JHLT Open最新文献

{"title":"Pneumocystis pneumonia in thoracic organ transplantation: Current perspectives and updates","authors":"Seyed M. Hosseini-Moghaddam MD, MSc, MPH ,&nbsp;Jay A. Fishman M.D.","doi":"10.1016/j.jhlto.2025.100367","DOIUrl":"10.1016/j.jhlto.2025.100367","url":null,"abstract":"<div><div><em>Pneumocystis jirovecii</em> pneumonia (PCP) is an opportunistic infectious disease in thoracic solid organ transplant (SOT) recipients, occurring particularly in the setting of augmented immunosuppression. Thoracic allograft recipients are particularly at risk of severe outcomes. Diagnosis is frequently delayed due to nonspecific clinical findings and challenges in ruling out other opportunistic pathogens and distinguishing between pneumonia and colonization. Advances in molecular diagnostics, such as quantitative PCR (qPCR), droplet digital PCR (ddPCR), and loop-mediated isothermal amplification (LAMP), have considerably improved PCP diagnosis. Meanwhile, non-invasive diagnostic applications such as artificial intelligence (AI)-assisted imaging and radiomics hold promise for timely diagnosis. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the first-line therapy; however, shorter treatment durations and lower-dose regimens have not been investigated to reduce toxicity. Alternative agents such as clindamycin-primaquine are used for documented intolerance. The effectiveness of adjunctive glucocorticoid therapy in post-transplant PCP remains unclear. Careful management of immunosuppression following a PCP diagnosis is essential to minimize the risk of allograft rejection. PCP prophylaxis remains a crucial component of the post-transplant preventive strategy, although further research is necessary to determine the optimal duration and dosing regimen. Future efforts should focus on developing risk stratification tools to implement tailored prevention strategies. Interventional studies are needed to provide evidence-based guidelines for PCP management and prevention. Continued advancements in diagnostics, therapeutics, and prophylaxis are vital to reducing the burden of PCP among thoracic SOT recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100367"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885973","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 for lung transplant candidate waitlist removal in the era of the composite allocation score","authors":"AH Toporek ,&nbsp;E. Adjei ,&nbsp;WD Gannon ,&nbsp;JW Stokes ,&nbsp;CT Demarest ,&nbsp;M. Bacchetta ,&nbsp;K. Hoetzenecker ,&nbsp;AJ Trindade","doi":"10.1016/j.jhlto.2025.100368","DOIUrl":"10.1016/j.jhlto.2025.100368","url":null,"abstract":"<div><div>Implementation of the composite allocation score (CAS) has improved, but not eliminated, waitlist mortality amongst lung transplant candidates. Identifying risk factors for clinical deterioration is important to stratify patients who may benefit from closer monitoring or increased support.</div><div>We performed a UNOS registry-based study of lung transplant candidates listed between March 9, 2022 to March 8, 2024; analysis was stratified by listings before or after CAS implementation. Univariate and multivariate logistic regression analyses were performed to identify factors associated with waitlist removal for clinical decompensation or death.</div><div>Traits associated with waitlist removal during the pre-CAS era were short stature, ECMO support at listing, and amount of supplemental oxygen. Following CAS implementation, ECMO support, low BMI, poor functional status, short stature, and ABO blood type O were significantly associated with waitlist removal.</div><div>Close monitoring of patients with increased likelihood for waitlist removal, especially patients with multiple risk factors, may be appropriate.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100368"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932426","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":"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":"2025-08-05","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":"Critical care management of right ventricular failure in pediatric left ventricular assist devices: An advanced cardiac therapies improving outcomes network (ACTION) endorsed statement","authors":"Edon J. Rabinowitz MD ,&nbsp;Nancy Ghanayem MD ,&nbsp;Lydia Wright MD ,&nbsp;Amee M. Bigelow MD ,&nbsp;Shilpa Vellore-Govardhan MD ,&nbsp;Tara M. Neumayr ,&nbsp;Tanya Perry DO ,&nbsp;Meghna D. Patel MD ,&nbsp;Robert A. Niebler MD ,&nbsp;Kevin P. Engelhardt MD ,&nbsp;Isaura Diaz MD ,&nbsp;Joseph Philip MD ,&nbsp;Arene Butto MD ,&nbsp;Iki Adachi MD ,&nbsp;David M. Peng MD ,&nbsp;David Kwiatkowski MD ,&nbsp;Sebastian C. Tume MD","doi":"10.1016/j.jhlto.2025.100361","DOIUrl":"10.1016/j.jhlto.2025.100361","url":null,"abstract":"<div><div>The care of the right ventricle (RV) following left ventricular assist device (LVAD) implantation remains a major clinical challenge, with right ventricular failure (RVF) contributing significantly to morbidity and mortality. While much of the literature focuses on preoperative risk stratification and long-term management, there is limited guidance on the immediate postoperative period from a critical care perspective, particularly in pediatric patients. This review aims to provide practical guidance on the bedside management of the RV in the perioperative period following LVAD implantation in children with biventricular circulation, offering a framework for optimizing RV function and preventing failure. We discuss the pathophysiology of RVF in this setting, highlight key hemodynamic principles, and explore targeted interventions including volume management, inotropic and pulmonary vasodilator support, ventilatory strategies, mechanical circulatory support options, and strategies to mitigate secondary organ dysfunction. By addressing these pediatric-specific critical care considerations, we aim to assist bedside providers in optimizing outcomes for children undergoing LVAD implantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100361"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932377","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":"Respiratory viral infections in lung transplantation: Recent advances in epidemiology, clinical impact, and therapeutic approaches","authors":"Hannah Bahakel MD,&nbsp;Lara Danziger-Isakov MD, MPH","doi":"10.1016/j.jhlto.2025.100362","DOIUrl":"10.1016/j.jhlto.2025.100362","url":null,"abstract":"<div><div>Respiratory viruses encompass a diverse group of viruses, including influenza, respiratory syncytial virus (RSV), parainfluenza (PIV), human metapneumovirus (hMPV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and adenovirus. Lung transplant recipients are particularly vulnerable to complications from respiratory viral infections (RVIs), leading to increased morbidity and mortality. This heightened risk is a result of both anatomical and functional modifications from transplant surgery, as well as immunosuppressive therapy. Beyond the immediate morbidity associated with infection, RVIs are also recognized for their association with both acute rejection and chronic lung allograft dysfunction (CLAD)/bronchiolitis obliterans syndrome (BOS). This article provides updated insights into epidemiology, clinical outcomes, prevention strategies, and treatment options for RVIs in lung transplant recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100362"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879522","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":"Simultaneous heart-kidney transplantation outcomes in Asian populations in the United States: A united network for organ sharing database study","authors":"Shin Yajima MD, PhD ,&nbsp;Hao He PhD ,&nbsp;Stefan Elde MD ,&nbsp;Yuanjia Zhu MD, PhD ,&nbsp;Y. Joseph Woo MD ,&nbsp;Yasuhiro Shudo MD, PhD, Clinical Associate Professor","doi":"10.1016/j.jhlto.2025.100364","DOIUrl":"10.1016/j.jhlto.2025.100364","url":null,"abstract":"<div><h3>Purpose</h3><div>Simultaneous heart-kidney transplantation (HKTx) remains underutilized in regions outside the United States and Europe. Assessing the clinical outcomes of HKTx in Asian recipients is crucial for promoting its adoption in Asia. This retrospective study aimed to compare the survival outcomes of HKTx between Asian and non-Hispanic White (NHW) recipients with similar baseline characteristics.</div></div><div><h3>Methods</h3><div>This study included 1494 recipients aged ≥18 years who underwent HKTx for the first time between 2000 and 2022. Among them, 1392 were NHW and 102 were Asian. Propensity score matching was used to balance the baseline characteristics between the Asian and NHW recipients. Kaplan–Meier survival analysis and log-rank tests were utilized to evaluate and compare overall survival.</div></div><div><h3>Results</h3><div>In the prematched cohort, the in-hospital mortality rates were 10.0% and 6.7% for Asian and NHW recipients, respectively (p=0.216). Kaplan–Meier mortality estimates at 1, 5, and 10 years were 17.3%, 42.2%, and 67.7% for Asians, and 14.6%, 35.5%, and 65.9% for NHW recipients (p=0.692), respectively. After matching, the in-hospital mortality rates were 10.0% for Asians and 6.6% for NHW recipients (p=0.355). Long-term 1-, 5-, and 10-year mortality rates remained comparable: 13.9%, 36.1%, and 62.5% for Asians, versus 10.7%, 34.3%, and 59.2% for NHW recipients, respectively (p=0.665).</div></div><div><h3>Conclusion</h3><div>Asian recipients demonstrated comparable long-term survival to NHW recipients after HKTx.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100364"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879521","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":"Cardiomyopathy as indication for pediatric heart transplantation","authors":"Alireza Raissadati MD/PHD ,&nbsp;Drishti Tolani MD ,&nbsp;Elizabeth L. Profita MD","doi":"10.1016/j.jhlto.2025.100360","DOIUrl":"10.1016/j.jhlto.2025.100360","url":null,"abstract":"<div><div>Pediatric cardiomyopathy (CMP), with an incidence of approximately 1 in 100,000 children, remains a critical clinical challenge. Often progressive, these myocardial disorders frequently culminate in end-stage heart failure, establishing CMP as the primary indication for pediatric heart transplantation. Key considerations for transplantation include specific CMP etiologies and subtypes alongside established listing criteria and strategies to navigate waitlist complexities. The evolving role of mechanical circulatory support, especially ventricular assist devices (VADs), has transformed bridging strategies and significantly improved survival to transplant. Contemporary post-transplant outcomes demonstrate continued improvement, with advancements in survival rates and ongoing refinement of essential long-term management strategies. This review provides a comprehensive analysis of pediatric CMP as it progresses to end-stage heart failure requiring transplantation. It synthesizes current knowledge on etiologies, clinical presentations, transplant evaluation, the transformative impact of VADs, and contemporary post-transplant management, aiming to equip clinicians with an updated framework for complex decision-making and optimizing outcomes in this high-risk population.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100360"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831065","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":"Clarity in ex-vivo cardiac transport system naming conventions","authors":"Robert L. Gottlieb MD, PhD, FACC, FAST, FIDSA ,&nbsp;Joseph G. Rogers MD ,&nbsp;Amarat Kongsompong MD ,&nbsp;Francesco Fioretti MD ,&nbsp;Melina Giugni MD ,&nbsp;Yaron D. Barac MD, PhD ,&nbsp;Dirk Van Raemdonck MD, PhD","doi":"10.1016/j.jhlto.2025.100352","DOIUrl":"10.1016/j.jhlto.2025.100352","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100352"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908459","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":"Worldwide practices in pulmonary function test reporting after lung transplantation","authors":"Jens Gottlieb MD ,&nbsp;Erika Lease MD ,&nbsp;Merel Hellemons MD, PhD ,&nbsp;Kieran Halloran MD ,&nbsp;Tereza Martinu MD, MHSc","doi":"10.1016/j.jhlto.2025.100347","DOIUrl":"10.1016/j.jhlto.2025.100347","url":null,"abstract":"<div><h3>Background</h3><div>Spirometry interpretation after lung transplantation (LTx) is complex, requiring a clear understanding of reference values and normal thresholds globally. Abnormal values are typically based on general population reference standards.</div></div><div><h3>Methods</h3><div>In April 2025, a 10-question online survey was conducted among International Society of Heart and Lung Transplantation-members to determine the reference values and normal thresholds used worldwide for post-transplant spirometry interpretation.</div></div><div><h3>Results</h3><div>Responses from 58 centers, covering 22,080 lung transplant recipients and representing ∼40% of global transplant activity, were analyzed. Most patients (63%) were followed in the United States or Canada. Global lung initiative (GLI) reference was used for 60%, with 47% using the race-neutral version. The lower limit of normal (LLN) was reported in only 19% of pulmonary function assessments. Regional differences were noted in obstruction definition and impairment grading.</div></div><div><h3>Conclusions</h3><div>While GLI-reference values are widely adopted, 40% of centers have yet to implement them, and LLN remains underutilized in spirometry reporting after LTx.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100347"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738083","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":"Living myocardial slices retain patient-specific features: Insights into etiology and therapeutic history","authors":"Jort S.A. van der Geest ,&nbsp;Willem B. van Ham ,&nbsp;Ernest Diez Benavente ,&nbsp;Mohsin El Amrani ,&nbsp;M. Mostafa Mokhles ,&nbsp;Marish I.F.J. Oerlemans ,&nbsp;Pieter A. Doevendans ,&nbsp;Teun P. de Boer ,&nbsp;Joost P.G. Sluijter ,&nbsp;Linda W. van Laake ,&nbsp;Vasco Sampaio-Pinto","doi":"10.1016/j.jhlto.2025.100345","DOIUrl":"10.1016/j.jhlto.2025.100345","url":null,"abstract":"<div><h3>Background</h3><div>Living myocardial slices (LMS) are an emerging translational <em>ex vivo</em> model for studying myocardial function, disease mechanisms, and therapeutics. However, the extent to which <em>ex vivo</em> findings correlate with clinical characteristics is unknown. This study aimed to evaluate whether LMS retain patient-specific functional and pathological characteristics, reflecting diverse etiologies, pharmacological regimens, and clinical interventions.</div></div><div><h3>Methods</h3><div>300-µm-thick LMS were prepared from myocardial biopsies of end-stage heart failure patients (<em>N</em> = 12, <em>n</em> = 138). Functional assessment of freshly prepared LMS included refractory period, stimulation threshold, force-frequency relationship, post pause potentiation, contractile force, alongside simultaneous optical recordings of calcium transients and action potentials. Variability and grouping analyses were conducted to identify features linked to patient-specific parameters, such as etiology and therapeutic history, including prior left ventricular assist device (LVAD) implantation and amiodarone usage.</div></div><div><h3>Results</h3><div>LMS exhibited lower intrapatient variability (LMS from the same patient) compared to interpatient variability (LMS from different patients), confirming their ability to retain patient-specific functional properties. LMS from LVAD-treated patients exhibited reduced intrapatient variability and reduced diastolic tension, correlated with lower N-terminal pro-B-type natriuretic peptide levels. Stratification by etiology revealed distinct functional characteristics, including enhanced contractile force in titin-mutant LMS and a positive force-frequency relationship in ischemic cardiomyopathy-derived LMS. LMS derived from amiodarone-treated patients demonstrated prolonged action potential duration, reduced excitability at higher pacing frequencies, and enhanced post pause potentiation, reflecting the drug’s established pharmacological effects.</div></div><div><h3>Conclusions</h3><div>LMS effectively capture distinct functional parameters associated with patient-specific features. These findings establish LMS as a valuable translational platform for personalized cardiac research, therapeutic testing, and precision medicine.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100345"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766524","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}