JHLT Open最新文献

{"title":"Clinical utility of 1:16 serum dilution as a predictor of response to therapeutic plasma exchange for HLA antibody-mediated rejection treatment and overall survival in lung transplant recipients: A two center study","authors":"Mohamed Elrefaei MD PhD ,&nbsp;Tathagat Narula MD ,&nbsp;Francisco Alvarez MD ,&nbsp;Elizabeth A. Godbey MD ,&nbsp;Jasmine Kendrick ,&nbsp;Gerard Criner MD ,&nbsp;Francis C. Cordova MD ,&nbsp;Norihisa Shigemura MD PhD ,&nbsp;Yoshiya Toyoda MD PhD ,&nbsp;Olga Timofeeva PhD","doi":"10.1016/j.jhlto.2025.100302","DOIUrl":"10.1016/j.jhlto.2025.100302","url":null,"abstract":"<div><h3>Purpose</h3><div>Antibody-Mediated Rejection (AMR) due to HLA donor-specific antibodies (DSA) is associated with poor outcomes in lung transplant recipients (LTR). AMR treatment using therapeutic plasma exchange (TPE) improves clinical outcomes in LTR. The objective of this study was to assess the clinical utility of 1:16 serum dilution HLA antibody test results as a predictor of response to TPE for de novo DSA (dnDSA) levels and AMR treatment in LTR.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 32 LTR diagnosed with AMR due to dnDSA and treated with TPE was performed at Mayo Clinic (n = 18) and Temple University Hospital (n = 14). HLA antibodies were detected by Luminex single antigen beads assay. Mean Fluorescence Intensity (MFI) levels were measured in undiluted and 1:16 diluted sera before the 1st and after the 5th TPE session. Statistical analysis was performed using GraphPad PRISM software.</div></div><div><h3>Results</h3><div>Of 32 patients, 14 and 18 patients were diagnosed with early (&lt; 3 months post-transplant) and late (6 months – 3 years post-transplant) AMR respectively. All patients, except one, had HLA Class II dnDSA (97%). In addition, 9/14 (64.2%) and 3/18 (16.6%) of LTR with early and late AMR respectively had HLA class I dnDSA. The MFI for all positive dnDSA in 1:16 diluted sera collected before 1st TPE demonstrated a significant correlation with MFI in undiluted sera collected after 5th TPE in both early (R² = 0.8786) and late (R² = 0.9045) AMR post-transplant. In addition, MFI in 1:16 diluted pre TPE sera correlated with better overall LTR survival following TPE (p = 0.001).</div></div><div><h3>Conclusion</h3><div>The MFI of 1:16 serum dilution before 1st TPE may be utilized as a surrogate to predict response to TPE for AMR treatment and overall survival in LTR.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100302"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144331239","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":"Assessment of chest wall elastance in patients with pulmonary fibrosis waiting for lung transplantation, interest in donor size selection","authors":"Hadrien Rozé MD, PhD ,&nbsp;Xavier Demant MD ,&nbsp;Yaniss Belaroussi MD ,&nbsp;Gaël Dournes MD, PhD ,&nbsp;Eline Bonnardel MD ,&nbsp;Arnaud Rodriguez MD ,&nbsp;Marie Gerin MD ,&nbsp;Clément Boisselier MD ,&nbsp;Elodie Blanchard MD ,&nbsp;Virginie Perrier MD ,&nbsp;Julie Macey MD ,&nbsp;Benjamin Repusseau MD ,&nbsp;Jacques Jougon MD,PhD ,&nbsp;Matthieu Thumerel MD,PhD","doi":"10.1016/j.jhlto.2025.100296","DOIUrl":"10.1016/j.jhlto.2025.100296","url":null,"abstract":"<div><div>Some patients with pulmonary fibrosis (PF) can have severe and fixed chest wall retraction; others regain the shape of their original rib cage once the lungs are removed. These 2 possibilities determine the size of the lung graft to be allocated but are not predictable with classical respiratory tests or computed tomography (CT) scan. We first measured chest wall elastance (E_cw) with esophageal pressure on the day of transplantation (group 1) and then during pretransplant medical check-up, and used for donor selection (group 2). Twenty patients in group 1 had low pretransplantation actual total lung capacity/predicted total lung capacity (pTLC) ratio that was not correlated with E_cw. The amount of transplanted lung TLC_transplanted/pTLC was correlated to E_cw (R² = 0.43, <em>p</em> = 0.003). Patient with higher E_cw required lung resection and had more primary graft dysfunction. In group 2, 20 patients' E_cw measurements allowed for increase in TLC_transplanted/pTLC from 79 ± 20% to 93 ± 18%, <em>p</em> = 0.023 with only 2 lung resections. E_cw can be measured before transplantation to optimize size mismatch and lung resection.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100296"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571149","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 increasing utilization of ventricular assist devices in fontan failure","authors":"Darren Turner MD ,&nbsp;Amir Mehdizadeh-Shrifi MD,&nbsp;Grant Chappell BS,&nbsp;David L. Morales MD","doi":"10.1016/j.jhlto.2025.100282","DOIUrl":"10.1016/j.jhlto.2025.100282","url":null,"abstract":"<div><div>The Fontan population has increased dramatically owing to advances in medical and surgical therapies, with many living well into adulthood with Fontan circulation. Unfortunately, patients will develop heart failure due to the chronic effects of their altered circulatory system. Management of heart failure in these patients is very complex and requires multi-disciplinary approaches with input from both cardiologists and surgeons. In the case of patients who develop cardiogenic shock, transplantation is often not feasible due to instability. Recently, there has been increased use of ventricular assist devices (VADs) as a bridge to transplantation with promising results. In this work, we briefly review the physiology of Fontan failure, provide criteria for VAD workup, and discuss VAD outcomes in Fontan patients. Finally, we describe a single institution’s experience and outcomes with VADs in Fontan patients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100282"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298536","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":"Lung transplant bridging strategies in patients with idiopathic pulmonary fibrosis: An SRTR database analysis","authors":"Yota Suzuki MD ,&nbsp;Rachel L. Deitz MD, MPH ,&nbsp;John Ryan PhD ,&nbsp;Ernest Chan MD ,&nbsp;Masashi Furukawa MD ,&nbsp;Chadi Hage MD ,&nbsp;Pablo G. Sanchez MD","doi":"10.1016/j.jhlto.2025.100291","DOIUrl":"10.1016/j.jhlto.2025.100291","url":null,"abstract":"<div><h3>Objective</h3><div>Extracorporeal Membrane Oxygenation (ECMO) plays an important role in bridge-to-transplant, but the ideal bridging strategy is not well-defined for idiopathic pulmonary fibrosis (IPF), particularly in the setting of pulmonary hypertension (PH).</div></div><div><h3>Methods</h3><div>We queried data from the Scientific Registry of Transplant Recipients database for adult lung transplant candidates with IPF who were bridged to lung transplant, either with venovenous (VV)-ECMO, venoarterial (VA)-ECMO, or mechanical ventilator (MV) alone. A subgroup analysis was performed on patients with moderate-severe PH (mean pulmonary artery pressure ≥ 40 mmHg).</div></div><div><h3>Results</h3><div>During the period, 1485 patients were identified who met inclusion criteria: 653 on VV-ECMO, 234 on VA-ECMO, and 598 on MV. The competing risk analysis found that relative to VV-ECMO, both VA-ECMO and MV bridge were associated with lower rates of survival to transplant (HR 0.69 [0.57-0.84], <em>p</em> &lt; 0.001; HR 0.39 [0.383-0.46], <em>p</em> &lt; 0.001, respectively). Within the PH subgroup, there was no difference in survival to transplant between VV- and VA-ECMO (HR 1.01 [0.64-1.58]; <em>p</em> &gt; 0.9), but patients bridged with ventilator had a lower waitlist survival rate HR 0.46 [0.27, 0.79]; <em>p</em> = 0.005) relative to VV-ECMO. There was no difference in long-term survival among the three bridging strategies, either in the complete cohort (<em>p</em> = 0.52) or the PH cohort (<em>p</em> = 0.84).</div></div><div><h3>Conclusions</h3><div>Even in the presence of severe PH, VA- and VV-ECMO were both effective in bridging IPF patients to lung transplant, and VV-ECMO can be an initial setup for bridging. Conversion to VA ECMO may be considered early when there is a sign of right ventricular dysfunction.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100291"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254589","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":"Pregnancy outcomes and management in lung and heart transplant recipients: A systematic review","authors":"Aya Tanaka ,&nbsp;Filippos T. Filippidis ,&nbsp;Marie Line El Asmar ,&nbsp;Anna Reed ,&nbsp;Andrew Morley-Smith ,&nbsp;Vasiliki Gerovasili","doi":"10.1016/j.jhlto.2025.100297","DOIUrl":"10.1016/j.jhlto.2025.100297","url":null,"abstract":"<div><div>Immunosuppression advances have enabled organ transplant recipients to consider parenthood, but pregnancy poses risks to maternal and fetal health. This systematic review examines pregnancy outcomes and immunosuppression management in cardiothoracic transplant recipients. We conducted a literature search of PubMed/Medline, Embase, and Maternity and Infant Care Database in December 2022. We identified 54 relevant studies and data from the Transplant Pregnancy Registry International, covering 404 pregnancies from 272 heart recipients (HTR) and 148 pregnancies from 121 lung recipients (LTR). Live births occurred in 74.3% of HTR and 65.5% of LTR pregnancies (22% preterm). Graft dysfunction developed in 11.5% (during) and 12.4% (after) of HTR pregnancies and 17.6% (during) and 18% (after) of LTR pregnancies. Other complications included hypertension (HTR: 36.9%, LTR: 58.8%), preeclampsia (HTR: 19.7%, LTR: 12.2%), and diabetes (HTR: 11%, LTR: 27%). Mortality was 17.4% for HTR and 26.5% for LTR. Half of HTR and two-thirds of LTR were on Tacrolimus. Common immunosuppression changes included discontinuation of Mycophenolate Mofetil, Azathioprine, or Sirolimus with corticosteroid dose adjustment. Despite high successful pregnancy rates, heart and lung transplant recipients may face substantial risks of graft dysfunction and maternal death post-pregnancy.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100297"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281172","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":"Post-operative management of children after lung transplantation","authors":"Nicolaus Schwerk PD Dr. med. ,&nbsp;Julia Carlens ,&nbsp;Harald Köditz ,&nbsp;Fabio Ius ,&nbsp;Nicholas Avdimiretz ,&nbsp;Don Hayes Jr. ,&nbsp;Melinda Solomon","doi":"10.1016/j.jhlto.2025.100301","DOIUrl":"10.1016/j.jhlto.2025.100301","url":null,"abstract":"<div><div>Post-operative care for children and adolescents who undergo lung transplantation is a challenge because of the potential for numerous complications during this period, which can considerably impact the short- and long-term outcomes. The immediate post-operative phase is particularly critical, and complications are frequent; therefore, knowledge, early recognition, and appropriate treatment of these complications are imperative and can only be achieved through close collaboration between a wide range of medical specialties. The aim of this review is to provide an abbreviated overview of the optimal post-operative management of children in an intensive care unit, as well as to describe frequently occurring complications and their treatment.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313448","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":"Ex vivo lung perfusion-to-lung transplant rat survival model with reproducible development of acute lung injury and graft rejection","authors":"Ei Miyamoto ,&nbsp;Akihiro Ohsumi ,&nbsp;David Hwang ,&nbsp;Kristen Boonstra ,&nbsp;Marcelo Cypel ,&nbsp;Tereza Martinu ,&nbsp;Shaf Keshavjee ,&nbsp;Stephen C. Juvet","doi":"10.1016/j.jhlto.2025.100299","DOIUrl":"10.1016/j.jhlto.2025.100299","url":null,"abstract":"<div><h3>Background</h3><div>Ex vivo lung perfusion (EVLP) has been clinically applied as a lung preservation and assessment tool prior to lung transplantation (LTx) and is evolving to become a platform to deliver cellular and gene therapies or inactivate pathogens. Here we aimed to investigate the utility of our recently reported rat EVLP-to-LTx model as the smallest ever experimental survival model of EVLP-to-LTx and to compare late graft endpoints between strain combinations.</div></div><div><h3>Methods</h3><div>We tested three strains as normothermic EVLP donors: Fisher 344 (F344), Lewis (LEW), and Wistar Kyoto (WKy) rats. Then we tested three strain combinations of EVLP-to-LTx (F344-to-WKy, F344-to-LEW, and LEW-to-LEW) to compare histologic and radiologic changes.</div></div><div><h3>Results</h3><div>F344 and LEW, but not WKy rat lungs, tolerated 4 hours of normothermic EVLP. F344-to-WKy EVLP-to-LTx developed significant histologic (as measured by acute lung injury score, ISHLT A and B grade rejection score) and radiologic (volume and mean Hounsfield units of aerated lung graft analyzed by computed tomography at day 7 after EVLP-to-LTx) changes in the lung allograft. In this strain combination, progressive deterioration with time was noted up to day 28, while F344-to-LEW grafts exhibited only mild injuries similar to LEW-to-LEW. In addition, flow cytometric analyses of F344-to-WKy EVLP-to-LTx revealed a sharp rise in activation marker expression in lung graft T cells beginning at day 3.</div></div><div><h3>Conclusions</h3><div>Our F344-to-WKy EVLP-to-LTx model generates reproducible and clinically relevant histological, radiological, and immunological results similar to those seen in humans. The model is therefore well suited to experimental EVLP studies with long-term follow-up prior to moving to large animal and human studies.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100299"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221816","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":"Donation after circulatory death with thoracoabdominal normothermic regional perfusion recovery has similar outcomes with donation after brain death for lung transplantation","authors":"Sarah Y. Park MD ,&nbsp;Emily Hay-Arthur BA ,&nbsp;Elizabeth J. Bashian MD ,&nbsp;Han Le MS ,&nbsp;Michal Schäfer MD, PhD ,&nbsp;David N. Campbell MD ,&nbsp;Nicholas R. Teman MD ,&nbsp;Alice L. Gray MD ,&nbsp;Jordan R.H. Hoffman MD, MPH ,&nbsp;Michael T. Cain MD","doi":"10.1016/j.jhlto.2025.100289","DOIUrl":"10.1016/j.jhlto.2025.100289","url":null,"abstract":"<div><h3>Introduction</h3><div>Donation after circulatory death (DCD) with thoracoabdominal normothermic regional perfusion (TA-NRP) has been increasingly used to procure cardiac allografts; however, concerns persist regarding its impact on lung allografts. We present our institution’s experience with DCD TA-NRP and donation after brain death (DBD) lung transplants, comparing outcomes between the two techniques.</div></div><div><h3>Methods</h3><div>All lung transplants recovered with DBD or DCD TA-NRP performed between October 2022 and December 2024 were included. DCD TA-NRP procured lungs were retrieved using a lung protective strategy including early reintubation and pulmonary venting as previously described. The primary outcome was survival, with secondary outcomes of primary graft dysfunction (PGD) and pulmonary-related mortality.</div></div><div><h3>Results</h3><div>There were 85 DBD and 23 DCD TA-NRP lung transplants performed in the study period. Overall survival was not significantly different by Kaplan-Meier curve (<em>p</em> = 0.49), with 1-year absolute survival of 81.6% for DCD TA-NRP, with only one pulmonary-related mortality, and 89.4% for DBD, with six pulmonary-related mortalities. PGD grade 3 rates were not statistically different at postoperative day (POD) 0 (47.8% DCD TA-NRP vs 35.2% DBD, <em>p</em> = 0.27), POD 1 (21.7% vs 10.6%, <em>p</em> = 0.16), POD2 (8.7% vs 11.7%, <em>p</em> = 0.68), and POD3 (13.0% vs 11.8%, <em>p</em> = 0.87). Other intraoperative and postoperative outcomes were not significantly different.</div></div><div><h3>Conclusion</h3><div>Lung transplantation outcomes were not significantly different between lung grafts recovered by DCD TA-NRP and DBD. This early data suggests TA-NRP may not adversely impact DCD lung allografts during procurement.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100289"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261497","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":"Social contributions as risk factors for readmissions after lung transplantation: Clinical and financial implications","authors":"Catherine Lu Dugan BA ,&nbsp;Margaret V. Kudlinski BS ,&nbsp;Sivagini Ganesh MD ,&nbsp;Graeme Rosenberg MD ,&nbsp;Takashi Harano MD ,&nbsp;Sean Wightman MD ,&nbsp;Scott Atay MD ,&nbsp;Anthony W. Kim MD ,&nbsp;Brooks V. Udelsman MD, MHS","doi":"10.1016/j.jhlto.2025.100300","DOIUrl":"10.1016/j.jhlto.2025.100300","url":null,"abstract":"<div><h3>Introduction</h3><div>Lung transplant is associated with a 60%–80% 1-year post-transplant readmission rate. Social contributors represent potentially modifiable risk factors for readmission. We compared the clinical and financial of implications of readmissions associated with and without social factors.</div></div><div><h3>Methods</h3><div>Retrospective single-center study of lung transplant patients surviving to discharge between 2/2/2013 and 4/11/2023. Two reviewers categorized 1-year readmissions into two groups: social (eg, housing instability or rejection due to medication non-compliance) and non-social (eg, pancreatitis). Sociodemographics, transplant indications, Stanford Integrated Psychosocial Assessment for Transplant scores, lung allocation score, pre-operative hospitalization status, in-hospital post-operative course, and readmission costs were compared between patients with and without a social readmission.</div></div><div><h3>Results</h3><div>Among 192 transplants (109 double, 83 single), there were 436 1-year readmissions, including 33 social readmissions. Reviewer inter-rater reliability was &gt;95% and Kappa was 0.91. A social readmission occurred in 21 (11%) patients, and 9 of these patients had multiple social readmissions. A social readmission was either the first or second readmission for 81% of these patients. Patients with a social readmission had a greater median number of readmissions (4 vs 2; <em>p</em> &lt; 0.001) and were associated with longer length of stay (8 vs 5 days; <em>p</em> &lt; 0.004), increased hospital costs ($23,813 vs $14,245; <em>p</em> = 0.04), and decreased margin (-$6145 vs $2287; <em>p</em>&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Social readmissions represent a burden on patients and health systems. There is a strong association between social readmissions and increased costs, length of stay, and number of readmissions. Outpatient investment in patients with first-time social readmissions may improve outcomes and decrease healthcare costs.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100300"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221815","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":"Utilizing cardiac magnetic resonance to assess the sequelae of prior rejection episodes on myocardium and correlation with clinical outcomes","authors":"Akila Bersali MD ,&nbsp;Farhan Ishaq MD, MPH, MBA ,&nbsp;Mianli Xiao PhD ,&nbsp;Edward A Graviss PhD, MPH ,&nbsp;George Naufal ,&nbsp;Ashrith Guha MD, MPH ,&nbsp;Dipan J. Shah MD ,&nbsp;Rayan Yousefzai MD","doi":"10.1016/j.jhlto.2025.100298","DOIUrl":"10.1016/j.jhlto.2025.100298","url":null,"abstract":"<div><div>This study compared structural and functional alterations using cardiac MRI (CMR) in heart transplant recipients with and without acute cellular rejection (ACR) and analyzed their association with clinical outcomes. ACR patients showed reduced left ventricular global longitudinal strain (LV GLS) (10% vs 12%; <em>P</em> = 0.03), reduced right ventricular global longitudinal strain (16% vs 18%; <em>P</em> = 0.04), increased left ventricular (LV) mass (72 vs 61 g/m²; <em>P</em> = 0.003), and decreased right ventricular stroke volume (70 vs 79 mL; <em>P</em> = 0.05). Univariate analysis revealed that LV ejection fraction (EF) (HR 0.90, <em>P</em> &lt; 0.001), RV ejection fraction (HR 0.91, <em>P</em> = 0.004), LV stroke volume (SV) (HR 0.96, <em>P</em> = 0.01), RV SV (HR 0.96, <em>P</em> = 0.003), and LV scar size (HR 1.13, <em>P</em> = 0.002) were significantly associated with cardiovascular hospitalization or mortality. After adjusting for relevant covariates, indexed RV SV (HR 0.90, <em>P</em> = 0.015) and LV scar size (HR 1.17, <em>P</em> = 0.026) remained significant predictors of the clinical outcome. CMR can identify sequelae of ACR, potentially influencing clinical decisions.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100298"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281173","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}