Stephanie Hsiao, MD

All Publications

• Cardiac Allograft Vasculopathy in the Era of Precision Medicine: The Role of Biomarkers and Advanced Imaging. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Kim, J. S., Brashear, T. K., Collins, B., Valantine, H., Khush, K. K., Tapaskar, N., Hsiao, S., Njoroge, J. N. 2025

  Abstract

  Cardiac allograft vasculopathy (CAV) remains a leading cause of mortality among heart transplant recipients with morbid complications including graft dysfunction, arrhythmias, and sudden cardiac death. While few medications may reduce the incidence of CAV, the only true treatment for prevalent severe CAV is retransplantation. Current practice is limited with few validated tools for predicting these complications or informing appropriate timing for retransplantation. In this review, we highlight novel molecular and imaging markers of CAV incidence and prognosis and propose future applications to improve precise risk stratification and management of CAV.

  View details for DOI 10.1016/j.healun.2025.12.019

  View details for PubMedID 41456623

• Fifty-Year Pediatric Heart Transplant Outcomes: A Pediatric-Adult Center Linked Analysis. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Hollander, S. A., Hsiao, S., Varshney, A. S., Luikart, H., Raissadati, A., Bernstein, D., Ma, M., Wujcik, K., Barkoff, L., Dykes, J., Lee, D., Rosenthal, D. N. 2025

  Abstract

  Long-term outcomes after pediatric heart transplant (pHT) are rarely reported owing to young programs and loss of follow-up after transition to adult care. We leveraged our program age, center volume, and linked electronic medical record (EMR) to analyze 50-year outcomes after pHT, including events after adult care transfer.Retrospective review of all pHT over 50 years at Stanford (8/19/1974-8/19/2024). Patient characteristics and post-transplant outcomes, including death, retransplant, and subsequent kidney transplantation, were ascertained from the pediatric and adult EMRs, public records, and personal communication with other centers.There were 567 pHTs in 540 patients. Status as of 8/19/2024 was confirmed for 526 (97%),11 (2%) had partial follow-up, and 3 were missing. Over 1,888,341 follow-up days, 50 (9%) received a 2nd heart transplant (HT) (27 pediatric, 23 adult) after a median of 9 (5, 14) years; 3 (1%) received a 3rd HT; 6 (1%) received a subsequent kidney transplant, and 212 (39%) died (172 pediatric, 40 adult). Median survival was 16.7 years; survival improved in successive eras (P<0.001).This linked analysis of pediatric and adult programs shows excellent long-term pHT outcomes with median survival exceeding 15 years and improving. Nearly half of retransplants occur after transfer; subsequent kidney transplant occurs infrequently.

  View details for DOI 10.1016/j.healun.2025.10.022

  View details for PubMedID 41297732

• Trends and Innovations in Heart Transplantation: Donor Procurement, Organ Preservation, and Evolving Therapies CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE Hsiao, S., Alfaris, I., Varshney, A., Khush, K. 2025; 27 (1)

  View details for DOI 10.1007/s11936-025-01120-3

  View details for Web of Science ID 001595017100002

• Recognition of the Large Ambulatory C2D Stage of Advanced Heart Failure-A Call to Action. JAMA cardiology Dunlay, S. M., Pinney, S. P., Lala, A., Stewart, G. C., McIlvennan, C., Wong, R. P., Morris, A. A., Pagani, F. D., Allen, L. A., Breathett, K., Cogswell, R., Colvin, M. M., Cowger, J. A., Drakos, S. G., Gelfman, L. P., Kanwar, M. K., Kiernan, M. S., Kittleson, M. M., Lewis, E. F., Moazami, N., Ogunniyi, M. O., Pandey, A., Rogers, J. G., Schumacher, K. R., Slaughter, M. S., Tedford, R. J., Teuteberg, J., Valantine, H. A., DeFilippis, E. M., Dixon, D. D., Golbus, J. R., Gulati, G., Hanff, T. C., Hsiao, S., Lewsey, S. C., McCormick, A. D., Nayak, A., Fenton, K. N., Longacre, L. S., Shanbhag, S. M., Taddei-Peters, W. C., Stevenson, L. W. 2025

  Abstract

  The advanced ambulatory heart failure (HF) population comprises patients who have progressed beyond the pillars of recommended stage C HF therapies but can still find meaningful life-years ahead. Although these patients are commonly encountered in practice, national databases selectively capture the small groups accepted for heart transplant listing or left ventricular assist devices. The epidemiology, trajectories, and therapies for other ambulatory patients with advanced HF are poorly understood.In December 2022, the National Heart, Lung and Blood Institute convened a team of experts to identify knowledge gaps and research priorities for the ambulatory population with limiting daily symptoms and transition toward refractory end-stage D HF, designated as stage C2D. This article summarizes the findings from that 3-day workshop. Workshop participants surveyed the initial challenges and knowledge gaps for (1) recognition of ambulatory C2D HF, (2) estimation of the magnitude of the affected population and identifiable subpopulations, and (3) physiologic phenotypes, such as low cardiac output, right HF, cardiorenal syndromes, congestive hepatopathy and frailty, which offer distinct targets for existing and emerging therapies. Social drivers of HF and patient preferences for quality/length of survival were highlighted as essential modifiers for personalization of therapies.Ten key points summarized workshop findings, with target cohorts for study proposed as a crucial next step. This workshop summary is intended as a call for action to address knowledge gaps and develop new strategies to improve outcomes in the large ambulatory population with C2D HF.

  View details for DOI 10.1001/jamacardio.2024.5328

  View details for PubMedID 39908057

• Validating the Association Between Composite Metrics of Guideline-Directed Medical Therapy (GDMT) and Clinical Outcomes for Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). Journal of cardiac failure Steverson, A., Calma, J., Hsiao, S., Sallam, K., Varshney, A. S., Golbus, J. R., Heidenreich, P. A., Sandhu, A. T. 2024

  View details for DOI 10.1016/j.cardfail.2024.08.054

  View details for PubMedID 39357668

• Uptake of sodium-glucose cotransporter-2 inhibitors in hospitalized patients with heart failure: insights from the veterans affairs healthcare system. Journal of cardiac failure Varshney, A. S., Calma, J., Kalwani, N. M., Hsiao, S., Sallam, K., Cao, F., Din, N., Schirmer, J., Bhatt, A. S., Ambrosy, A. P., Heidenreich, P., Sandhu, A. T. 2024

  Abstract

  The use of sodium-glucose cotransporter-2 inhibitor (SGLT2i) in Veteran Affairs (VA) patients hospitalized with heart failure (HF) has not been previously reported.VA electronic health record data were used to identify patients hospitalized for HF (primary or secondary diagnosis) from 01/2019-11/2022. Patients with SGLT2i allergy, advanced/end-stage chronic kidney disease (CKD), or advanced HF therapies were excluded. We identified factors associated with discharge SGLT2i prescription among hospitalizations in 2022. We also compared SGLT2i and angiotensin receptor-neprilysin inhibitor (ARNI) prescription rates. Hospital-level variation in SGLT2i prescription was assessed via the median odds ratio.A total of 69,680 patients were hospitalized for HF; 10.3% were prescribed SGLT2i at discharge (4.4% newly prescribed, 5.9% continued pre-admission therapy). SGLT2i prescription increased over time and was higher in patients with HFrEF and primary HF. Among 15,762 patients hospitalized in 2022, SGLT2i prescription was more likely in patients with diabetes (adjusted odds ratio [aOR] 2.27; 95% confidence interval [CI]: 2.09-2.47) and ischemic heart disease (aOR 1.14; 95% CI: 1.03-1.26). Patients with increased age (aOR 0.77 per 10 years; 95% CI: 0.73-0.80) and lower systolic blood pressure (aOR 0.94 per 10mmHg; 95% CI: 0.92-0.96) were less likely to be prescribed SGLT2i, and SGLT2i prescription was not more likely in patients with CKD (aOR 1.07; 95% CI 0.98-1.16). The adjusted median odds ratio suggested a 1.8-fold variation in the likelihood that similar patients at 2 random VA sites were prescribed SGLT2i (range 0%-21.0%). In patients with EF ≤40%, 30.9% were prescribed SGLT2i while 26.9% were prescribed ARNI (p<0.01).One-tenth of VA patients hospitalized for HF were prescribed SGLT2i at discharge. Opportunities exist to reduce variation in SGLT2i prescription across hospitals and promote use in patients with CKD and older age.

  View details for DOI 10.1016/j.cardfail.2023.12.018

  View details for PubMedID 38281540

• Donor selection for multiorgan transplantation. Current opinion in organ transplantation Hsiao, S., Khush, K. K. 1800; 27 (1): 52-56

  Abstract

  PURPOSE OF REVIEW: There is limited data and guidance on donor selection for multiorgan transplantation. In this article, we review the current Organ Procurement and Transplantation Network policy on multiorgan allocation and the ideal donor criteria for each specific organ, in order to provide a framework to guide donor selection for various scenarios of multiorgan transplantation, including heart-kidney, heart-lung, heart-liver and heart-kidney-liver transplant procedures.RECENT FINDINGS: Combined heart-kidney transplantation is the most common multiorgan transplant procedure and requires the most stringent HLA matching to ensure optimal graft survival. Using the virtual crossmatch and desensitization therapies can shorten waitlist times without increasing posttransplant rejection or mortality rates. The ideal heart-lung donor tends to be younger than other multiorgan transplants, and more tolerant to HLA mismatch, but ideally requires donors with no prior history of smoking, a short period of time on mechanical ventilation, adequate oxygenation and absence of pulmonary infection. The ideal heart-liver donor is often driven by criteria specific to the donor heart. Finally, several observational studies suggest that livers are more tolerant to HLA mismatch than other organs, and offer some degree of immune protection in combined organ transplants.SUMMARY: Multiorgan transplantation is a steadily growing field. The required short ischemic time for the donor heart is often the limiting factor, as well as the scarcity of appropriate donors available within geographical confines. In general, as with single organ transplantation, younger age, size matching, few medical comorbidities and HLA compatibility confer the best posttransplant outcomes.

  View details for DOI 10.1097/MOT.0000000000000940

  View details for PubMedID 34939964