JHLT Open最新文献

{"title":"Trends in primary graft dysfunction and early mortality following lung transplantation: A single center experience","authors":"Yuriko Terada ,&nbsp;Michael K. Pasque ,&nbsp;Chad A. Witt ,&nbsp;Ruben G. Nava ,&nbsp;Benjamin D. Kozower ,&nbsp;G. Alexander Patterson ,&nbsp;Daniel Kreisel ,&nbsp;Varun Puri ,&nbsp;Ramsey R. Hachem ,&nbsp;Tsuyoshi Takahashi","doi":"10.1016/j.jhlto.2026.100488","DOIUrl":"10.1016/j.jhlto.2026.100488","url":null,"abstract":"<div><h3>Objectives</h3><div>Although the long-term prognosis after lung transplantation has improved recently, primary graft dysfunction (PGD) remains the major cause of early mortality. The aim of this study was to elucidate trends in PGD incidence and short-term mortality following lung transplantation in the contemporary era.</div></div><div><h3>Methods</h3><div>We analyzed a single-center database of lung transplantations performed across three periods (Era 1: 2009–2013, Era 2: 2014–2017, and Era 3: 2018–2021). PGD was graded according to the 2016 International Society for Heart and Lung Transplantation definition, and PGD grade 3 within T0–T72 was used as the primary outcome. Trends in PGD incidence, factors associated with PGD, and early mortality rates after lung transplantation were identified.</div></div><div><h3>Results</h3><div>This study included 856 lung transplants: 277 in Era 1, 296 in Era 2, and 283 in Era 3. PGD grade 3 incidence decreased significantly over time: 35.9% (99 cases) in Era 1, 26.4% (78 cases) in Era 2, and 18.4% (52 cases) in Era 3 (P&lt;0.001). During the study period, the lung allocation score (LAS) and intraoperative cardiopulmonary bypass (CPB) use decreased, whereas the use of intraoperative nitric oxide and extracorporeal membrane oxygenation increased. Logistic multivariate modeling identified era, recipient sex (male), underlying disease, race, and blood transfusion as factors associated with PGD. No significant difference was observed in 30-day hospital mortality across the three eras (2.9%, 1.4%, and 1.4% for Era 1, Era 2, and Era 3, respectively; P=0.313).</div></div><div><h3>Conclusion</h3><div>This study demonstrated a significant reduction in PGD incidence over time, which coincided with a decrease in LAS and intraoperative CPB use. However, no significant changes were observed in short-term mortality after lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190240","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":"Rescuing lung transplant candidates with rapidly progressive interstitial lung disease who fail V-V ECMO: A case series of dual veno-arterial and veno-venous extracorporeal membrane oxygenation circuits","authors":"Enock Adjei MD ,&nbsp;Blaine Sklar DNP, AGACNP-BC ,&nbsp;John W. Stokes MD ,&nbsp;Whitney D. Gannon MSN, MS ,&nbsp;Amir Teimouri Dereshgi MD ,&nbsp;Anil J. Trindade MD ,&nbsp;Caitlin T. Demarest MD, PhD ,&nbsp;Matthew Bacchetta MD, MBA ,&nbsp;Konrad Hoetzenecker MD, PhD","doi":"10.1016/j.jhlto.2026.100495","DOIUrl":"10.1016/j.jhlto.2026.100495","url":null,"abstract":"<div><h3>Background</h3><div>Providing adequate, awake and ambulatory mechanical circulatory support to patients with rapidly progressive advanced intersitial lung disease (ILD) remains challenging. In a subset of ILD patients with refractory hypoxemia or hemodynamic instability, despite optimal veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) support, the addition of a veno-arterial (V-A) ECMO circuit may avoid the need for mechanical ventilation and protect against right ventricular dysfunction and subsequent end-organ dysfunction.</div></div><div><h3>Methods</h3><div>We herein report the first case series of three patients with ILD who received dual VV-VA ECMO support as a bridge to transplantation.</div></div><div><h3>Results</h3><div>All patients survived until lung transplantation 2 to 8 days after V-A ECMO initiation and had an unremarkable post-transplant recovery.</div></div><div><h3>Conclusion</h3><div>Although the addition a second ECMO circuit is a complex and resource-intensive strategy, it is a feasible approach to stabilze a subset of ILD patients who are indequately supported with V-V ECMO.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100495"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190236","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":"Recent change in bridging strategy and improved clinical outcomes following durable left ventricular assist device implantation in Japan","authors":"Makiko Nakamura ,&nbsp;Teruhiko Imamura ,&nbsp;Yoshikatsu Saiki ,&nbsp;Minoru Ono ,&nbsp;Koichiro Kinugawa ,&nbsp;on behalf of J-MACS Investigators","doi":"10.1016/j.jhlto.2026.100499","DOIUrl":"10.1016/j.jhlto.2026.100499","url":null,"abstract":"<div><h3>Background</h3><div>Destination therapy (DT) was approved in Japan in May 2021. Use of Impella device as a bridge to left ventricular assist device (LVAD) implantation has been increasing. The difference of clinical outcomes between Impella-bridge (a conversion from Impella to durable left ventricular assist device [LVAD]), bridge-to-bridge (BTB) (a conversion from extracorporeal LVAD to durable LVAD), and primary LVAD remains unclear especially in Japanese.</div></div><div><h3>Methods</h3><div>Patients who underwent durable LVAD implantation between October 2017 and March 2025 and were prospectively registered in the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS) were included. The baseline characteristics, cumulative mortality, and adverse events following durable LVAD implantation were retrospectively compared between 2 bridging strategies and primary LVAD cohort.</div></div><div><h3>Results</h3><div>A total of 964 patients who received durable LVAD implantation (median age: 49 years; primary LVAD: 77.4%; Impella-bridge: 11.6%; BTB: 11.0%) were analyzed. The prevalence of Impella-bridge strategy increased especially after DT approval and the introduction of Impella 5.5. The cumulative mortality during durable LVAD support was lowest in Impella-bridge cohort and highest in BTB cohort during a median follow-up of 1053 days (8.0% vs 21.0%). Among the total cohort, an Impella-bridge strategy tended to be associated with a lower mortality following durable LVAD implantation with an adjusted hazard ratio of 0.316 (95% confidence interval 0.095-1.048, <em>p</em> = 0.060).</div></div><div><h3>Conclusions</h3><div>Impella-bridge strategy increased after the introduction of Impella 5.5 in the era of DT and tended to be associated with a lower mortality following durable LVAD implantation. Further studies are warranted to validate the hypothesis.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100499"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190238","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":"Heart transplantation graft survival following donation after circulatory death via thoracoabdominal normothermic regional perfusion","authors":"Sarah Y. Park MD ,&nbsp;Rocio Lopez MS, MPH ,&nbsp;Michael J. Kirsch MD, MSCR ,&nbsp;Elizabeth J. Bashian MD ,&nbsp;Emily Hay-Arthur BA ,&nbsp;Jack Zakrzewski MD ,&nbsp;Jesse D. Schold PhD ,&nbsp;Nicholas R. Teman MD ,&nbsp;Jordan R.H. Hoffman MD, MPH ,&nbsp;Michael T. Cain MD","doi":"10.1016/j.jhlto.2025.100470","DOIUrl":"10.1016/j.jhlto.2025.100470","url":null,"abstract":"<div><h3>Background</h3><div>The impact of thoracoabdominal normothermic regional perfusion (TA-NRP) use in donation after circulatory death (DCD) on rates of graft survival after heart transplantation has yet to be established.</div></div><div><h3>Methods</h3><div>A cohort study of the Scientific Registry of Transplant Recipients was performed identifying all primary adult heart transplants performed in the United States between January 1, 2020, and May 31, 2024, comparing donation after brain death (DBD), DCD with direct procurement and perfusion (DPP) (defined as declaration of circulatory death to cross clamp &lt;30 min), and DCD with TA-NRP (defined as declaration of circulatory death to cross clamp &gt;40 min). The primary outcome was graft loss (re-transplant or death).</div></div><div><h3>Results</h3><div>There were 474 (3.5%) DCD TA-NRP, 899 (6.6%) DCD DPP, and 12,185 (89.9%) DBD heart transplants during the study period, with varying donor and baseline characteristics, including more male and non-Hispanic White DCD TA-NRP recipients, and fewer DCD TA-NRP recipients listed as Status 1. On multivariable analysis, graft survival rates did not significantly differ between cohorts [Adjusted Hazard Ratio (aHR) (95% CI): 0.98 (0.70, 1.37) for DCD TA-NRP vs. DBD; and 1.04 (0.69, 1.56) for DCD TA-NRP vs. DCD DPP].</div></div><div><h3>Conclusion</h3><div>DCD TA-NRP recovery in heart transplantation yields comparable rates of two-year graft survival compared to DCD DPP and DBD recovery, supporting greater utilization of TA-NRP recovery in DCD allografts.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100470"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081933","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":"Expedited Lung Allocation in The Era of Continuous Distribution","authors":"Sajjad Ali ,&nbsp;Robin High ,&nbsp;Marian Urban ,&nbsp;David Axelrod ,&nbsp;Steven Potter ,&nbsp;Aleem Siddique","doi":"10.1016/j.jhlto.2026.100487","DOIUrl":"10.1016/j.jhlto.2026.100487","url":null,"abstract":"<div><h3>Background</h3><div>The frequency of use of expedited offers in lung allocation has increased.</div></div><div><h3>Methods</h3><div>This study retrospectively analyzed lung offers accepted for transplant in the United States for the period from the introduction of continuous distribution in allocation in March 2023 to March 2024 to identify characteristics of donors, recipients, and offers associated with expedited placement. Data were obtained from the Scientific Registry of Transplant Recipients and categorized by expedited vs non-expedited offers.</div></div><div><h3>Results</h3><div>Of the 3,136 lung organ offers transplanted, 9% (284) were expedited. Expedited offers were more likely for male donors with blood type O, while recipients were typically older, male, non-Hispanic, and diagnosed with lung condition category A. These recipients also demonstrated lower composite allocation and medical urgency scores, and were less likely to be hospitalized, ventilated, or on extracorporeal life support. Time on the waitlist and post-transplant 30-day survival rates were similar between expedited and non-expedited groups. One-year survival was higher in recipients of expedited lung placements. Expedited offers had a median sequence number at acceptance of 83.5, bypassing a median of 54.5 listed patients, and were more often placed at centers with higher offer acceptance ratios.</div></div><div><h3>Conclusion</h3><div>Expedited placements are associated with lower-acuity recipients. Further policy reform should aim to ensure equity while optimizing organ placement and recipient outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100487"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190237","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":"First implantation of a bioprosthetic total artificial heart for a mediastinal paraganglioma","authors":"Ali Akamkam MD, MSc ,&nbsp;Marie-Eve Garcia MD ,&nbsp;Elie Fadel MD, PhD ,&nbsp;Julien Guihaire MD, PhD","doi":"10.1016/j.jhlto.2026.100485","DOIUrl":"10.1016/j.jhlto.2026.100485","url":null,"abstract":"<div><div>Resection of cardiac-invasive tumors is challenging, as transplantation is not a viable option for patients with cancer. We report the first implantation of the Aeson total artificial heart (TAH) (Carmat, Vélizy-Villacoublay, France), as a bridge to transplant in a patient with a mediastinal paraganglioma. A 54-year-old man presented with restrictive heart failure related to a paraganglioma. The tumor was invading the right ventricle. No tumor reduction was achieved after chemotherapy. A surgical resection of the tumor combined with the implantation of the Aeson TAH was decided. Embolization of the nutrient vessels of the tumor was performed before surgery to decrease hemorrhagic risk. A positron emission tomography scan at 3 months showed no tumor recurrence. The patient was transplanted 6 months after TAH implantation. No severe primary graft dysfunction or acute rejection was observed. However, the patient developed refractory vasoplegia, which ultimately led to multiorgan failure and death 6 months after transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100485"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081934","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 3-stage hybrid strategy for heart transplantation following ascending-to-descending aortic bypass grafting","authors":"Salem T. Argaw ,&nbsp;Ali Akamkam ,&nbsp;Sébastien Hascoet ,&nbsp;Stéphan Haulon ,&nbsp;Julien Guihaire MD, PhD","doi":"10.1016/j.jhlto.2026.100486","DOIUrl":"10.1016/j.jhlto.2026.100486","url":null,"abstract":"<div><div>Cardiac reoperation after an extra-anatomic aortic bypass graft entails considerable risk due to the proximity of the graft to the sternum. In the case discussed here, a woman with 2 prior sternotomies and a retrosternal aortic bypass graft for a history of aortic coarctation presented with advanced dilated cardiomyopathy requiring heart transplantation. The patient was managed through a novel 3-stage hybrid strategy. In the first stage, a catheter-based approach was used to stent the coarcted aorta. Subsequently, the extra-anatomic graft was endovascularly excluded and, finally, the patient underwent reoperation for heart transplantation. The use of interdisciplinary collaboration for coordinated staging and shared decision-making, as in this case, allows for innovative solutions and improved outcomes in complex surgical needs.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100486"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146184044","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":"Promoting utilization of donors after circulatory death in lung transplantation","authors":"Doug A. Gouchoe MD ,&nbsp;Ashley Cardenas MAS, FAST ,&nbsp;Gary F. Marklin MD, MA ,&nbsp;Errol Bush MD ,&nbsp;Bryan A. Whitson MD, PhD ,&nbsp;Jordan R.H. Hoffman MD, MPH ,&nbsp;Darren Stewart MS ,&nbsp;David A. Axelrod MD, MBA ,&nbsp;Aleem Siddique MBBS, FACS, FACC","doi":"10.1016/j.jhlto.2026.100491","DOIUrl":"10.1016/j.jhlto.2026.100491","url":null,"abstract":"<div><div>Lungs recovered from donation after circulatory death (DCD) are markedly underutilized for transplantation in the U.S. Evidence demonstrating excellent outcomes after DCD lung transplantation underpins the need for strategies to mitigate barriers to DCD lung utilization, including data driven revisions to allocation policy, revising program-specific quality metrics, removing financial barriers, and minimizing logistical disincentives. Expanded DCD transplantation is vital to reduce waitlist mortality and increase lung transplant rate.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100491"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190876","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 looming threat of invasive fungal infections in heart transplant recipients: Will it be the last of us","authors":"Adam Lowe MD ,&nbsp;S. Travis King PharmD ,&nbsp;Jonathan Hand MD","doi":"10.1016/j.jhlto.2026.100482","DOIUrl":"10.1016/j.jhlto.2026.100482","url":null,"abstract":"<div><div>Patients with mechanical circulatory support (MCS) devices and those who undergo heart transplants are at risk for invasive fungal infections (IFI). Though <em>Candida</em> and <em>Aspergillus spp.</em> account for most infections, the evolving epidemiology of resistant-<em>Candida spp</em>. such as <em>Candida auris</em>, endemic mycoses, and other molds impacted by climate change, threaten MCS and transplant patients. Fungal diagnostics are overall limited, and current, widely used antifungal agents are suboptimal with significant toxicities. However, innovative diagnostic strategies coupled with novel antifungal agents for prevention and treatment of invasive fungal disease encourage optimism for MCS and transplant patients and clinicians.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100482"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146057389","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":"MicroRNAs and their role in heart transplantation insights into rejection mechanisms: A narrative review","authors":"Rossella Loria ,&nbsp;Antonio Giuseppe Bianculli ,&nbsp;Paola Giustiniani ,&nbsp;Maria Troiano ,&nbsp;Marco Andreani ,&nbsp;Giorgia Grutter","doi":"10.1016/j.jhlto.2026.100496","DOIUrl":"10.1016/j.jhlto.2026.100496","url":null,"abstract":"<div><div>Heart transplantation is the definitive treatment for patients with advanced heart failure and refractory symptoms. However, allograft rejection—both acute and chronic—remains a major cause of morbidity, leading to graft dysfunction and failure. Traditionally, endomyocardial biopsy (EMB) has been the standard method for screening allograft rejection. MicroRNAs (miRNAs) are small, non-coding RNA sequences that regulate gene expression by binding to the 3' untranslated regions of complementary mRNA transcripts. This review explores the potential of miRNAs as biomarkers for detecting allograft rejection in heart transplant recipients. MiRNAs may serve as non-invasive “liquid biopsies,” providing a novel approach to monitor and manage post-transplant patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100496"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190262","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}