JHLT Open最新文献

{"title":"Pretransplant screening for infections in lung and heart transplant candidates","authors":"Felix Riunga MD ,&nbsp;Carlos Cervera MD, PhD ,&nbsp;Dima Kabbani MD, MSc","doi":"10.1016/j.jhlto.2025.100409","DOIUrl":"10.1016/j.jhlto.2025.100409","url":null,"abstract":"<div><div>Solid organ transplantation (SOT) is the definitive treatment for end-stage organ disease but also introduces a heightened risk of infection in the post-transplant period. In heart and lung transplantation, unique factors predisposing to infection include exposure of the lungs to the external environment, alteration of airway anatomy, pretransplant infection and colonization with difficult-to-treat organisms, and pretransplant presence of infected devices. This is in addition to risks common to all SOT leading, including immunosuppression. The aim of pretransplant infectious disease screening in SOT recipients is to prospectively identify infectious risks through careful history taking, examination, and laboratory testing, as well as mitigating these risks through vaccination, treatment, prophylaxis, and counseling on safe living. In this article, we review infectious risks in heart and lung transplant candidates and discuss recommendations for screening before transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100409"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571794","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":"Growth in pediatric heart transplantation","authors":"Erik L. Frandsen ,&nbsp;Natalie S. Shwaish ,&nbsp;Richard E. Chinnock","doi":"10.1016/j.jhlto.2025.100425","DOIUrl":"10.1016/j.jhlto.2025.100425","url":null,"abstract":"<div><div>The control of linear growth from fetal life through adolescence is complex and variable. Many factors, intrinsic and extrinsic, can affect growth at all stages of transplant. In this review, we highlight the normal process of linear growth. We describe factors affecting growth before heart transplant and review the typical patterns of growth after transplant. We review ways to optimize growth during all stages of transplantation, and finally we highlight the limited experience with recombinant human growth hormone in heart and other solid organ transplants.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100425"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571795","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":"Primary graft dysfunction prevention strategies in the perioperative period","authors":"Jérémie Guillemin MD ,&nbsp;Michael Cutrone DO ,&nbsp;Suraj Yalamuri MD ,&nbsp;Monica Arndt MD ,&nbsp;Adrien Bouglé MD, PhD ,&nbsp;Sharon L. McCartney MD, FASE","doi":"10.1016/j.jhlto.2025.100413","DOIUrl":"10.1016/j.jhlto.2025.100413","url":null,"abstract":"<div><h3>Background</h3><div>Primary graft dysfunction (PGD) remains a leading cause of early morbidity and mortality after heart and lung transplantation. It results from a multifactorial process involving ischemia–reperfusion injury, inflammatory and immune responses, and donor-, recipient-, and procedural factors. Despite advances in perioperative management, PGD continues to adversely affect both short- and long-term transplant outcomes.</div></div><div><h3>Methods</h3><div>This narrative review synthesizes contemporary evidence and consensus recommendations from the International Society for Heart and Lung Transplantation (ISHLT) and recent clinical studies to delineate perioperative strategies aimed at preventing PGD in heart and lung transplantation. Focus areas include donor and recipient optimization, organ preservation strategies, intraoperative management, and emerging perfusion technologies.</div></div><div><h3>Results</h3><div>In heart transplantation, modifiable factors such as pre-transplant amiodarone exposure and donor–recipient mismatch increase PGD risk. Among preservation methods, hypothermic oxygenated perfusion has demonstrated reductions in PGD incidence, while controlled hypothermia has been associated with reduced PGD rates in observational studies. Normothermic ex vivo perfusion has shown improved graft preservation. In lung transplantation, the use of low-potassium dextran preservation solutions is associated with lower PGD rates. Ex vivo lung perfusion improves allograft utilization and may reduce PGD incidence. Implantation techniques such as off-pump lung transplantation or veno-arterial extracorporeal membrane oxygenation, rather than cardiopulmonary bypass, have been associated with lower PGD rates.</div></div><div><h3>Conclusions</h3><div>Every step of the transplant process is important in reducing the risk of PGD. Emerging machine perfusion technologies represent a promising advancement to enhance graft utilization, reduce PGD incidence, and improve overall outcomes following heart and lung transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ex vivo lung perfusion in donation after circulatory death lung transplantation: A systematic review and meta-analysis","authors":"Bianca S. Costa MS ,&nbsp;Bruna C. Coelho MS ,&nbsp;Iago T.C. Grillo MD ,&nbsp;Rachid Eduardo Noleto da Nobrega Oliveira MD, MSc ,&nbsp;Tulio Caldonazo MD, MSc ,&nbsp;Felipe S. Passos MD ,&nbsp;Erlon de Avila Carvalho MD, PhD","doi":"10.1016/j.jhlto.2026.100480","DOIUrl":"10.1016/j.jhlto.2026.100480","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation is the definitive therapy for end-stage lung disease, but donor shortages contribute to high waiting list mortality. Donation after circulatory death (DCD) expands the donor pool, and ex vivo lung perfusion (EVLP) enables graft assessment and optimization. However, its impact in this setting remains uncertain. This meta-analysis aimed to evaluate whether EVLP in DCD lungs affects graft function and short-term outcomes compared with direct transplantation.</div></div><div><h3>Methods</h3><div>Three databases were searched. The main outcome was grade 3 primary graft dysfunction (PGD). Additional outcomes included intensive care unit (ICU) and hospital length of stay (LOS), both analyzed quantitatively. Outcomes assessed qualitatively comprised short-term survival, pneumonia, and acute rejection. Random-effects models were applied to quantitative analyses.</div></div><div><h3>Results</h3><div>Five observational studies (654 patients) were included. The incidence of grade 3 PGD was comparable between EVLP and non-EVLP groups (RR 1.29; 95%CI 0.97 to 1.71; <em>p</em> = 0.08; <em>I</em>² = 12.63%). Similarly, ICU LOS (<em>p</em> = 0.12) and hospital LOS (<em>p</em> = 0.83) were also comparable. Qualitative assessment showed no apparent differences in short- and mid-term survival or in the frequency of pneumonia and acute rejection between groups.</div></div><div><h3>Conclusion</h3><div>EVLP in DCD lung transplantation was not associated with significant differences in grade 3 PGD, ICU or hospital LOS, or short- to mid-term outcomes compared with direct transplantation. Given its time and resource demands, EVLP may not be necessary for all DCD grafts; however, it remains particularly valuable for evaluating uncertain-quality lungs, where its selective use can help ensure graft safety.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100480"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026194","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 right kind of rarefaction: Coronary microvascular remodeling in right ventricle failure","authors":"Cyrus Vahdatpour MD, MS ,&nbsp;Katharine Clapham MD ,&nbsp;Steven M. Kawut MD, MS ,&nbsp;Kirk Jones Jr DO ,&nbsp;John J. Ryan MD ,&nbsp;Danielle Petty MD ,&nbsp;Shannon Talbot MD ,&nbsp;Kimberly Dumoff MD ,&nbsp;Ellen C. Keeley MD, MS ,&nbsp;Priti Lal MD ,&nbsp;Andrew J. Bryant MD ,&nbsp;Alex M. Parker MD ,&nbsp;Jeremy A. Mazurek MD ,&nbsp;Leonid Mirson MD ,&nbsp;Andrew Murphy MD ,&nbsp;Andrew Baird MD ,&nbsp;Megan Schwietert MD ,&nbsp;Alissa Schurr DO ,&nbsp;Andrew Stein MD, PHD ,&nbsp;Scott M. Hansen ,&nbsp;Dylan Miller MD","doi":"10.1016/j.jhlto.2025.100459","DOIUrl":"10.1016/j.jhlto.2025.100459","url":null,"abstract":"<div><h3>Background</h3><div>Right ventricular failure (RVF) is the primary determinant of outcomes in pulmonary hypertension (PH). Coronary microvascular dysfunction (CMD), defined by capillary rarefaction and endothelial dysfunction, may contribute to RVF but remains poorly characterized. CMD, defined by capillary rarefaction and endothelial dysfunction, may contribute to RVF through impaired myocardial oxygen delivery and fibrotic remodeling.</div></div><div><h3>Objectives</h3><div>To characterize right ventricle (RV) CMD and myocardial fibrosis in explanted human hearts and examine associations with echocardiographic and hemodynamic indices of RVF across PH subtypes.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 57 adult patients who underwent orthotopic heart transplantation at 3 institutions (2023-2024). Explanted hearts were classified by PH subtype: combined pre-/post-capillary PH (CpcPH, <em>n</em> = 24), isolated post-capillary PH (IpcPH, <em>n</em> = 22), and no PH (<em>n</em> = 11). Digital pathology quantified RV and left ventricle (LV) capillary density and interstitial fibrosis across epicardial, mid-wall, and endocardial regions. Associations with echocardiographic measures and hemodynamic parameters were assessed.</div></div><div><h3>Results</h3><div>A total of 57 hearts (70% male, median age 52 years) were analyzed. Median time from listing to transplantation was 1.6 months (IQR: 0.7-6.1). Mean RV capillary density was 653 ± 204 microvessels/mm² and correlated significantly with TAPSE (ρ_s = 0.49, <em>p</em> &lt; 0.001) and tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio (ρ_s = 0.33, <em>p</em> = 0.037). Compared to patients without PH, patterns of reduced mid-wall capillary density in PH subtypes were observed (CpcPH: β = −228 microvessels/mm², <em>p</em> = 0.031; IpcPH: β = −238 microvessels/mm², <em>p</em> = 0.043). Diabetes mellitus was associated with reduced LV sub-endocardial capillary density (β = −207, <em>p</em> = 0.006). Unadjusted analysis showed higher RV fibrosis in patients without PH (<em>p</em> = 0.024); however, after adjusting for clinical confounders, including heart failure etiology, this difference was not significant, highlighting the heterogenous nature of fibrosis in end-stage heart failure.</div></div><div><h3>Conclusions</h3><div>Capillary rarefaction is a measurable histopathologic feature in explanted RV tissue that correlates with functional indices of RV performance. Our proof-of-concept findings suggest CMD may contribute to RV systolic dysfunction independent of PH subtype.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100459"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924331","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":"Safety and efficacy of sodium-glucose cotransporter 2 inhibitors in post-heart transplant patients: A multi-center retrospective cohort study","authors":"Josephine Harrington ,&nbsp;Alex Severino ,&nbsp;Lisa Yanek ,&nbsp;Nadia Fida ,&nbsp;Farhan Ishaq ,&nbsp;Farrah Al-Saffar ,&nbsp;Evelyn Song ,&nbsp;Katherine Clark ,&nbsp;Teresa De Marco ,&nbsp;H. Luise Holzhauser ,&nbsp;Amanda Vest ,&nbsp;Priya Umapathi","doi":"10.1016/j.jhlto.2025.100465","DOIUrl":"10.1016/j.jhlto.2025.100465","url":null,"abstract":"<div><h3>Background</h3><div>Despite compelling mechanistic and clinical data supporting the use of sodium glucose cotransporter 2 inhibitors (SGLT2i) in heart failure, chronic kidney disease (CKD), and type 2 diabetes (T2DM), the safety and efficacy of SGLT2i in patients with prior orthotopic heart transplant (OHT) patients remain underexplored, potentially due to concerns surrounding infection risk and kidney injury.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of patients receiving an SGLT2i following OHT at 7 large transplant centers between July 2016 and December 2023 to assess safety and tolerability. Key outcomes of interest included hospitalization attributed to SGLT2i use, genital/urinary tract (GU) infection, and acute kidney injury (AKI), as well as discontinuation of SGLT2i.</div></div><div><h3>Results</h3><div>Overall, 141 patients across 7 transplant centers were included in this cohort analysis. Patients had a median age of 61, and the median time from transplant was 5.3 years. Rates of hospitalization related to SGLT2i were low, occurring in 1.4% of the study population (2/141) at a rate of 0.007 events/person-year. GU infections occurred in 9.93% (14/141) of patients, and AKI within 30 days was observed in 20.59% (21/102 patients who had a complete dataset available for analysis). At the end of the observation period, 68.1% of patients remained on an SGLT2i, and 31.9% had discontinued their SGLT2i: 15.6% of patients discontinued their SGLT2i for medical reasons, most commonly AKI or GU infection.</div></div><div><h3>Conclusion</h3><div>Our results suggest that though discontinuation of SGLT2i use was high in patients post-OHT, the overall safety profile of the drug class was reassuring, with a low observed risk of hospitalization, kidney failure, or GU infection. Future larger prospective studies are needed to more fully elucidate the impact of SGLT2i on long-term outcomes in patients following OHT.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100465"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donation after circulatory death in adult congenital heart disease: A fragile match","authors":"Jose B. Cruz Rodriguez ,&nbsp;Deepak Acharya","doi":"10.1016/j.jhlto.2025.100414","DOIUrl":"10.1016/j.jhlto.2025.100414","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100414"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145161","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":"Intermediate-term risk of cardiac allograft vasculopathy following heart transplantation from hepatitis C viremic donors in the era of direct-acting antiviral therapy","authors":"K. Paternostro,&nbsp;A. Birs,&nbsp;S. Aslam,&nbsp;E. Adler,&nbsp;K. Hong,&nbsp;N. Wettersten","doi":"10.1016/j.jhlto.2025.100416","DOIUrl":"10.1016/j.jhlto.2025.100416","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac allograft vasculopathy (CAV) is a leading cause of death in heart transplant (HTx) recipients. Chronic hepatitis C virus (HCV) infection has been associated with increased inflammation and accelerated CAV. The advent of direct-acting antiviral (DAA) therapy has renewed interest in transplanting HCV-viremic donors, though long-term outcomes remain limited.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of adult HTx recipients at UC San Diego from 2015 to 2019 who underwent routine intravascular ultrasound (IVUS) surveillance. Recipients were stratified by donor HCV nucleic acid amplification test (NAT) status. Donor-derived HCV infection was treated with DAA therapy. We used multivariable-adjusted Cox regression to evaluate the primary endpoint of developing CAV, defined as maximal intimal thickness (MIT) ≥ 0.5 mm, and endpoints of MIT ≥ 0.7 mm and a composite outcome of incident acute coronary syndrome, percutaneous coronary intervention (PCI), and all-cause mortality.</div></div><div><h3>Results</h3><div>Among 131 recipients, 22 received HCV NAT+ hearts. Baseline donor and recipient characteristics were similar, except for recipients of HCV NAT- hearts were younger (53.7 years vs 61.0 years; <em>P</em> = 0.022). Over a median follow-up of 6.6 years, HCV NAT+ status was not associated with a higher risk of CAV (MIT ≥ 0.5 mm: adjusted HR 0.89, 95% confidence interval (CI), 0.52-1.53; <em>p</em> = 0.673; MIT ≥ 0.7 mm: adjusted HR 0.91, 95% CI 0.51-1.61; <em>p</em> = 0.750), nor the composite outcome (adjusted HR 1.23, 95% CI, 0.45-3.40; <em>p</em> = 0.690).</div></div><div><h3>Conclusion</h3><div>In the modern DAA era, transplantation of HCV NAT+ donor hearts is not associated with increased risk of CAV or adverse clinical outcomes over intermediate-term follow-up.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521154","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":"Reflecting on the potential impact of donor-derived Kaposi sarcoma in lung transplantation","authors":"Zsofia Rosselli","doi":"10.1016/j.jhlto.2025.100471","DOIUrl":"10.1016/j.jhlto.2025.100471","url":null,"abstract":"","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100471"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975963","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":"Contemporary evidence to inform management of deceased potential thoracic organ donors after brain death","authors":"Federico Ciardi MBBS ,&nbsp;Chiara Magri MD ,&nbsp;Antonio Rubino MD ,&nbsp;Emily A. Vail MD, MSc","doi":"10.1016/j.jhlto.2025.100474","DOIUrl":"10.1016/j.jhlto.2025.100474","url":null,"abstract":"<div><div>Brain death triggers profound physiologic derangements that threaten organ viability and contribute to the persistent shortage of transplantable thoracic organs. This narrative review synthesizes contemporary evidence informing the management of deceased potential thoracic organ donors after brain death, focusing on clinical studies published over the past decade. We identified 14 trials addressing key aspects of donor management, including lung-protective ventilation strategies, prone positioning, targeted temperature management, hormonal supplementation, and cardiovascular support. Notable findings include validation of lung-protective ventilation with higher positive end-expiratory pressure improving lung recovery rates, observational evidence suggesting that prone position is associated with increased lung and heart procurement, and recent randomized trials demonstrating no benefit from routine levothyroxine administration even in hemodynamically unstable donors. Corticosteroid therapy appears to effectively reduce vasopressor requirements, while newer evidence supports the safety of lower-dose regimens with improved glycemic control. Despite these advances, significant knowledge gaps persist regarding optimal hemodynamic monitoring, vasopressor selection, and other fundamental management decisions. The fragmented nature of the donation and transplantation system presents unique challenges for evidence generation and implementation. Ongoing developments, including donor care units, international collaboration, and innovative trial designs, offer opportunities to address these gaps. This review provides intensivists with an evidence-based framework for optimizing donor management while highlighting priority areas for future research to increase the availability and quality of thoracic organs for transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"11 ","pages":"Article 100474"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975965","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}