JHLT Open最新文献

{"title":"Association between tacrolimus blood levels and biopsy-proven acute cellular rejection in adult heart transplant recipients","authors":"Chengliang Yang MD ,&nbsp;Casey P. Shannon BSc ,&nbsp;Sara Assadian MHS ,&nbsp;Linda Lapp PhD ,&nbsp;Rithika Nair BSc ,&nbsp;Tao Huan PhD ,&nbsp;Nilu Partovi PharmD ,&nbsp;Mustafa Toma MD ,&nbsp;Scott J. Tebbutt PhD","doi":"10.1016/j.jhlto.2025.100373","DOIUrl":"10.1016/j.jhlto.2025.100373","url":null,"abstract":"<div><h3>Background</h3><div>Acute cellular rejection (ACR) is a common complication following heart transplantation (HTx). This study examined the association between tacrolimus whole-blood concentrations and endomyocardial biopsy (EMB)-proven ACR in adult HTx recipients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 41 adult HTx recipients enrolled in the HEARTBiT study at St. Paul’s Hospital (Vancouver, Canada) between August 2018 and February 2020. A total of 315 EMB visits were analyzed and matched with tacrolimus whole-blood trough concentrations measured within ±1 day using liquid chromatography-tandem mass spectrometry. Patients were stratified into 2 post-transplant intervals: 0 to 90 days and 91 to 180 days, based on BC Clinical Guidelines for Transplant Medications for target tacrolimus levels.</div></div><div><h3>Results</h3><div>During the first 90 days post transplant, tacrolimus concentrations were significantly lower in 2R rejection episodes compared to both 0R (<em>p</em> = 0.006) and 1R (<em>p</em> = 0.013) groups. No significant differences in tacrolimus levels were observed beyond 90 days. In a linear mixed effects model adjusting for time post transplant (days) and tacrolimus dose, 2R rejection remained independently associated with lower tacrolimus concentrations (−2.73 µg/ml; <em>p</em> = 0.021), despite slightly higher dosing at those visits (+0.10 mg/d; <em>p</em> = 0.047). Clinical review confirmed no concurrent cytomegalovirus infections or major changes in other immunosuppressive therapies.</div></div><div><h3>Conclusions</h3><div>Lower tacrolimus concentrations during moderate ACR episodes were not attributable to underdosing or clinical confounders, suggesting the role of altered pharmacokinetics or patient-specific factors. Taken together, our results emphasize the clinical relevance of tailoring tacrolimus targets to individual pharmacokinetics, especially in early-phase post-transplant care.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100373"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932425","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":"Disseminated varicella zoster in a cardiac-transplant patient presenting with 10th cranial nerve palsy: A case report","authors":"Ellen Crisp,&nbsp;Sarah Coghill,&nbsp;Mark Cribb","doi":"10.1016/j.jhlto.2025.100400","DOIUrl":"10.1016/j.jhlto.2025.100400","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100400"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323860","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":"Optimization of pretransplant amiodarone therapy to prevent primary graft dysfunction following heart transplantation","authors":"Ye In Christopher Kwon BA ,&nbsp;Michael Keller BS ,&nbsp;Alan Lai BS ,&nbsp;Matthew Ambrosio MS ,&nbsp;Jay Patel MD ,&nbsp;Kelli Fox DO ,&nbsp;Inna F. Tchoukina MD ,&nbsp;Keyur B. Shah MD ,&nbsp;Zachary Fitch MD ,&nbsp;Josue Chery MD ,&nbsp;Mohammed Quader MD ,&nbsp;Patricia Nicolato DO ,&nbsp;Vigneshwar Kasirajan MD ,&nbsp;Zubair A. Hashmi MD","doi":"10.1016/j.jhlto.2025.100390","DOIUrl":"10.1016/j.jhlto.2025.100390","url":null,"abstract":"<div><h3>Background</h3><div>Despite its side effects, amiodarone remains widely used for arrhythmias in patients awaiting heart transplantation (HT). We evaluated the impact of pretransplant amiodarone use and the timing of its discontinuation on the risk of primary graft dysfunction (PGD), graft survival, and recipient outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed adults undergoing primary isolated HT from the United Network for Organ Sharing registry (October 2018-December 2024). Patients were categorized by amiodarone use on the waitlist: never used, continued until HT, or discontinued within 5 days before HT. Recipient and donor characteristics were balanced using 1:1 propensity score matching between continued and discontinued groups. Kaplan-Meier methods evaluated survival, while multivariate Cox and logistic regression models identified predictors of mortality and PGD, respectively.</div></div><div><h3>Results</h3><div>The matched cohort included 7,040 recipients (continued: <em>n</em> = 3,520; discontinued: <em>n</em> = 3,520). Continued amiodarone therapy significantly increased severe PGD (4.1% vs 2.9%; <em>p</em> = 0.037; adjusted odds ratios 1.63, 95% confidence intervals [1.31-2.01]), pacemaker implantation (2.6% vs 1.6%; <em>p</em> = 0.035), dialysis (20.8% vs 18.7%; <em>p</em> = 0.024), and length of hospital stay (27 vs 25.4 days; <em>p</em> = 0.043). No significant differences in mortality were observed (<em>p</em> = 0.916), nor in overall graft failure rates (<em>p</em> = 0.051). Discontinuation of amiodarone was associated with significant reduction in severe PGD compared to continued use (3.1% vs 4.3%, <em>p</em> = 0.012<em>).</em> Subgroup analysis demonstrated significantly reduced PGD in recipients discontinuing amiodarone 5 to 30 days before HT compared to continued users (2.2% vs 4.1%; <em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Discontinuing amiodarone closer to HT significantly reduces severe PGD without compromising long-term recipient or graft survival. This timing strategy may further optimize perioperative outcomes in donation after circulatory death recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100390"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265872","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":"Alterations in implantable cardioverter defibrillator lead parameters following left ventricular assist device implantation","authors":"David Gittess MD ,&nbsp;David J. King MD ,&nbsp;Steven Brady DO ,&nbsp;Ang Li ,&nbsp;Yi Guo PhD ,&nbsp;Sara Geiger APRN ,&nbsp;Mustafa M. Ahmed MD ,&nbsp;Alex M. Parker MD ,&nbsp;Ramil Goel MD","doi":"10.1016/j.jhlto.2025.100350","DOIUrl":"10.1016/j.jhlto.2025.100350","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist devices (LVADs) are increasingly used in the management of advanced heart failure. The majority of these patients have pre-existing implantable cardioverter defibrillators (ICDs). The proximity between the LVAD inflow cannula and right ventricular (RV) defibrillation lead raises the potential for disruption of ICD function.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of 95 patients with ICDs at a single tertiary care center who underwent LVAD implantation and who met inclusion criteria. The primary outcome was changes in the pre-operative and post-operative transvenous ICD RV lead parameters. These changes were stratified by the age of the RV lead and analyzed via a paired t-test. The secondary outcome was disruption to the ICD requiring an intervention.</div></div><div><h3>Results</h3><div>LVAD implantation was associated with significant decreases in sensed amplitude (p &lt; 0.01) and high voltage impedance (p &lt; 0.01) and an increase in capture threshold (p = 0.017). When stratified by age of the RV lead, patients with leads older than two years had similar trends in all parameters. However, RV leads that were two years old or younger only showed a significant change in high voltage impedance (p &lt; 0.01). Mechanical disruption of the ICD related to the surgery was infrequent but significant.</div></div><div><h3>Conclusion</h3><div>Because LVAD implantation is capable of impacting ICD function and causing mechanical disruption, close monitoring should be paid to the ICD in the peri-operative period including obtaining a full interrogation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100350"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826825","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":"Management of microaspiration and gastrointestinal dysfunction after lung transplantation: A narrative review","authors":"René Hage ,&nbsp;Carolin Steinack ,&nbsp;Macé M. Schuurmans","doi":"10.1016/j.jhlto.2025.100363","DOIUrl":"10.1016/j.jhlto.2025.100363","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Lung Allograft Dysfunction (CLAD) is the leading cause of late morbidity and mortality following lung transplantation. Increasing evidence implicates microaspiration, often secondary to gastroesophageal reflux disease (GERD) and gastrointestinal (GI) dysfunction, as a critical non-alloimmune driver of CLAD. However, its often silent presentation, diagnostic complexity, and heterogeneous management contribute to persistent knowledge and treatment gaps.</div></div><div><h3>Methods</h3><div>This narrative review synthesizes recent literature on the pathophysiology, diagnosis, and clinical impact of microaspiration and GI dysfunction in lung transplant recipients. We focus on emerging biomarkers (e.g., conjugated bile acids and pepsinogen A4), diagnostic modalities, and both medical and surgical treatment strategies aimed at mitigating aspiration-induced graft injury.</div></div><div><h3>Key Content and Findings</h3><div>Microaspiration leads to epithelial damage, surfactant disruption, immune activation, and microbial dysbiosis, collectively promoting allograft dysfunction. Conjugated bile acids in large airway bronchial wash fluid and pepsinogen A4 have shown superior specificity as aspiration biomarkers compared to pepsin alone. Gastrointestinal disorders, such as GERD, gastroparesis, and esophageal dysmotility, frequently co-exist post-transplant and contribute to aspiration risk. Pharmacologic interventions provide limited benefit, while anti-reflux surgery significantly improves graft outcomes, particularly when performed early. Conservative measures such as head-of-bed elevation also reduce reflux burden and may complement therapeutic strategies.</div></div><div><h3>Conclusions</h3><div>Microaspiration is a modifiable and underrecognized contributor to allograft injury. Integration of aspiration biomarkers, early reflux evaluation, and personalized stepwise management, including surgical intervention when indicated, may improve long-term transplant outcomes. This review provides clinicians with a structured framework for diagnosis and management of microaspiration-related injury in lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100363"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885974","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":"High profile transvalvular microaxial flow pump as a bridge to heart transplantation for amyloid cardiomyopathy: A case series","authors":"Pankaj Garg MBBS ,&nbsp;Mohammad Alomari MD ,&nbsp;Ishaq Wadiwala MBBS ,&nbsp;Melissa Lyle MD ,&nbsp;Si Pham MD ,&nbsp;Nafiye Busra Celik MD ,&nbsp;Juan C. Leoni Moreno MD ,&nbsp;Rohan Goswami MD ,&nbsp;Kevin Landolfo MD ,&nbsp;Jose Nativi-Nicolau MD ,&nbsp;Daniel Yip MD ,&nbsp;Parag C. Patel MD ,&nbsp;Basar Sareyyupoglu MD","doi":"10.1016/j.jhlto.2025.100340","DOIUrl":"10.1016/j.jhlto.2025.100340","url":null,"abstract":"<div><h3>Background</h3><div>The definitive treatment for end-stage heart failure (ESHF) due to amyloid cardiomyopathy (ACM) is an orthotopic heart transplant (OHT). However, associated pulmonary hypertension (PH) can present as a contraindication to OHT and be challenging to manage with conventional therapies. We herein reported the successful use of Impella 5.5 in a series of patients with ACM to improve PH and successfully bridge to OHT.</div></div><div><h3>Methods</h3><div>Five patients with ACM associated ESHF were analyzed. All patients had moderate to severe PH on admission. As a bridge to transplant, Impella 5.5 was inserted through the axillary artery, and continued until OHT.</div></div><div><h3>Results</h3><div>All patients were male, and mean age was 62.2 ± 1.3 years. One patient had light chain associated amyloid cardiomyopathy (AL-CM), 2 had wild-type transthyretin associated amyloid cardiomyopathy (ATTRwt-CM), and 2 had variant transthyretin amyloid cardiomyopathy (ATTRv-CM). Indication for Impella 5.5 was to support acute on chronic heart failure and improve elevated PA pressures. Mean support time was 34.4 ± 11.97 days. Mean PA pressures decreased from 38.2 ± 4.43 mm<!--> <!-->Hg to 27 ± 4.24 mm<!--> <!-->Hg, and cardiac index increased from 1.58 ± 0.44 liter/min/m² to 2.46 ± 0.43 liter/min/m². No major adverse events related to Impella insertion occurred. All patients were successfully transplanted and doing well after OHT with no mortality after a mean follow-up of 13 ± 10.88 months.</div></div><div><h3>Conclusion</h3><div>Bridging patients with ACM to OHT remains challenging due to small left ventricular cavity and associated PH. Temporary mechanical circulatory support with Impella 5.5 helps reduce PA pressures and improve cardiac index. Impella 5.5 can be safe and feasible option to bridge patients with ACM to OHT.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100340"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829481","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":"Allosensitization status predicts excess mortality in pediatric congenital heart disease transplant recipients in the current era: An analysis of the United Network for Organ Sharing database","authors":"Matthew J. O’Connor MD ,&nbsp;Courtney Vu BS ,&nbsp;Xuemei Zhang MS ,&nbsp;Laura Bennett PhD ,&nbsp;Humera Ahmed MD ,&nbsp;Jonathan J. Edwards MD ,&nbsp;Kimberly Y. Lin MD ,&nbsp;Yang Li MD PhD ,&nbsp;Katsuhide Maeda MD PhD ,&nbsp;Brooke Marcellus BS ,&nbsp;Dimitrios Monos PhD ,&nbsp;Joseph W. Rossano MD ,&nbsp;Carol A. Wittlieb-Weber MD ,&nbsp;Jonathan B. Edelson MD","doi":"10.1016/j.jhlto.2025.100406","DOIUrl":"10.1016/j.jhlto.2025.100406","url":null,"abstract":"<div><h3>Background</h3><div>Patients with congenital heart disease are at high risk of allosensitization and as such may be at risk for inferior outcomes following heart transplantation.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing database was studied for patients &lt;18 years with congenital heart disease undergoing heart transplantation from April 2015 to December 2020. Patients were grouped into 3 categories of allosensitization status based on % calculated panel reactive antibody at transplant: non- (&lt;10%), moderately- (10%–&lt;80%), and highly sensitized (≥80%). Primary outcome measures were 1-year patient and graft survival. Multivariable analysis controlled for differences in preoperative clinical characteristics among categories.</div></div><div><h3>Results</h3><div>During the study period, 1,086 patients with congenital heart disease underwent transplant at a median of 3 years of age. Nonsensitized patients comprised 70%; 22% were moderately sensitized and 9% were highly sensitized. Unadjusted 1-year mortality was 25% in the highly sensitized and 8.7% in the nonsensitized group (<em>p</em> &lt; 0.001). After adjustment, highly sensitized patients were &gt;3 times more likely to die within the first year than nonsensitized patients (HR 3.44, <em>p</em> &lt; 0.001). The relationship between calculated panel reactive antibody and crossmatch result was assessed using multivariable regression. Regardless of crossmatch result, highly sensitized patients had an increased risk of 1-year mortality (HR 3.4, <em>p</em> &lt; 0.001) and graft failure (HR 3.32, <em>p</em> &lt; 0.001) compared to nonsensitized and moderately sensitized patients.</div></div><div><h3>Conclusions</h3><div>Highly sensitized patients with congenital heart disease undergoing heart transplantation in the current era experience 25% 1-year mortality. The magnitude of sensitization predicts adverse outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100406"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415668","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-lung transplantation—global activity between 2003 and 2023, indications and outcomes","authors":"Jens Gottlieb ,&nbsp;Charlotte Sybrecht ,&nbsp;Are Martin Holm MD","doi":"10.1016/j.jhlto.2025.100405","DOIUrl":"10.1016/j.jhlto.2025.100405","url":null,"abstract":"<div><h3>Background</h3><div>Historically, heart-lung transplantation (HLTx) was the primary treatment for end-stage cardiopulmonary disease. However, advancements in surgery and postoperative care have increasingly enabled the use of bilateral lung transplantation (LTx) instead. This article reviews recent global trends, indications, and outcomes of HLTx.</div></div><div><h3>Methods</h3><div>Global transplant activity was analyzed using data from the European Committee on Organ Transplantation (CD-P-TO). Outcome data were drawn from international registries.</div></div><div><h3>Results</h3><div>From 2003 to 2023, 103 countries reported transplant activity to CD-P-TO, covering a population that grew from 3.22 to 6.07 billion. Between 2019 and 2023, 27 countries reported performing HLTx, with 94 to 108 procedures annually worldwide—equivalent to 0.02 per million population (pmp). In comparison, isolated heart and lung transplants occurred at 1.42-1.75 pmp and 1.05-1.39 pmp, respectively.</div><div>In Europe, HLTx rates declined from 0.15-0.16 pmp (2003-2008) to 0.04-0.06 pmp (2019-2023). In the U.S., while in the US it slightly increased from 0.08-0.13 pmp to 0.13-0.16 pmp. Pulmonary vascular disease is now the leading indication for HLTx, with recipients averaging 15 years younger than those undergoing isolated thoracic transplants.</div><div>One-year survival after HLTx is still lower than LTx but slowly increasing. Long-term survival improves in those surviving the first year is better in comparison to isolated LTx.</div></div><div><h3>Conclusion</h3><div>HLTx is currently performed in about one-quarter of reporting countries, accounting for just 1.3%-1.6% of thoracic transplant volume. Despite lower early survival, younger HLTx recipients who survive the initial year show promising long-term outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100405"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415541","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":"Impact of COVID-19 after lung transplantation: A retrospective multicenter comparison of clinical outcomes in Denmark and Sweden","authors":"Embla Bodén ,&nbsp;Michael Perch ,&nbsp;Regitze Hertz Liebermann ,&nbsp;John Mackay Søfteland ,&nbsp;Jesper M. Magnusson ,&nbsp;Sandra Lindstedt","doi":"10.1016/j.jhlto.2025.100377","DOIUrl":"10.1016/j.jhlto.2025.100377","url":null,"abstract":"<div><h3>Background</h3><div>The coronavirus disease-2019 (COVID-19) pandemic posed pronounced challenges in the care of lung transplant (LTx) recipients. Global variations in containment strategies and the introduction of messenger ribonucleic acid (mRNA) vaccines have sparked extensive debate in both scientific and public arenas.</div></div><div><h3>Methods</h3><div>This retrospective study compared outcomes among LTx recipients in Denmark, which implemented a more restrictive COVID-19 containment strategy, and Sweden, which adopted a less restrictive approach. A total of 318 LTx recipients with at least 1 episode of polymerase chain reaction (PCR)-confirmed COVID-19 were included. Propensity score weighting was applied to balance covariates, and survival outcomes were analyzed using weighted Cox proportional hazards and Kaplan-Meier analyses.</div></div><div><h3>Results</h3><div>No significant differences in mortality or risk of chronic lung allograft dysfunction (CLAD) were found between countries (hazard ratios [HR] for death, Sweden = 1.49, 95% confidence intervals [CI]: 0.68-3.26, <em>p</em> = 0.314; HR for CLAD, Sweden = 0.63, 95% CI: 0.32-1.25, <em>p</em> = 0.187). Unvaccinated patients had a significantly higher risk of death compared to vaccinated patients (HR = 3.49, 95% CI: 1.46-8.34, <em>p</em> = 0.005), and infections with the original Wuhan strain carried a higher risk than Omicron (HR = 3.59, 95% CI: 1.53-8.44, <em>p</em> = 0.003). CLAD development or progression was not significantly associated with any subgroup.</div></div><div><h3>Conclusions</h3><div>Despite differences in timing of infections and case load between Sweden and Denmark, clinical outcomes among infected LTx recipients were comparable. mRNA vaccination was strongly associated with improved survival. The results of the current study highlight the importance of continued vaccination efforts and tailored containment strategies in vulnerable populations.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100377"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988635","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":"Geographic disparity beyond the physical distance: Heart transplant outcomes in patients living in states without a transplant program","authors":"Toyokazu Endo MD ,&nbsp;Joshua Crane MD ,&nbsp;Isabelle Lytle ,&nbsp;Jaimin Trivedi MD, MPH ,&nbsp;Michele Gallo MD ,&nbsp;Siddharth Pahwa MD ,&nbsp;Mark S. Slaughter MD ,&nbsp;Erin M. Schumer MD, MPH","doi":"10.1016/j.jhlto.2025.100365","DOIUrl":"10.1016/j.jhlto.2025.100365","url":null,"abstract":"<div><h3>Background</h3><div>In the United States, outcomes of adult heart transplant are not well studied in those living in states without an active transplant program.</div></div><div><h3>Methods</h3><div>Adult heart transplant patients were identified using the United Network of Organ Sharing database (2014-2023). Two groups were formed: out-of-state (OOS) for those in states without a program and in-state (IS) for those with a program. The primary outcome is post-transplant survival. Secondary outcomes examine listing characteristics and patterns using the Center for Disease Control WONDER database.</div></div><div><h3>Results</h3><div>The OOS group (14 states) had 1,561 patients, with Nevada having the highest proportion. Fewer non-White individuals and those with government-sponsored insurance programs were in the OOS group (<em>p</em> &lt; 0.05). Additionally, more patients in the OOS moved out of their primary state residence at the time of transplant (9.3% vs 2%, <em>p</em> &lt; 0.01). Most patients traveled to high-volume centers in neighboring states to be listed. There was no difference in waitlist outcome (<em>p</em> = 0.13), but post-transplant survival was slightly higher in the OOS group (<em>p</em> = 0.04). Fewer patients in the OOS group were listed relative to their state population and the heart failure mortality cohort compared to those in the IS group (<em>p</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Overall, the outcomes for individuals living in states without a transplant program did not differ compared to those in states with a program. However, variations in listing characteristics and patterns suggest a potential geographical disparity. Policy changes are crucial to address these inequalities and improve access to heart transplants in states that lack a transplant program.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100365"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925574","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}