JHLT Open最新文献

{"title":"Challenges in medication titration in children with heart failure","authors":"Jessie Yester MD, PhD,&nbsp;Deipanjan Nandi MD, MSc","doi":"10.1016/j.jhlto.2025.100358","DOIUrl":"10.1016/j.jhlto.2025.100358","url":null,"abstract":"<div><div>The management of pediatric heart failure and titration of oral medical therapies remains in its infancy. Burdened by a lack of understanding of the diverse pediatric heart failure etiologies, limitations in clinical trials, a lack of society guidelines, as well as other health care systemic issues, titration of medications is greatly lacking. We herein review the difficulties with medication titration in pediatric heart failure, and highlight important next steps to remedy the situation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858449","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":"Prognostic value of NT-proBNP monitoring in patients with left ventricular assist devices","authors":"Miloud Cherbi MD ,&nbsp;Joaquim Verdaguer MD ,&nbsp;Romain Itier MD ,&nbsp;Laurence Barde MD ,&nbsp;Pauline Fournier MD ,&nbsp;Etienne Grunenwald MD ,&nbsp;Philippe Gaudard MD, PhD ,&nbsp;Philippe Rouvière MD ,&nbsp;Adrien Molina MD ,&nbsp;Aurore Ughetto MD ,&nbsp;Clément Delmas MD, PhD","doi":"10.1016/j.jhlto.2025.100387","DOIUrl":"10.1016/j.jhlto.2025.100387","url":null,"abstract":"<div><h3>Background</h3><div>N-terminal fragment of the brain natriuretic peptide (NT-proBNP) is a well-established biomarker in heart failure; however, its prognostic value in patients supported by left ventricular assist devices (LVAD) remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including patients implanted with an LVAD between 2008 and 2025 at 2 tertiary care centers. NT-proBNP levels were measured at 3 and 6 months postimplantation, and their relationships with invasive hemodynamic parameters and 1-year clinical outcomes were evaluated at each time point.</div></div><div><h3>Results</h3><div>A total of 128 patients were included. Whereas NT-proBNP measured at 3 months showed no significant correlation with any hemodynamic parameters, NT-proBNP at 6 months correlated with right atrial pressure (ρ = 0.46, <em>p</em> &lt; 0.01), systolic pulmonary artery pressure (ρ = 0.39, <em>p</em> = 0.03), and pulmonary capillary wedge pressure (ρ = 0.39, <em>p</em> = 0.02). NT-proBNP measured at 3 months was not significantly associated with 1-year mortality, pump thrombosis, or right ventricular (RV) failure. Conversely, NT-proBNP at 6 months was independently associated with an increased risk of the composite end-point of mortality or pump thrombosis (adjusted hazard ratio 1.34 [1.07-1.62] per 500 pg/ml increase), and the composite end-point of mortality or RV failure (adjusted odds ratio 1.53 [1.17-2.01] per 500 pg/ml increase).</div></div><div><h3>Conclusions</h3><div>NT-proBNP measured at 6 months post-LVAD implantation is a significant predictor of adverse clinical and hemodynamic outcomes at 1 year, supporting its role in risk stratification. Prospective studies are warranted to validate these findings.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100387"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265874","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":"Pediatric heart transplant survival in single ventricle disease","authors":"Jillian Wen MD,&nbsp;Marc Richmond MD, MS","doi":"10.1016/j.jhlto.2025.100396","DOIUrl":"10.1016/j.jhlto.2025.100396","url":null,"abstract":"<div><div>Outcomes in pediatric heart transplantation have steadily improved since the first pediatric heart transplant was performed by Dr. Kantrowitz and his team in 1967; however, there is still progress to be made. Patients with congenital heart diseases (CHD) consistently have worse waitlist mortality, post-transplant survival, infection rates, and post-transplant lymphoproliferative disease (PTLD) risk, with single ventricle disease (SVD) patients being at particularly high risk for rejection and rejection with severe hemodynamic compromise (RSHC). Furthermore, there has been little improvement in the development of cardiac allograft vasculopathy (CAV) and PTLD over the decades, and survival following diagnosis continues to remain poor for all patients regardless of diagnosis. Hopefully, as new advances in immunosuppression, mechanical support, and surgical techniques emerge, we will continue to develop a deeper understanding of the co-morbidities associated with pediatric heart transplant to further improve the survival and quality of life of pediatric heart transplant recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100396"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323839","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":"Molecular diagnostics for the monitoring of the cardiac allograft","authors":"Lauren K. Truby MD, MS ,&nbsp;Jeffrey Teuteberg MD","doi":"10.1016/j.jhlto.2025.100354","DOIUrl":"10.1016/j.jhlto.2025.100354","url":null,"abstract":"<div><div>Heart transplantation (HT) remains the optimal long-term therapy to improve survival in eligible patients living with end-stage heart disease. Monitoring the health of the allograft over its lifespan is critical to ensure the rapid diagnosis of immunologic, vascular, and myocardial events to enable the timely deployment of appropriate medical therapies. Advances in next-generation sequencing are being applied to screening for allograft rejection to the early detection of malignancy and have already been integrated into the routine care of HT recipients. Further personalization of care by integrating omics and imaging technologies, combined with novel data analysis methods, is at hand.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100354"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826907","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":"Corrigendum to “Outcomes of combined liver-lung transplant in pediatric patients with cystic fibrosis: An ISHLT transplant registry study” [JHLT Open (2025) 100212]","authors":"Renita Wilson BS ,&nbsp;J. Asher Jenkins MD ,&nbsp;Juan Maria Farina MD ,&nbsp;Blake Langlais MS ,&nbsp;Bashar Aqel MD ,&nbsp;Ashraf Omar MD ,&nbsp;Jonathan D’Cunha MD, PhD ,&nbsp;Pedro Reck dos Santos MD, PhD","doi":"10.1016/j.jhlto.2025.100432","DOIUrl":"10.1016/j.jhlto.2025.100432","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100432"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519452","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":"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}