JHLT Open最新文献

{"title":"Frailty assessment and candidate optimization before cardiothoracic transplantation","authors":"Antoine Premachandra MD ,&nbsp;Jacob Klapper MD ,&nbsp;Jonathan Messika MD, PhD ,&nbsp;Maira Gaillard MD ,&nbsp;Martin Kloeckner MD ,&nbsp;Kamrouz Ghadimi MD, MHSc ,&nbsp;Matthieu Reffienna PT ,&nbsp;Krista Ingle PhD ,&nbsp;Kirti Magudia MD ,&nbsp;Brandi Bottiger MD","doi":"10.1016/j.jhlto.2026.100492","DOIUrl":"10.1016/j.jhlto.2026.100492","url":null,"abstract":"<div><div>Frailty is an important syndrome in an aging thoracic transplant population, particularly in the context of end-stage cardiopulmonary disease. In this review, we discuss the core problem of lack of physiologic reserve in these patients and its relationship to perioperative outcomes, how to define and measure frailty in the context of heart and lung transplant and identify interventions to treat contributors to this clinical syndrome. We highlight the critical need in the transplant community to identify and treat these conditions prior to their transplantation and to prevent comorbidity and mortality.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100492"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190261","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":"Risk factors when considering heart transplants with donors aged 45 or above: Development of a Novel Mortality Risk Score using UNOS data","authors":"Anh Nguyen MD, PhD ,&nbsp;Abbas Rana MD ,&nbsp;Alexis Shafii MD ,&nbsp;Gabriel Loor MD ,&nbsp;Andrew Civitello MD ,&nbsp;Todd Rosengart MD ,&nbsp;Kenneth Liao MD, PhD","doi":"10.1016/j.jhlto.2026.100497","DOIUrl":"10.1016/j.jhlto.2026.100497","url":null,"abstract":"<div><h3>Background</h3><div>Current International Society for Heart and Lung Transplantation guidelines support the use of donor hearts aged ≥45 if significant coronary artery disease is excluded and ischemic time remains &lt;4 hours. This study aimed to identify additional risk factors affecting patient survival and develop a risk score for recipients of older donor hearts.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of adult heart transplants using donors aged ≥45 from January 2000 to June 2024, using United Network for Organ Sharing data. Multivariable Cox regression identified risk factors for mortality, and the most significant variables were used to construct a risk score.</div></div><div><h3>Results</h3><div>Of 58,859 adult heart transplants, 9,843 (16.7%) involved donors aged ≥45. Recipient median age was 58 years (interquartile range, 51-64). One-, 5-, and 10-year patient survival rates were 87.0%, 73.3%, and 53.5%, respectively. Statistically significant risk factors included ischemic time ≥4 hours (HR = 1.11), cytomegalovirus (CMV)-positive donor status (hazard ratio [HR] = 1.11), donor cigarette use (HR = 1.10) and recipient factors: age &gt;55 (HR = 1.37), Black race (HR = 1.19), obesity (HR = 1.20), diabetes (HR = 1.27), pretransplant dialysis (HR = 1.44), pretransplant mechanical ventilator use (HR = 1.37), and prior cardiac surgery (HR = 1.28). Model discrimination was moderate with C-statistics of 0.58.</div></div><div><h3>Conclusions</h3><div>When considering heart transplants with donors aged ≥45, we should screen for ischemic time ≥4 hours, CMV-positive donor, donor cigarette use, and the following recipient factors: age &gt;55, Black race, obesity, diabetes, pretransplant dialysis or mechanical ventilation, and prior cardiac surgery.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190239","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":"Cytomegalovirus infections in thoracic organ transplant recipients: Updates on prevention, treatment, and immune monitoring","authors":"Brennan J. Collis BBIOMED, MD,&nbsp;Madeleine R. Heldman MD, MS ,&nbsp;Cameron R. Wolfe MBBS(Hons), MPH","doi":"10.1016/j.jhlto.2025.100449","DOIUrl":"10.1016/j.jhlto.2025.100449","url":null,"abstract":"<div><h3>Background</h3><div>Cytomegalovirus (CMV) is a major cause of morbidity following solid organ transplantation, with thoracic organ transplant recipients (TOTRs) representing one of the highest risk groups. Despite this elevated risk, TOTRs are under-represented in clinical research, and current management strategies are largely extrapolated from other transplant populations.</div></div><div><h3>Methods</h3><div>This review synthesizes evidence on CMV epidemiology, clinical outcomes, prevention, and treatment in TOTRs.</div></div><div><h3>Key content</h3><div>Despite the success of antiviral prophylaxis and pre-emptive monitoring strategies in reducing CMV-related complications in this population, late-onset infection and antiviral resistance remain major clinical challenges. We explore the potential role of CMV in chronic rejection, evaluate the utility of CMV cell-mediated immune monitoring, and review the clinical experience with novel antivirals in TOTRs. By identifying key evidence gaps and outlining priorities for future research, this review aims to support the development of targeted and more effective CMV management strategies in this high-risk population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100449"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190263","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":"SCARCE: aSymptomatic respiratory viral Carriage in pre-lung transplant recipients and the effect on eArly-post lung tRansplant CoursE","authors":"Myrthe B. Bolt ,&nbsp;Johanna P. van Gemert ,&nbsp;Coretta van Leer-Buter ,&nbsp;Erik A.M. Verschuuren ,&nbsp;On behalf of TransplantLines, UMCG","doi":"10.1016/j.jhlto.2025.100452","DOIUrl":"10.1016/j.jhlto.2025.100452","url":null,"abstract":"<div><div>Asymptomatic community-acquired respiratory viral (CARV) carriage before lung transplantation (LTx) has not been studied. This study analyzed CARV carriage pre-LTx and its impact on early post-LTx outcome. This retrospective cohort study included adult LTx recipients at UMC Groningen from January 2017 to August 2023. Pre-LTx viral swabs were routinely tested for CARV. The primary outcome was incidence of primary graft dysfunction (PGD) at 48 or 72 h post-LTx. Secondary outcomes included mechanical ventilation duration, ICU stay, hospital length of stay (LOS), 30- and 90-day mortality, and early rejection therapy. Of 222 recipients, 23 (10.4%) tested positive for a CARV, most commonly rhinovirus (n=10). PGD grade 3 occurred in 14.3% of CARV-positive vs. 9.1% of CARV-negative recipients (p=0.434). No differences were observed in secondary outcomes. Our study provides early data suggesting that asymptomatic carriage may not be associated with worse short-term outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100452"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146184038","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: Meeting allocation challenges in France","authors":"Justin Issard ,&nbsp;Claire Merveilleux du Vignaux ,&nbsp;Sébastien Renard ,&nbsp;Thierry Lepoivre ,&nbsp;Paul Michel Mertes ,&nbsp;Richard Dorent ,&nbsp;Eric Epailly ,&nbsp;Sébastien Hascoet ,&nbsp;Anne Olland ,&nbsp;Jérôme Le Pavec ,&nbsp;Elie Fadel ,&nbsp;Laurent Savale ,&nbsp;Olaf Mercier MD, PhD","doi":"10.1016/j.jhlto.2026.100490","DOIUrl":"10.1016/j.jhlto.2026.100490","url":null,"abstract":"<div><h3>Background</h3><div>Our study aims to describe the French heart–lung graft allocation system, to compare it with allocation systems used in other countries, and to explore potential solutions to improve access to this rare transplantation procedure.</div></div><div><h3>Methods</h3><div>Our study integrates published literature and multidisciplinary expert opinions to examine heart–lung graft allocation in France.</div></div><div><h3>Results</h3><div>The heart–lung transplantation (HLTx) programme was initiated in France in 1987. The number of procedures then increased steadily until the 2010s. Improved knowledge on right ventricular function recovery after double lung transplantation (LTx) for pulmonary hypertension combined with the organ shortage then led to a sharp drop in the number of HLTx recipients worldwide. In France, the number of HLTx procedures is only about ten per year and the main indication is Eisenmenger syndrome. Most HLTx candidates in France receive grafts only if they are in the high-urgency category highlighting the difficulty of access to heart–lung transplants. A re-appraisal of graft allocation rules thus seems mandatory to allow graft access to patients who do not meet high-urgency criteria and whose better general health predicts better post-HLTx outcomes.</div></div><div><h3>Conclusions</h3><div>As HLTx candidates in France are placed on the heart-transplant list in competition with heart-only transplant candidate, one option would be to reconsider the heart score assigned to HLTx candidates upon listing.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100490"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168794","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":"Waitlist and post-transplant outcomes in rural communities with the current heart transplant allocation","authors":"Mohammad U. Ahmed ,&nbsp;Michael Dickinson ,&nbsp;David Fermin ,&nbsp;Milena Jani ,&nbsp;Eesha Purohit ,&nbsp;Matthew Gonzalez ,&nbsp;Ryan Grayburn ,&nbsp;Sangjin Lee ,&nbsp;Nabin K. Shrestha ,&nbsp;Dana Marsy ,&nbsp;Robert Hooker ,&nbsp;Erin McNeely ,&nbsp;Richard C. Sadler ,&nbsp;Renzo Y. Loyaga-Rendon MD. MSPH, PhD.","doi":"10.1016/j.jhlto.2025.100457","DOIUrl":"10.1016/j.jhlto.2025.100457","url":null,"abstract":"<div><h3>Background</h3><div>The OPTN heart transplant allocation policy implemented in 2018 led to significant improvements in waitlist outcomes, but disparities persist. Our study evaluated the effect of the implementation of the new allocation on waitlist and post-transplantation outcomes in rural versus urban communities.</div></div><div><h3>Methods</h3><div>Patients registered for HT in the OPTN database between January 1, 2014, and December 31, 2021, were included as rural or urban according to ZIP code. The cumulative incidence (CI) of death/delisting and transplantation in the different allocations were calculated. Post-transplant survival was calculated using Kaplan-Meier methodology.</div></div><div><h3>Results</h3><div>26,450 patients were listed for transplant. Rural residents were more commonly white and had a higher incidence of ischemic cardiomyopathy. Both allocations saw a similar decrease in the CI of death/delisting from the wait list and an increase in the CI of HT in both rural and urban communities. In the prior allocation, no differences existed in the CI of death/delisting or transplantation between rural and urban residents. In the current allocation, rural residents had a higher frequency of death/delisting (p=0.01) after adjusting for risk factors. No differences existed in the CI of transplantation or post-transplant survival.</div></div><div><h3>Conslusions</h3><div>Our findings suggest that despite an overall decrease in CI of death/delisting in both rural and urban communities, rural residence is associated with a disproportionately higher CI of death/delisting on the transplant list in the current allocation. We found no differences in the CI of transplantation or survival after transplant.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"12 ","pages":"Article 100457"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190264","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":"Correlation between acute cellular rejection detected with cryobiopsy and elevated dd-cfDNA in lung transplant recipients","authors":"Carolin Steinack ,&nbsp;Macé M. Schuurmans ,&nbsp;Silvan M. Vesenbeckh ,&nbsp;René Hage ,&nbsp;Zsofia Rosselli ,&nbsp;Silvia Ulrich ,&nbsp;Malcolm Kohler ,&nbsp;Jan Rüschoff ,&nbsp;Martina Haberecker ,&nbsp;Maurice Roeder ,&nbsp;Thomas Gaisl","doi":"10.1016/j.jhlto.2025.100454","DOIUrl":"10.1016/j.jhlto.2025.100454","url":null,"abstract":"<div><h3>Introduction</h3><div>Donor-derived cell-free DNA (dd-cfDNA) may be a promising biomarker for detecting acute cellular rejection (ACR) in lung transplant recipients (LTR) without the need for invasive transbronchial biopsies. We aimed to validate a clinical plasma dd-cfDNA assay for the detection of ACR, as determined by cryobiopsy, and to assess its clinical utility.</div></div><div><h3>Methods</h3><div>In this prospective cohort, dd-cfDNA fraction was measured using a novel single-nucleotide polymorphism-based assay in LTR undergoing surveillance bronchoscopy with cryobiopsies 2, 4, 6, and 12 months after transplantation (and when indicated). Performance characteristics were calculated for LTR without ACR and LTR with ACR (defined as ACR based on pathological assessment of the cryobiopsies ≥A1).</div></div><div><h3>Results</h3><div>The incidence of ACR (A1 (N = 2), grade A2 (N = 3), grade A3 (N = 1), and no grade A4 or antibody-mediated rejection) was 14% in 43 samples of 39 LTR. The median dd-cfDNA fraction was similar for the stable cohort and the cohort with ACR (median 0.41% [0.15% to 0.72%] vs. 0.56% [0.10% to 3.07%], <em>p</em> = 0.630). The area under the receiver operator characteristic curve for ACR was 59.3% (95% CI 38.3% to 80.3%). Using a ≥1% dd-cfDNA fraction threshold (≥0.5% for single lung transplantations), the negative predictive value for ACR was 87.9% (95% CI 74.1% to 97.6%), and the positive predictive value was 20.0% (95% CI 8.0% to 32.0%). In the sensitivity analysis, altering the ACR category (≥A1 vs. ≥A2) or the dd-cfDNA threshold &gt;0.85% did not produce significant changes in the outcomes.</div></div><div><h3>Conclusions</h3><div>The incidence of ACR (≥A1 or ≥A2) did not appear to be closely associated with the fraction of dd-cfDNA. More research with a larger sample size and long-term follow-up is needed to evaluate the association between dd-cfDNA and ACR incidence detected by cryobiopsy.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100454"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839589","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 genetics variants and clinical outcomes in patients with left ventricular assist device","authors":"Elizabeth Silver ,&nbsp;Kimberly N. Hong MD, MHSA ,&nbsp;Hao A. Tran MD ,&nbsp;Victor Pretorius MBchB ,&nbsp;Mark J. Kearns MD ,&nbsp;Marcus A. Urey MD ,&nbsp;Eric D. Adler MD ,&nbsp;Quan M. Bui MD","doi":"10.1016/j.jhlto.2025.100477","DOIUrl":"10.1016/j.jhlto.2025.100477","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist device (LVAD) implantation is a life-saving therapy for end-stage heart failure, but right ventricular failure (RVF) remains a major complication. Current RVF risk models are limited. We hypothesized that pathogenic/likely pathogenic (P/LP) variants increase intrinsic RV vulnerability and post-LVAD RVF risk.</div></div><div><h3>Methods and Results</h3><div>In a single-center retrospective study of 136 adults undergoing LVAD implantation in 2018–2024, 87% were male, 65% non-White, and 68% had non-ischemic cardiomyopathy. Genetic testing was completed in 48 (35%), identifying P/LP variants in 19%. Patients with P/LP variants had higher early RVF rates (89% vs. 38% vs. 15%, <em>p</em>&lt;0.01) and longer hospitalizations (84 vs. 31 vs. 24 days, p=0.02) than those with variants of uncertain significance or negative results. Outcomes did not differ by ischemic versus non-ischemic etiology.</div></div><div><h3>Conclusions</h3><div>P/LP variants were associated with early RVF, suggesting that genetic testing may inform RVF risk stratification and perioperative management.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100477"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026193","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":"Exercise capacity after mechanical circulatory support compared to heart transplant in advanced heart failure","authors":"Hui Zhen Lo ,&nbsp;Louise Fuller ,&nbsp;Peter Bergin ,&nbsp;Caitlin Cheshire ,&nbsp;Sarah Gutman ,&nbsp;James Hare ,&nbsp;David M. Kaye ,&nbsp;Hitesh Patel ,&nbsp;Janelle Mclean ,&nbsp;Julia Rix ,&nbsp;Andrew J. Taylor","doi":"10.1016/j.jhlto.2026.100484","DOIUrl":"10.1016/j.jhlto.2026.100484","url":null,"abstract":"<div><h3>Background</h3><div>In patients with advanced heart failure, it is assumed that orthotopic heart transplant (OHTx) results in greater exercise capacity compared to ventricular assist device (VAD), however this has not been formally examined. In this study, we evaluated the exercise capacity of patients following VAD and OHTx after a structured outpatient rehabilitation program.</div></div><div><h3>Methods</h3><div>We performed a retrospective single-center cohort study of patients undergoing OHTx or VAD at a tertiary centre from January 2022 to January 2024. Comorbidities and the option of either intervention was used as inputs in a multivariate linear regression model for prediction of 3-month 6-minute walk test (6MWT). Major factors identified were added as covariates in the combined cohort to determine predictors of 6MWT.</div></div><div><h3>Results</h3><div>A total of 78 patients were included. The maximal recorded 6MWT was similar between both cohorts (median 6MWT OHTx: 534.0 (478.8-600.3)m; VAD: 608.5 (487.0-643.5)m, <em>p</em>=0.30). Gender was a significant predictor of 6MWT in the OHTx cohort (β=-69.1, <em>p</em>&lt;0.02) with a strong trend in the VAD cohort (β=-199, <em>p</em>&lt;0.09). VAD was not predictive of 3-month 6MWT (<em>p</em>=0.99) in OHTx patients bridged with VAD. VAD or OHTx was also not predictive of 6MWT (<em>p</em>=0.88) while total length of stay was a significant predictor of 6MWT (<em>p</em>&lt;0.0001) in the combined cohort.</div></div><div><h3>Conclusions</h3><div>In patients with advanced heart failure, VAD and OHTx are associated with a similar level of exercise capacity and does not impact exercise capacity in patients undergoing OHTx who are bridged with a VAD. In patients with OHTx, gender was the strongest predictor of exercise capacity.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100484"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076770","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 role of high-sensitivity troponin in identifying patients with cardiac allograft rejection","authors":"André A. Scussel ,&nbsp;Fabiana G. Marcondes-Braga ,&nbsp;Cristhian V. Espinoza Romero,&nbsp;Daniel C. de Marchi,&nbsp;Mônica Samuel Ávila Grinberg,&nbsp;Fernanda Barone Alves do Santos,&nbsp;Ana Maria Peixoto Cardoso Duque,&nbsp;Sandrigo Mangini,&nbsp;Luís Fernando Bernal Seguro,&nbsp;Iáscara Wozniak Campos,&nbsp;Fabio Gaiotto,&nbsp;Fernando Bacal","doi":"10.1016/j.jhlto.2025.100446","DOIUrl":"10.1016/j.jhlto.2025.100446","url":null,"abstract":"<div><h3>Background</h3><div>Biomarkers for acute rejection diagnosis are frequently searched, and data from medical literature are conflicting. The role of high-sensitivity troponin I in the diagnosis of acute cellular rejection (ACR) after heart transplant (HT) is uncertain. However, it is a widely used and accessible tool in developing countries.</div></div><div><h3>Objective</h3><div>This study aims to determine whether hs-TnI can serve as a reliable and accessible tool to identify patients with clinically significant rejection (ACR &gt;2R) in a real-world Latin American cohort that has different etiologies than the epidemiology of the main trials.</div></div><div><h3>Methods</h3><div>In this retrospective cohort, we evaluated data from electronic records of HT recipients submitted to HT from March, 2020 to September, 2022 using REdCAp database. All patients who underwent endomyocardial biopsies (EMB) between 3 months and 2 years of HT and had samples of HS-troponin I previously measured were included in this study. The HS-troponin levels were compared between patients with ACR higher or lower than 2R.</div></div><div><h3>Results</h3><div>In this analysis, we included data from 187 biopsies performed at least 3 months after HT in 94 recipients who had paired Hs-troponin I samples collected. Fifty-four (57%) were men, and their median age at heart transplant was 48<!--> <!-->±11 years. The median hs-TnI levels were 29 (11-118) ng/L. ACR &gt; 2R was observed in 48 EMB and the median hs-TnI levels were 69 (26-224) ng/L, which was significantly higher than levels observed in patients with grade 0R/1R [21 (9-64) ng/L, <em>p</em>&lt;0.001]. The ROC curve of hs-TnI shows an AUC of 0.705; <em>p</em>&lt;0.001 for the diagnosis of ACR &gt; 2R. A cutoff of 19<!--> <!-->ng/L showed a sensitivity of 88% and specificity of 49%, with a negative predictive value of 92%. Among biopsies from patients with Chagas disease (36.9% of the sample), hs-TnI also showed significant discriminatory power for ACR &gt;2R (<em>p</em> = 0.037).</div></div><div><h3>Conclusion</h3><div>In this cohort, HS-troponin I was able to identify patients with acute cellular rejection. This is the largest Latin American cohort assessing hs-TnI after HT, and the first to explore its performance across specific etiologies, including Chagas disease. Prospective studies may confirm the role of HS-troponin I as a biomarker of acute rejection.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100446"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790212","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}