Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Background: Shortage of organ donors in the Republic of Korea has become a major problem. To address this, it has been questioned whether heart transplant (HTx) allocation should be modified to reduce priority of older patients. We aimed to evaluate post-HTx outcomes according to recipient age and specific pre-HTx conditions using a nationwide prospective cohort. Methods: We analyzed clinical characteristics of 628 patients from the Korean Organ Transplant Registry who received HTx from January 2015 to December 2020. Enrolled recipients were divided into three groups according to age. We also included comorbidities including ambulatory status. Non-ambulatory status was defined as pre-HTx support with either extracorporeal membrane oxygenation, continuous renal replacement therapy, or mechanical ventilation. Results: Of the 628 patients, 195 were < 50 years, 322 were 50–64 years and 111 were ≥ 65years at transplant. Four hundred nine (65.1%) were ambulatory and 219 (34.9%) were nonambulatory. Older recipients tended to have more comorbidities, ischemic cardiomyopathy, and received older donors. Post-HTx survival was significantly lower in older recipients (P = 0.025) and recipients with non-ambulatory status (P < 0.001). However, in contrast to non-ambulatory recipients who showed significant survival differences according to the recipient’s age (P = 0.004), ambulatory recipients showed comparable outcomes (P = 0.465). Conclusion Our results do not support use of age alone as an allocation criterion. Transplant candidate age in combination with some comorbidities such as non-ambulatory status may identify patients at a sufficiently elevated risk at which suitability of HTx should be reconsidered.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Background and Objectives: The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group. Results: For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332). Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Purpose: Optimal treatment for stage IIIA/N2 non–small cell lung cancer (NSCLC) is controversial. We aimed to assess the efficacy and safety of adjuvant pembrolizumab for stage IIIA/N2 NSCLC completely resected after neoadjuvant concurrent chemoradiation therapy (CCRT). Materials and Methods: In this open-label, single-center, single-arm phase 2 trial, patients with stage IIIA/N2 NSCLC received adjuvant pembrolizumab for up to 2 years after complete resection following neoadjuvant CCRT. The primary endpoint was disease-free survival (DFS). Secondary endpoints included overall survival (OS) and safety. As an exploratory biomarker analysis, we evaluated the proliferative response of blood CD39+PD-1+CD8+ T cells using fold changes in the percentage of proliferating Ki-67+ cells from days 1 to 7 of cycle 1 (Ki-67D7/D1). Results: Between October 2017 and October 2018, 37 patients were enrolled. Twelve (32%) and three (8%) patients harbored EGFR and ALK alterations, respectively. Of 34 patients with programmed cell death ligand 1 assessment, 21 (62%), nine (26%), and four (12%) had a tumor proportion score of < 1%, 1%-50%, and ≥ 50%, respectively. The median follow-up was 71 months. The median DFS was 22.4 months in the overall population, with a 5-year DFS rate of 29%. The OS rate was 86% at 2 years and 76% at 5 years. Patients with tumor recurrence within 6 months had a significantly lower Ki-67D7/D1 among CD39+PD-1+CD8+ T cells than those without (p=0.036). No new safety signals were identified. Conclusion Adjuvant pembrolizumab may offer durable disease control in a subset of stage IIIA/N2 NSCLC patients after neoadjuvant CCRT and surgery.