JHLT Open最新文献

{"title":"Long-term outcomes after percutaneous withdrawal of HeartWare left ventricular assist device (HVAD) support: A 10-year update","authors":"Chokanan Thaitirarot ,&nbsp;Leonard M. Shapiro ,&nbsp;Clive Lewis ,&nbsp;Jayan Parameshwar ,&nbsp;Steven S.L. Tsui ,&nbsp;Stephen J. Pettit","doi":"10.1016/j.jhlto.2024.100169","DOIUrl":"10.1016/j.jhlto.2024.100169","url":null,"abstract":"<div><div>Ten years have passed since we reported percutaneous decommissioning of an implantable left ventricular assist device (LVAD) using 2 Amplatzer vascular plugs in a 17-year-old male who was bridged to recovery after 22 months of LVAD support. While his left ventricular (LV) dimensions never completely normalized and there has been persistent mild impairment of LV systolic function, the patient remains free of heart failure symptoms and his natriuretic peptide level has been well suppressed on guideline-directed medical therapy. He is anticoagulated with Warfarin. There have been no adverse events relating to either the decommissioned LVAD or the percutaneous driveline remnant, or anticoagulation. This case highlights the potential for long-term survival without adverse events in individuals who are left with a redundant implantable LVAD after successful percutaneous withdrawal of mechanical circulatory support.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the TAPSE/sPAP ratio as a predictor of mortality in Pulmonary Arterial Hypertension: Its value for patient risk stratification","authors":"Paul Palacios-Moguel MD ,&nbsp;Guillermo Cueto-Robledo MD ,&nbsp;Héctor González-Pacheco MD ,&nbsp;Jorge Ortega-Hernández MD ,&nbsp;María Berenice Torres-Rojas MD ,&nbsp;Dulce Iliana Navarro-Vergara MD ,&nbsp;Marisol García-Cesar MD ,&nbsp;Cinthia Alejandra González-Nájera MD ,&nbsp;Carlos Alfredo Narváez-Oríani MD ,&nbsp;Julio Sandoval MD","doi":"10.1016/j.jhlto.2024.100168","DOIUrl":"10.1016/j.jhlto.2024.100168","url":null,"abstract":"<div><h3>Background</h3><div>The tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) ratio has been proposed as an indicator of ventriculo-arterial coupling, predicting right ventricular failure (RVF) and mortality in patients with pulmonary arterial hypertension (PAH).</div></div><div><h3>Objective</h3><div>To evaluate the usefulness of the TAPSE/sPAP ratio in predicting outcomes and improving risk stratification in patients with PAH.</div></div><div><h3>Methods</h3><div>156 patients with PAH were included. Clinical, functional, echocardiographic, and haemodynamic variables, along with the TAPSE/sPAP ratio, were analysed based on etiological PAH subgroups and outcomes. Additional statistical measures, such as the area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement, assessed the predictive ability of TAPSE/sPAP in combination with the ESC/ERS risk score, and other risk assessment strategies (COMPERA and Reveal Lite 2).</div></div><div><h3>Results</h3><div>Most patients were female (86.5%), with a median age of 45.5 (IQR: 29–58) years. The TAPSE/sPAP ratio for the whole group was 0.26 (IQR: 0.190–0.347) mm/mmHg, which was similar among different aetiologies, but different between deceased and surviving patients (0.14 vs. 0.27 mm/mmHg, respectively, <em>P</em> &lt; 0.001). A TAPSE/sPAP ratio &lt;0.18 mm/mmHg independently predicted mortality (AUC: 0.859, 95% CI: 0.766– 0.952; <em>P</em> &lt; 0.001). Integration with the ESC/ERS risk score improved predicted mortality (AUC: 0.87 vs. 0.75, <em>p</em> = 0.002) and risk stratification, reclassifying 14.28% of events and 36.92% of non-events, with an NRI of 39.4% (<em>P</em> &lt; 0.001). Likewise, integration with other scores improved predicted ability of COMPERA and REVEA Lite2; COMPERA+TAPSE/sPAP (AUC: 0.837 vs 0.742; <em>p</em> = 0.005) and REVEAL Lite 2 +TAPSE/sPAP (AUC: 0.840 vs. 0.713; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>A TAPSE/sPAP ratio &lt;0.18 mm/mmHg predicts mortality in PAH. The combination of the TAPSE/sPAP ratio with the ESC/ERS risk score improved risk stratification, and reclassification emphasizing the potential of ESC/ERS+TAPSE/sPAP as a valuable tool for risk assessment and clinical decision-making in PAH patients. Integration of TAPSE/sPAP ratio with other scores (COMPERA and (REVEAL Lite 2) also improved the risk stratification and reclassification of these risk scores.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic 19F-MRI of pulmonary ventilation in lung transplant recipients with and without chronic lung allograft dysfunction","authors":"Mary A. Neal PhD ,&nbsp;Saskia Bos MD, PhD ,&nbsp;Charlotte W. Holland MRCP ,&nbsp;Kieren G. Hollingsworth ,&nbsp;Gerard Meachery FRCP ,&nbsp;Arun Nair MD, FRCP ,&nbsp;James L. Lordan FRCP ,&nbsp;Andrew J. Fisher FRCP, PhD ,&nbsp;Peter E. Thelwall PhD","doi":"10.1016/j.jhlto.2024.100167","DOIUrl":"10.1016/j.jhlto.2024.100167","url":null,"abstract":"<div><h3>Background</h3><div>By the time chronic lung allograft dysfunction (CLAD), with its main phenotypes bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), is diagnosed by pulmonary function testing, irreversible damage to the lung allograft may already have occurred. Dynamic ¹⁹F-MRI of inhaled perfluoropropane may detect subtle changes in regional lung ventilation and provides a quantitative measure of regional lung function. We assessed feasibility of detecting regional ventilation dysfunction due to CLAD in lung transplant recipients.</div></div><div><h3>Methods</h3><div>Dynamic ¹⁹F-MRI was performed in ten lung transplant recipients, four without CLAD and six with CLAD (5 BOS, 1 RAS). Gas wash-in and washout dynamics were assessed and regional lung clearance index (RLCI) provided a quantitative metric of regional lung ventilation.</div></div><div><h3>Results</h3><div>BOS patients had substantially greater variation in regional ventilation compared with stable patients, with more regions of reduced ventilation, especially in the periphery. Tracer washout was homogeneous and rapid in stable patients but highly heterogeneous in CLAD. CLAD patients exhibited significant difference in RLCI between central and peripheral lung regions (<em>p</em> = 0.0016) and a wider interquartile range of RLCI for wash-in compared with stable patients (no CLAD 4.1, BOS 10.5, <em>p</em> = 0.036). FEV₁ (% of baseline) negatively correlated with ventilation during wash-in, most strongly for the periphery (r = −0.844, <em>p</em> = 0.0021).</div></div><div><h3>Conclusions</h3><div>Dynamic ¹⁹F-MRI identified quantifiable differences in regional ventilation in lung transplant recipients with and without CLAD and was well tolerated. Larger longitudinal studies using this approach will determine if early detection of changes in regional ventilation in lung transplant patients allows earlier CLAD detection.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical heterotopic heart transplantation in mice using a novel suture technique","authors":"Hao Dun MD MSc ,&nbsp;Maura Sticco-Ivins ,&nbsp;Yuriko Terada MD PhD ,&nbsp;Amber Berning MD ,&nbsp;Kory J. Lavine MD PhD ,&nbsp;Daniel Kreisel MD PhD ,&nbsp;Benjamin J. Kopecky MD PhD","doi":"10.1016/j.jhlto.2024.100164","DOIUrl":"10.1016/j.jhlto.2024.100164","url":null,"abstract":"<div><h3>Background</h3><div>Vascularized transplantation models in mice are critical to understand mechanisms that mediate rejection and to develop new therapeutics. Standard abdominal heterotopic heart transplantation techniques employ an <em>end-to-side</em> suture technique and are the workhouse of transplant immunology research laboratories. Recently, cervical heterotopic heart transplantation in mice has emerged as an alternative due to several advantages but is conventionally performed by suture or cuff techniques in an <em>end-to-end</em> fashion. Therefore, we introduce an <em>end-to-side</em> anastomosis technique.</div></div><div><h3>Methods</h3><div>The donor pulmonary artery is <em>end-to-side</em> anastomosed to the recipient right external jugular vein, using a continuous 10–0 nylon suture. Vascular suturing is accomplished inside the vessel on the posterior wall, and then outside the vessel on the anterior wall. Finally, the donor ascending aorta is <em>end-to-side</em> anastomosed to the recipient common carotid artery with an identical suture technique.</div></div><div><h3>Results</h3><div>The median times for the donor heart harvest, recipient preparation, anastomoses of the pulmonary artery to the external jugular vein, and the ascending aorta to the common carotid artery were 12, 10, 12 and 11 minutes, respectively. The survival rate was 100% (<em>n</em> = 20).</div></div><div><h3>Conclusions</h3><div>We provide a detailed description of how to perform <em>end-to-side</em> anastomoses using a suture technique in the mouse cervical heart transplantation model. This procedure reconstitutes coronary blood flow in the heart graft with minimal interruption to recipient anatomy and provides an experimental platform to study transplant immunology.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten hour donor heart ischemic time with 10ºC static storage","authors":"William Tucker MD ,&nbsp;Yatrik Patel MD ,&nbsp;Mark Petrovic MS ,&nbsp;Chris Schwartz RN ,&nbsp;Brandon Petree DO ,&nbsp;Steve Devries DMSc, PA-C ,&nbsp;Brian Lima MD ,&nbsp;John Trahanas MD ,&nbsp;Matthew Bacchetta MD, MBA ,&nbsp;Ashish Shah MD ,&nbsp;Swaroop Bommareddi MD","doi":"10.1016/j.jhlto.2024.100163","DOIUrl":"10.1016/j.jhlto.2024.100163","url":null,"abstract":"<div><div>Utilization of 10ºC static storage safely extended both ischemic time and travel radius in heart transplantation. A 57-year-old man with ischemic cardiomyopathy, a left ventricular assist device (LVAD), and end-stage renal disease was listed for combined heart-kidney transplant. The donor hospital in Anchorage, AK, was located approximately 2,700 nautical miles and 8 hours from the recipient center. The organ was transported in 10ºC static storage with over 10 hours of ischemic time and had superb early allograft function. Excellent outcomes with extended ischemic times can be achieved without machine perfusion, provided good recovery, storage, and implant techniques are followed.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation","authors":"Anouk Frering MD ,&nbsp;Antoine Abi Lutfallah MD ,&nbsp;Aude Carillion MD, PhD ,&nbsp;Daniel Wendt MD ,&nbsp;Pascal Leprince MD, PhD ,&nbsp;Adrien Bougle MD, PhD ,&nbsp;Guillaume Lebreton MD, PhD","doi":"10.1016/j.jhlto.2024.100165","DOIUrl":"10.1016/j.jhlto.2024.100165","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplantation is an emergency surgery requiring cardio-pulmonary bypass (CPB) and its timing is unpredictable. Patients on the transplant waiting list often have multiple reasons for being anticoagulated. Intraoperative removal of apixaban using CytoSorb seems to be an interesting solution for patients on DOACs requiring an emergency CPB intervention. The aim of this short communication is to describe the perioperative effects of the use of the CytoSorb hemoadsorption device during emergency CPB for a heart transplant patient.</div></div><div><h3>Methods</h3><div>A 61-year-old male patient wait-listed for heart transplantation was admitted to our hospital to benefit from a heart transplantation. This patient, has an end-stage heart failure with multiple episodes of decompensation over the previous year. He was anticoagulated with a Vitamin K antagonist (VKA) due to atrial fibrillation and was switched to apixaban. Hemoadsorption by a CytoSorb cartridge was performed during the entire CPB duration. Anti-Factor Xa Activity (AFXaA) levels were taken before, during and after surgery in order to monitor anticoagulation.</div></div><div><h3>Results</h3><div>Surgery consisted of an orthotopic heart transplantation with bi-caval anastomoses. At the time of anesthesia induction and after UFH administration, AFXaA levels were 330ng/mL and 317ng/mL, respectively. Thereafter, AFXaA decreased to 137ng/mL during CPB and to 57ng/mL after the end of CPB and protamine administration. After surgery, AFXaA levels stabilized over 50ng/mL over the next 14 hours. No primary graft dysfunction was observed, and during the post-operative period of 72 hours, the patient did not have any bleeding events requiring reintervention or transfusion.</div></div><div><h3>Conclusion</h3><div>We observed that CytoSorb could be a potential solution to remove apixaban intraoperatively. If this efficacy is confirmed in larger trials, it would allow transplant candidates to be treated with DOACs without requiring a switch to VKAs.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of donor organ quality on recipient outcomes in lung transplantation: 14-Year single-center experience using the Eurotransplant lung donor score","authors":"Katharina Flöthmann ,&nbsp;Nunzio Davide de Manna MD ,&nbsp;Khalil Aburahma MD ,&nbsp;Sophie Kruszona ,&nbsp;Philipp Wand MD ,&nbsp;Dmitry Bobylev MD ,&nbsp;Carsten Müller MD ,&nbsp;Julia Carlens MD ,&nbsp;Nicolaus Schwerk MD ,&nbsp;Murat Avsar MD ,&nbsp;Arjang Ruhparwar MD ,&nbsp;Christian Kühn MD ,&nbsp;Mark Greer MD ,&nbsp;Jawad Salman MD ,&nbsp;Fabio Ius MD","doi":"10.1016/j.jhlto.2024.100166","DOIUrl":"10.1016/j.jhlto.2024.100166","url":null,"abstract":"<div><h3>Background</h3><div>The use of extended-criteria donor (ECD) organs has increased in lung transplantation, but their impact on long-term outcomes remains unclear. This retrospective single-center study evaluates the impact of donor quality, as defined by the Eurotransplant (ET) lung donor score, on long-term graft function and survival.</div></div><div><h3>Methods</h3><div>Records of recipients transplanted between January 2010 and May 2023 were reviewed. Eurotransplant lung donor scores (ET scores) were retrospectively calculated from the corresponding donor reports. Outcomes were compared between recipients of donor lungs with an ET score of 6 (group 1), 7 and 8 (group 2), and 9 to 13 (group 3, ECD lungs). Median follow-up was 64 (30-104) months.</div></div><div><h3>Results</h3><div>In total, 280 (19%) patients were transplanted with ET score 6 lungs, 717 (48%) patients with ET scores 7 and 8 lungs, and 506 (34%) patients with ET scores 9 to 13 (ECD) lungs. The occurrence of primary graft dysfunction grade 3 at 72 hours (<em>p</em> = 0.672), duration of mechanical ventilation (<em>p</em> = 0.062), and in-hospital mortality (<em>p</em> = 0.713) did not differ between groups. Long-term graft survival (%) was lower in group 2 and 3 vs group 1 recipients (at 10 years: 51 and 48 vs 56, <em>p</em> = 0.052, respectively). Similarly, freedom from chronic lung allograft dysfunction (CLAD, %) was lower in group 2 and 3 vs group 1 recipients (at 10 years: 57 and 55 vs 63, <em>p</em> = 0.033, respectively). Donor smoking history was associated with worse CLAD-free survival (hazard ratio = 1.466, 95% confidence interval = 1.215-1.769, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>ECD lungs represented an important resource in lung transplantation. However, their use may be associated with a worse long-term graft and CLAD-free survival.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"6 ","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malnutrition risk, weight loss, and subsequent survival in patients listed for heart transplantation","authors":"Tae Kyung Yoo MD, MS ,&nbsp;Satoshi Miyashita MD ,&nbsp;Ariella Stein MSCIS-HI ,&nbsp;Michael Wu BS, MPH ,&nbsp;Lauren Parsly Read-Button MPH, RD, LDN ,&nbsp;Masashi Kawabori MD ,&nbsp;Greg S. Couper MD ,&nbsp;Edward Saltzman MD ,&nbsp;Amanda R. Vest MBBS, MPH","doi":"10.1016/j.jhlto.2024.100162","DOIUrl":"10.1016/j.jhlto.2024.100162","url":null,"abstract":"<div><h3>Background</h3><div>Higher malnutrition risk is associated with mortality among patients with heart failure and heart transplantation (HT). We investigated which malnutrition risk scores – geriatric nutrition risk index (GNRI), prognostic nutritional index (PNI), or controlling nutritional status (CONUT) – have the strongest mortality association for HT candidates, and whether they are prognostic at the time of HT listing or HT operation.</div></div><div><h3>Methods</h3><div>We reviewed adults listed for primary HT at a single center 1987–March 2022, with survival follow-up to November 2022. We constructed Cox proportional hazards models and restricted cubic spline curves for each risk score at both HT listing and HT operation and inputted HT operation as a time-varying covariate for models commencing at listing. Risk scores were assessed as continuous and binary variables. Weight change between listing and HT was evaluated similarly.</div></div><div><h3>Results</h3><div>The 1,024 patients [76% male; median age 55 (46–61) years; HT operation <em>n</em> = 656] had median follow-up of 4.6 (interquartile range 1.6–8.7) years. As a continuous variable, lower GNRI at HT listing (greater malnutrition risk) was independently associated with higher mortality. As binary variables, higher risk GNRI, PNI or CONUT scores at listing were all associated with higher mortality. Conversely, risk scores at time of HT operation were not associated with subsequent mortality. There was a non-significant trend towards higher mortality with greater weight loss between listing and HT operation.</div></div><div><h3>Conclusion</h3><div>Malnutrition risk scores showed prognostic utility only at time of HT listing. As a continuous variable, GNRI at HT listing was independently associated with subsequent mortality.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between pretransplant malignancy and post-transplant survival and cancer recurrence in bilateral lung transplantation: An analysis of 23,291 recipients","authors":"Wongi Woo MD ,&nbsp;Hye Sung Kim MD ,&nbsp;Ankit Bharat MBBS ,&nbsp;Young Kwang Chae MD, PhD, MBA","doi":"10.1016/j.jhlto.2024.100161","DOIUrl":"10.1016/j.jhlto.2024.100161","url":null,"abstract":"<div><h3>Background</h3><div>Given the increasing need for lung transplants among older patients with a history of cancer, this study analyzed database registry to assess outcomes for bilateral lung transplant (BLT) recipients with pre-transplant malignancy (TM).</div></div><div><h3>Methods</h3><div>This study evaluated the United Network for Organ Sharing registry for adult BLT performed between 2005 and 2023. Patients with a history of previous or multiorgan transplants, and those with donors who had cancer history, were excluded. Propensity score matching was used to compare patients with or without pre-TM. Overall and post-TM-free survival were analyzed.</div></div><div><h3>Results</h3><div>Among the 23,291 recipients of BLT, 8.0% (1,870) had pre-TM. Compared to those without pre-TM, patients with pre-TM had worse overall (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.12-1.29, <em>p</em> &lt; 0.001) and post-TM-free survival (HR 1.32, 95% CI 1.24-1.41, <em>p</em> &lt; 0.001). However, after adjusting for age, sex, and race through propensity score matching, the survival difference between the groups became nonsignificant (HR 1.05, 95% CI 0.97-1.13, <em>p</em> = 0.229). While the pre-TM group still had worse post-TM-free survival, this difference diminished after excluding cutaneous post-TM (HR 1.06, 95% CI 0.99-1.15, <em>p</em> = 0.116). Additionally, the recurrence rate of pre-TM after transplant was not higher than de novo cancers in patients without pre-TM.</div></div><div><h3>Conclusions</h3><div>Patients with pre-TM had similar survival rates after BLT as those without pre-TM. Importantly, there was no increased risk of the primary pre-TM type recurring post-transplant compared to patients without pre-TM. If patients with pre-TM are free from recurrence or metastasis for a significant time, there could be some who can benefit from BLT. Further data regarding timeline between pre-TM and BLT would be necessary to draw conclusion in this issue.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"7 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrepancy between pulmonary arterial wedge pressure and left ventricular end diastolic pressure in patients with interstitial lung disease","authors":"Ho Cheol Kim MD ,&nbsp;Onix Cantres Fonseca MD ,&nbsp;Behnam N. Tehrani MD ,&nbsp;Christopher S. King MD ,&nbsp;Christopher Thomas MD ,&nbsp;Vikramjit Khangoora MD ,&nbsp;Oksana A. Shlobin MD ,&nbsp;Steven D. Nathan MD","doi":"10.1016/j.jhlto.2024.100160","DOIUrl":"10.1016/j.jhlto.2024.100160","url":null,"abstract":"<div><h3>Background</h3><div>Right heart catheterization (RHC) is the gold standard for diagnosing pulmonary hypertension (PH) in patients with interstitial lung disease (ILD). However, discrepancies between pulmonary arterial wedge pressure (PAWP) and left ventricular end-diastolic pressure (LVEDP) remain understudied in this population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of data from ILD patients who underwent RHC and had concomitant LVEDP measurements. Pulmonary vascular resistance (PVR) was calculated using both PAWP and LVEDP. Patients were categorized based on PAWP and LVEDP values using a threshold of 15 mm<!--> <!-->Hg and PVR values using a threshold of 2 or 3 Wood Units. After that patients were categorized as concordant or discordant if both values were on the same or opposite sides of these thresholds, respectively. A discordantly higher PAWP group (left atrial dysfunction, LAD) was defined as patients with a PAWP-LVEDP difference of more than 3 mm<!--> <!-->Hg.</div></div><div><h3>Results</h3><div>Among 87 ILD patients, 9 patients (10.3%) showed discordance between PAWP and LVEDP. LAD was observed in 12 patients (13.8%) and was associated with lower forced vital capacity (Odd ratio [OR]: 0.956, <em>p</em> = 0.049) and a larger left atrium diameter (OR: 3.205, <em>p</em> = 0.033). Discordance in PVR values was also noted, with potential treatment targets for PH-specific therapy differing in 9 patients (22.0%) depending on whether PAWP or LVEDP was used.</div></div><div><h3>Conclusions</h3><div>This study highlights the clinical significance of PAWP-LVEDP discrepancies in suspected PH-ILD patients, emphasizing the need for comprehensive assessments incorporating LVEDP and clinical context for accurate diagnosis, risk stratification, and treatment decisions.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"6 ","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}