JHLT Open最新文献

{"title":"Specific risk factors for heart-lung transplantation","authors":"Justin Issard ,&nbsp;Jérôme Le Pavec ,&nbsp;Gaelle Dauriat ,&nbsp;Estibaliz Valdeolmillos ,&nbsp;Sébastien Hascoet ,&nbsp;Jean Noel Andarelli ,&nbsp;Sylvain Diop ,&nbsp;Thibaut Genty ,&nbsp;Laurent Savale ,&nbsp;Olaf Mercier ,&nbsp;Elie Fadel","doi":"10.1016/j.jhlto.2025.100389","DOIUrl":"10.1016/j.jhlto.2025.100389","url":null,"abstract":"<div><h3>Background</h3><div>Heart-lung transplantation (HLTx) has become increasingly rare, with fewer than 50 procedures performed annually worldwide. This decline reflects evolving indications, notably the predominance of Eisenmenger syndrome (ES) complicating congenital heart disease (CHD). HLTx remains a complex procedure associated with significant perioperative and long-term risks, particularly in this patient population.</div></div><div><h3>Methods</h3><div>This review synthesizes current literature and registry data to identify specific risk factors associated with HLTx in its modern indications. It examines changes in patient selection, timing of listing, perioperative challenges, and postoperative outcomes, with a focus on ES and CHD-related cases.</div></div><div><h3>Results</h3><div>HLTx candidates often present with prior thoracic surgeries, polycythemia, systemic arterial collaterals, and multi-organ dysfunction, all contributing to increased surgical complexity and bleeding risk. Long waitlist times and donor shortages further complicate management. Despite these challenges, recent data from expert centers show improved early survival, with 1-year survival rates exceeding 85%. HLTx may offer protective effects against chronic graft dysfunctions such as bronchiolitis obliterans syndrome and coronary artery vasculopathy compared to isolated organ transplants.</div></div><div><h3>Conclusions</h3><div>HLTx remains the treatment of choice for select patients with complex cardiopulmonary disease, particularly ES with CHD. Optimizing outcomes requires early referral, careful risk stratification, and management in high-volume expert centers. Advances in surgical techniques and perioperative care have improved survival, but HLTx continues to demand multidisciplinary expertise and individualized patient assessment.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100389"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD38-targeted therapy with Daratumumab in clinical lung transplantation: A single-center experience","authors":"Caroline Hillebrand ,&nbsp;Giuseppe Maggioni ,&nbsp;Sophia Auner ,&nbsp;Panja Maria Boehm ,&nbsp;Daniela Koren ,&nbsp;Zsofia Kovacs ,&nbsp;Stefan Schwarz ,&nbsp;Gottfried Fischer ,&nbsp;Antonia Müller ,&nbsp;Renate Kain ,&nbsp;Konrad Hoetzenecker ,&nbsp;Clemens Aigner ,&nbsp;Fiorella Calabrese ,&nbsp;Peter Jaksch ,&nbsp;Alberto Benazzo","doi":"10.1016/j.jhlto.2025.100386","DOIUrl":"10.1016/j.jhlto.2025.100386","url":null,"abstract":"<div><h3>Background</h3><div>Antibody-mediated rejection remains a major threat to long-term graft function after lung transplantation. Current therapies aim to eliminate circulating antibodies and suppress B-cell-activity but often fail to reduce donor-specific antibodies. Daratumumab, a monoclonal antibody targeting CD38, has shown potential in depleting antibody-producing plasma cells. This study investigates the clinical application of daratumumab in lung transplant recipients.</div></div><div><h3>Methods</h3><div>We performed a retrospective single-center study including all lung transplant recipients treated with subcutaneous daratumumab for antibody-mediated rejection A total of 14 patients with newly developed donor-specific antibodies and clinical antibody-mediated rejection were analyzed.</div></div><div><h3>Results</h3><div>In all patients with AMR, antibodies directed against human leukocyte antigen class I decreased to less than 25–50% of baseline levels within 12 weeks. Antibodies against class II also declined in 5 patients. Eleven patients survived the initial AMR episode. Chronic lung allograft dysfunction was already present in several patients before the AMR episode, while others developed CLAD during follow-up. The treatment was generally well tolerated with the most common side effects being leukopenia, hypogammaglobulinemia and infections.</div></div><div><h3>Conclusions</h3><div>CD38-targeted therapy with daratumumab may represent a promising addition to the antibody mediated rejection treatment panel.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical impact of an upfront RVAD strategy in HeartMate 3 LVAD recipients with severe early right ventricular failure requiring temporary mechanical support","authors":"Marta Lorente-Ros MD ,&nbsp;Mohammad S. Husain MD ,&nbsp;Miguel Pinilla-Vera MD ,&nbsp;Richa Gupta MD ,&nbsp;Rosaria S. Prasad MD ,&nbsp;Blanca Simon Frances MD ,&nbsp;Jiling Chou ,&nbsp;Ajay Kadakkal MD ,&nbsp;Alexander I. Papolos MD ,&nbsp;Benjamin B. Kenigsberg MD ,&nbsp;Michael Hockstein MD ,&nbsp;Ezequiel J. Molina MD ,&nbsp;Keki Balsara MD, MBA ,&nbsp;Farooq H. Sheikh MD ,&nbsp;Phillip H. Lam MD","doi":"10.1016/j.jhlto.2025.100388","DOIUrl":"10.1016/j.jhlto.2025.100388","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist device (LVAD) recipients are at risk of developing early right ventricular failure (RVF), at times necessitating temporary mechanical support with right ventricular assist device (RVAD). The optimal timing of RVAD implantation in these patients is unclear. The aim of this study is to compare clinical outcomes between upfront RVAD (U-RVAD) and rescue RVAD (R-RVAD) in LVAD recipients with early RVF.</div></div><div><h3>Methods</h3><div>In this single-center retrospective cohort study, we included all patients who underwent HeartMate 3 (HM3) LVAD implant and required temporary RVAD for severe early RVF (30 days of LVAD implantation), from January 2019 to September 2024. U-RVAD was defined as RVAD use during the index LVAD operation. Baseline characteristics, perioperative outcomes, and mortality were compared between patients with U-RVAD and those with R-RVAD.</div></div><div><h3>Results</h3><div>During the study period, 402 patients underwent HM3 LVAD implantation, of whom 64 received temporary RVAD for severe early RVF (mean age 57 years, 27% female). Thirty-six received U-RVAD. The incidence of perioperative atrial arrhythmia and renal replacement therapy was lower in patients who received U-RVAD compared to those who received R-RVAD (<em>p</em> = 0.041 and 0.008, respectively). In-hospital and 90-day all-cause mortality occurred in 11 (31%) and 12 (33%) patients receiving U-RVAD and 16 (57%) and 19 (68%) patients receiving R-RVAD, respectively. On binary logistic regression, U-RVAD was associated with lower 90-day mortality (adjusted odds ratio 0.23, 95% confidence interval 0.06-0.80).</div></div><div><h3>Conclusions</h3><div>In HM3 LVAD recipients with severe early RVF requiring RVAD, U-RVAD was associated with improved clinical outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100388"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension after bilateral lung transplantation","authors":"Bianca Battilana MD ,&nbsp;Jan Mengers MD ,&nbsp;György Lang MD ,&nbsp;Martina Haberecker MD ,&nbsp;Claudio Caviezel MD ,&nbsp;Macé M. Schuurmans MD ,&nbsp;Silvia Ulrich MD ,&nbsp;Isabelle Opitz MD FEBTS, Prof. Dr. med.","doi":"10.1016/j.jhlto.2025.100385","DOIUrl":"10.1016/j.jhlto.2025.100385","url":null,"abstract":"<div><h3>Case report</h3><div>A 30-year-old woman suffering from diffuse interstitial lung disease underwent bilateral lung transplantation in 2008. A high-risk bilateral pulmonary embolism (PE) occurred in 2020 after deep venous thrombosis. After lysis (Endovascular System and oral anticoagulation), 1-year follow-up imaging showed a persisting thrombus-load (Fig. 1). Right heart catheterization (RHC) 18 months after PE showed s/m/dPAP of 51/34/25mmHg, PVR of 5.6WU and CO 4.43l/min. Echocardiography demonstrated right ventricular dilation with impaired radial and longitudinal function. She reported worsening dyspnea (NYHA III) and impaired lung function (FEV1 1.3 l, DLCO 43%, best post-transplant value: FEV1 2.44 l, DLCO 68%) without diagnosis of CLAD. CT-imaging showed organized thrombotic material in the right inferior lobe and left pulmonary artery (Fig. 1). In 2022, bilateral PEA under deep hypothermic circulatory arrest was performed. On the right, multiple segments were obliterated, whereas in the left main trunk a cone-shaped occlusion of the complete left main PA at the level of the anastomosis was resected in addition to peripheral lesions (Fig. 1 and 2). Histopathological evaluation revealed cartilaginous metaplasia of the tunica intima (Fig. 2). This phenomenon represents a vascular remodeling process in which chronic thromboembolic injury, inflammation, TGF-<em>β</em>1-mediated vascular smooth muscle cell transdifferentiation, and transplant-related stress collectively drive the formation of cartilage-like tissue, resulting in irreversible maladaptive remodeling and pulmonary hypertension.</div><div>The patient was extubated on the first postoperative day and discharged to rehabilitation after 14 days. After 7 weeks, she reported improved performance (NYHA I), and echocardiography showed decreased sPAP (from 45 to 37 mmHg). 18-month postoperatively the patient was in an excellent condition, reported further improvements in performance (NYHA I) and RHC showing s/m/dPAP of 30/19/11mmHg, PVR 4.1WU and CO 3.65l/min.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100385"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adults with congenital heart disease experience worse short- and mid-term graft survival following heart transplantation from DCD donors: The early US experience","authors":"Alexander R. Berg BS ,&nbsp;Danielle M. Mullis BS ,&nbsp;Aravind Krishnan MD ,&nbsp;Elbert E. Heng MD ,&nbsp;Nataly Montano Vargas BS ,&nbsp;Daniel I. Alnasir BS ,&nbsp;Alyssa C. Garrison MS ,&nbsp;Y. Joseph Woo MD ,&nbsp;John W. MacArthur MD","doi":"10.1016/j.jhlto.2025.100383","DOIUrl":"10.1016/j.jhlto.2025.100383","url":null,"abstract":"<div><h3>Background</h3><div>Donation-after-circulatory-death (DCD) heart procurement is enlarging the donor pool, yet its safety in adults with congenital heart disease (ACHD) is uncertain. We compared early (90-day) and mid-term (3-year) graft outcomes after DCD versus donation-after-brain-death (DBD) heart transplantation in ACHD recipients.</div></div><div><h3>Methods</h3><div>Using the United Network for Organ Sharing registry (1 January 2018 – 1 April 2025), we identified adults (≥18 y) with ACHD undergoing isolated heart transplantation. Retransplants and multiorgan procedures were excluded. The primary endpoint was graft failure (death or retransplant). Survival was analysed with Kaplan-Meier curves, multivariable Cox models, and 1:1 nearest-neighbor propensity-score matching (caliper = 0.25 SD) adjusting for donor and recipient age, sex, body-mass index, renal and hepatic function, support devices, listing status, prior sternotomy, and regional ACHD center volume.</div></div><div><h3>Results</h3><div>Among 726 ACHD transplants, 61 (8.4%) used DCD grafts and 665 (91.6%) used DBD grafts. Baseline clinical characteristics were similar, although DCD grafts had longer ischemic times (median 5.3 h vs 3.8 h, p &lt; 0.001) and more frequent exvivo perfusion (65% vs 5.8%). Unadjusted 90-day and 3-year graft survival were lower after DCD (log-rank p = 0.009 and 0.040, respectively). On multivariable analysis, DCD procurement remained an independent risk factor for graft failure at 90 days (HR 2.56, 95% CI 1.23–5.17) and 3 years (HR 2.11, 95% CI 1.03–3.50).</div><div>Propensity-matched analysis (n = 148) confirmed inferior 90-day survival for DCD recipients (log-rank p = 0.020). Post-operative morbidity and length of stay did not differ between groups.</div></div><div><h3>Conclusions</h3><div>In the early US experience, ACHD recipients of DCD hearts experienced significantly worse short- and mid-term graft survival than those receiving DBD hearts, despite comparable peri-operative morbidity. Until preservation strategies further mitigate warm-ischemic injury, careful candidate selection is warranted when allocating DCD grafts to complex ACHD patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A structured institutional framework for establishing a living allogenic valve transplant program","authors":"Muhammad Faateh MBBS,&nbsp;Muhammad Aanish Raees MD,&nbsp;Yacmet Colón Berríos MSN, RN,&nbsp;Amra Zekic MSN, RN,&nbsp;Hosam F. Ahmed MD, PhD,&nbsp;Tara Karamlou MD, MSc,&nbsp;James F. Cnota MD,&nbsp;Benjamin S. Mantell MD, PhD,&nbsp;David L.S. Morales MD,&nbsp;Awais Ashfaq MD, FACS, FACC, Associate Professor","doi":"10.1016/j.jhlto.2025.100384","DOIUrl":"10.1016/j.jhlto.2025.100384","url":null,"abstract":"<div><div>Living allogenic valve transplantation (LAVT) refers to transplantation of viable human heart valves in an orthotopic or heterotopic fashion and has recently garnered significant interest for children in need of a living, growing, regenerating valve replacement option. However, at present, there is no standardized approach for establishing and implementing such a program. We provide a practical, step-by-step blueprint of the operational, administrative and regulatory requirements needed to establish an LAVT program based on our center's experience.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100384"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Aspergillus molds","authors":"Emily M. Eichenberger MD, MHS ,&nbsp;Maria Alejandra Mendoza MD ,&nbsp;John W. Baddley MD, MSPH","doi":"10.1016/j.jhlto.2025.100382","DOIUrl":"10.1016/j.jhlto.2025.100382","url":null,"abstract":"<div><div>Non-<em>Aspergillus</em> molds, including Mucorales, <em>Scedosporium, Lomentospora,</em> and <em>Fusarium</em> species, are a significant cause of morbidity and mortality in heart and lung transplant recipients. These organisms have a marked propensity for angioinvasion leading to thrombosis and tissue infarction and disseminated infection. General risk factors for infection with these non-<em>Aspergillus</em> molds include older age, augmented immunosuppression (e.g., hypogammaglobulinemia, neutropenia, T-cell depletion), presence of endobronchial stent, and airway ischemia. Infection is uncommon, but in many cases may ensue following respiratory colonization, particularly in lung transplant recipients. Timing of infection varies, although many invasive fungal infections occur within the first year following transplantation. Diagnosis is challenging and often delayed. Imaging is recommended to localize infection and to guide sampling of infected tissue for culture and histopathology. Management of these rare molds in lung and heart transplant recipients presents a major therapeutic challenge due to intrinsic resistance patterns, delayed diagnosis, and the complex pharmacologic interactions in this population. In general, lipid preparations of amphotericin B or azole antifungals (voriconazole, posaconazole, isavuconazole) are frequently used for treatment. Investigational therapies such as fosmanogepix or olorofim are promising as future treatment modalities for some of these difficult-to-treat non-<em>Aspergillus</em> molds<em>.</em></div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100382"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncharted territories on pediatric heart and lung transplant patients’ health-related quality of life: A scoping review","authors":"Fabienne Dobbels MSc, PhD ,&nbsp;Nathalie Duerinckx APN, PhD","doi":"10.1016/j.jhlto.2025.100378","DOIUrl":"10.1016/j.jhlto.2025.100378","url":null,"abstract":"<div><h3>Background</h3><div>Although survival is good after pediatric heart transplantation (HTx) and steadily improving after pediatric lung transplantation (LTx), it remains unclear whether this also translates into a satisfactory health-related quality of life (HRQOL).</div></div><div><h3>Methods</h3><div>This scoping review summarizes the findings on pediatric patients’ overall HRQOL after HTx or LTx published in PubMed up to January 23, 2025. Data on study design, population characteristics, measurement methods, HRQOL definitions, and results are tabulated and described narratively for HTx and LTx separately.</div></div><div><h3>Results</h3><div>Twenty-seven papers covering 24 original studies (3 qualitative and 21 quantitative) report on pediatric HTx’ patients HRQOL. Most quantitative studies indicate that their HRQOL is generally good, both during childhood and into adulthood, and is comparable to that of healthy peers or children with other chronic conditions. However, the 3 qualitative studies portray more varied experiences, with the post-Tx trajectory being marked by ups and downs. Only 4 papers focus on pediatric LTx patients’ HRQOL. The 2 prospective studies show a favorable HRQOL early post-Tx, while the 2 qualitative studies also report more mixed experiences. Nevertheless, studies are generally small, do not define HRQOL, use diverse measures, and exhibit substantial exclusion and refusal rates.</div></div><div><h3>Conclusions</h3><div>While most studies present an optimistic view of pediatric patients’ HRQOL, these findings should be interpreted with caution due to the methodological heterogeneity and selection bias present within the current evidence base. This review offers several directions for methodological improvement in future research, aiming to deepen our understanding of HRQOL in ALL pediatric cardiothoracic transplant patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100378"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of skin cancer in heart transplant recipients: Impact of immunosuppressive regimens","authors":"Matteo Marro ,&nbsp;Gabriele Roccuzzo ,&nbsp;Erika Simonato ,&nbsp;Gustavo Alfredo Sobrino Avellaneda ,&nbsp;Giulia Rocco ,&nbsp;Antonio Loforte ,&nbsp;Mauro Rinaldi ,&nbsp;Simone Ribero ,&nbsp;Massimo Boffini","doi":"10.1016/j.jhlto.2025.100380","DOIUrl":"10.1016/j.jhlto.2025.100380","url":null,"abstract":"<div><h3>Background</h3><div>Skin cancer is the most common post-transplant malignancy. We aimed to determine the incidence, timing, risk factors, and survival impact of skin cancer in heart transplant (HTx) recipients over long-term follow-up.</div></div><div><h3>Methods</h3><div>This retrospective, single-center cohort study analyzed 568 HTx patients surviving &gt;1 year (1990-2024). Patients with ≥1 histologically confirmed skin malignancy were compared to matched controls without skin cancer. Demographics, transplant characteristics, and immunosuppressive regimens were assessed. Logistic regression and Cox models identified independent risk factors for skin cancer and survival.</div></div><div><h3>Results</h3><div>Of 568 eligible patients, 42 (7.4%) developed skin cancer after a median of 15.5 years. Basal cell carcinoma was most common (54.7%), followed by squamous cell carcinoma (SCC, 33.3%). Immunosuppression with calcineurin inhibitor (CNI) plus azathioprine (AZA) was independently associated with increased skin cancer risk (odds ratio [OR] 9.41, <em>p</em> = 0.044), especially for SCC (OR 6.6, <em>p</em> = 0.027). Median time to first skin tumor onset was shortest with CNI + AZA (6 years, <em>p</em> = 0.0014) compared to other AZA-free immunosuppressive regimens. Overall survival (OS) did not differ significantly between skin cancer and control groups (<em>p</em> = 0.485), but SCC was independently associated with reduced OS (HR 2.14, <em>p</em> = 0.05).</div></div><div><h3>Conclusions</h3><div>Skin cancer is a relevant long-term complication after HTx, particularly SCC in patients receiving AZA. Our findings support limiting AZA use and reinforce the importance of structured dermatologic surveillance and early mammalian target of rapamycin conversion strategies to improve long-term outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100380"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving nutrition in pediatric heart failure","authors":"Shannon Oliver MBBS ,&nbsp;Stephanie Lavoie RD ,&nbsp;Chentel Cunningham NP,PhD ,&nbsp;Jennifer Conway MD","doi":"10.1016/j.jhlto.2025.100379","DOIUrl":"10.1016/j.jhlto.2025.100379","url":null,"abstract":"<div><div>Heart failure occurs in 0.9 to 3 per 100,000 children, and can be the result of either structural heart disease, genetic, or acquired cardiomyopathies. Malnutrition remains a major concern in this population, and results from the complex interplay between decreased dietary intake, decreased absorption, and an altered metabolic state. Assessing nutritional status remains a challenge, with conventional anthropometric measures often being unsuitable. To this end, the Subjective Global Nutrition Assessment has been developed and this, in combination with indirect calorimetry, can be used to give a better estimate of a child’s nutritional status and caloric needs. Determining the best way to meet these needs requires a multidisciplinary team approach, determining both the most appropriate feeding route and most appropriate type of feed. This is particularly important with the trend toward blended feeds, as these feeds must not only meet protein-energy requirements but must also not exceed daily sodium requirements or fluid restrictions. To further optimize heart failure through nutrition, the use of micronutrient supplementation has evolved. In particular, optimizing vitamin D, selenium, and iron has been shown to be beneficial from a heart failure management perspective. As nutrition plays such a vital role in the medical optimization of pediatric patients with heart failure, it is important to acknowledge the impact this can have on the child and the family unit.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}