Shudo Y, Wang H, Lingala B, et al. - Researchers utilized data from the United Network for Organ Sharing database to examine the link between donor and recipient risk factors and outcomes after heart-lung transplantation (HLTx). Overall, 997 adults were included, with stratification into cohorts of those who were alive without retransplant at 1 year (n = 664) and those who died or had retransplantation within 1 year of HLTx (n = 333). Significant predictors of mortality or retransplant, as revealed in multivariable analysis, were advanced donor age, recipient male sex, recipient extracorporeal membrane oxygenation support, transplant year, and transplantation at low-volume and medium-volume centers vs high-volume centers. By taking the strong impact of donor age, recipient sex, recipient hemodynamic status, and transplant center volume into account, improved HLTx results may be achieved. Transplantation may still be considered for marginal donors and recipients with no significant factors adding to poor post-HLTx results, potentially with less influence on the risk of early postoperative mortality or retransplant.