<0.001). In adjusted models, the No EVHP ≥6 hours group had greater one-year mortality than EVHP ≥6 hours (hazard ratio 1.90, 95% CI 1.08-3.35, p=0.027). In a four-level model, EVHP ≥6 hours had outcomes comparable to EVHP <6 hours and the No EVHP <6 hours group, with excess risk confined to the No EVHP ≥6 hours group. Splines showed rising mortality with longer preservation in the No EVHP group and attenuation with EVHP. Postoperative complications and cause of death were similar. Benefits concentrated at higher-volume centers.In contemporary U.S. practice, EVHP was associated with improved survival for ≥6-hour preservation, particularly at high-volume programs, mitigating the survival penalty from prolonged preservation.

    View details for DOI 10.1016/j.jtcvs.2025.11.025

    View details for PubMedID 41360280

  • Invited Response Letter. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Berg, A. R., Krishnan, A., Heng, E. E., Choi, A. Y., Garrison, A. C., Alnasir, D. I., Chawannuch Ruaengsri, Y., Shudo, Y., Joseph Woo, Y., MacArthur, J. W. 2025

    View details for DOI 10.1016/j.healun.2025.11.025

    View details for PubMedID 41349593

  • Ex-vivo Heart Perfusion Attenuates Early Post-Transplant Risk After Prolonged Agonal Period in DCD Heart Transplantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Berg, A. R., Krishnan, A., Heng, E. E., Choi, A. Y., Garrison, A. C., Alnasir, D. I., Chawannuch Ruaengsri, Y., Shudo, Y., Joseph Woo, Y., MacArthur, J. W. 2025

    Abstract

    Warm ischemic injury during the agonal period (AP) threatens graft viability in donation-after-circulatory-death (DCD) heart transplantation. Whether ex-vivo heart perfusion (EVHP) mitigates these risks remains unclear. ex-vivo METHODS: Adult (≥ 18 y) isolated heart transplants reported to the UNOS thoracic registry (January 2019-April 2025) were reviewed. Recipients lacking AP or perfusion data were excluded. The primary exposure was EVHP, defined as use of an ex-vivo perfusion device following donor cardiectomy; static cold storage served as the reference. Multivariable Cox and logistic models adjusted for donor, recipient, procedural, and center-level factors. Propensity score matching was performed in the prolonged AP subgroup.Among 1,682 DCD recipients, 1,175 (69.9%) received EVHP. Prolonged AP (≥30 min) occurred in 359 cases. One-year survival was 90.7% overall. In the fully adjusted Cox model, no-EVHP grafts with AP ≥30 min had higher 1-year mortality versus the reference (no-EVHP + <30 min) (HR 2.17; 95% CI 1.05-4.47; p=0.037). EVHP grafts showed no excess risk regardless of AP (EVHP + <30 min: HR 0.93; 95% CI 0.54-1.62; p=0.809; EVHP + ≥30 min: HR 0.98; 95% CI 0.49-1.96; p=0.953). Age, creatinine, out-of-body time, and ACHD increased mortality; VAD at listing and high-volume centers were protective; sex was not significant. In the AP ≥30-min PSM subgroup (n=240; 120 EVHP, 120 no EVHP), EVHP improved 1-year survival (log-rank p=0.03). Spline modeling showed rising mortality beginning ~20 minutes of AP for static-preserved grafts, with a flat risk curve under EVHP. Static-preserved prolonged-AP grafts had higher odds of acute rejection before discharge (aOR 2.56; 95% CI 1.07-6.14; p=0.04); stroke, dialysis, and pacemaker use did not differ.EVHP may mitigate survival and rejection penalties of prolonged AP in U.S. DCD heart transplantation. Broader EVHP adoption for donors with AP ≥ 30 min may safely expand the DCD heart pool without compromising outcomes.

    View details for DOI 10.1016/j.healun.2025.10.012

    View details for PubMedID 41241031