JHLT Open最新文献

{"title":"Priorities for lung transplantation research: a James Lind Alliance priority-setting partnership between patients, caregivers, and clinicians in Canada","authors":"Margret I. Michaels ,&nbsp;Kieran Halloran ,&nbsp;Lea Harper ,&nbsp;Nikki Marks ,&nbsp;Celine Bergeron ,&nbsp;Basil Nasir ,&nbsp;Dima Kabbani ,&nbsp;Laura van den Bosch ,&nbsp;Alim Hirji ,&nbsp;Rhea A. Varughese ,&nbsp;Jason Weatherald","doi":"10.1016/j.jhlto.2025.100349","DOIUrl":"10.1016/j.jhlto.2025.100349","url":null,"abstract":"<div><div>This study employed the James Lind Alliance Priority Setting Partnership methodology to identify and prioritize research priorities in lung transplantation through engagement of pre- and post-lung transplant patients, caregivers, and clinicians in Canada. An initial survey collected 490 questions from 204 respondents, which were collated into 117 summary questions. After removing duplicates and conducting evidence checks, 25 verified uncertainties were discussed at a final workshop, resulting in a consensus-based Top 10 list of research priorities. Key priorities addressed the need to improve immunosuppression regimens, patient education, lung allograft dysfunction, and donor lung availability. This first-of-its-kind initiative in lung transplantation created a stakeholder-driven research agenda that better aligns future research with patient needs. The findings establish a foundation for more patient-centered lung transplantation research.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100349"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766523","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":"Mid-term follow-up of non-ischemic heart preservation in heart transplantation","authors":"Victoria Jernryd PhD ,&nbsp;Oscar Braun MD, PhD ,&nbsp;Audrius Paskevicius ,&nbsp;Carsten Metzsch MD, PhD ,&nbsp;Ida Haugen Lofman MD, PhD ,&nbsp;Sigurdur Ragnarsson MD, PhD ,&nbsp;Joanna-Maria Papageorgiou MD ,&nbsp;Annika Ingvarsson PhD ,&nbsp;Stig Steen MD, PhD ,&nbsp;Johan Nilsson MD, PhD","doi":"10.1016/j.jhlto.2025.100285","DOIUrl":"10.1016/j.jhlto.2025.100285","url":null,"abstract":"<div><h3>Background</h3><div>Ex-vivo perfusion of donor hearts is gaining importance in minimizing ischemia-reperfusion injury during heart transplantation. The Non-Ischemic Heart Preservation (NIHP) device, developed in 2016, has shown promising results in pilot studies. This study aims to compare the mid-term follow-up outcomes of NIHP with traditional Static Cold Storage (SCS) in heart transplantation.</div></div><div><h3>Methods</h3><div>This hybrid cohort study included 47 patients. The primary outcome was event-free survival at one year, defined as survival free of severe primary graft dysfunction (PGD), extracorporeal membrane oxygenation (ECMO) use within 7 days, acute cellular rejection (ACR ≥ 2R), and death. Secondary outcomes included graft function, incidence of adverse events at one year, and overall survival.</div></div><div><h3>Results</h3><div>At 1 year, event-free survival was observed in 12 of 15 patients (80%) in the NIHP group and 23 of 32 patients (72%) in the SCS group. No patients in the NIHP group developed severe PGD, compared to three patients in the SCS group. ACR ≥ 2R occurred in 2/15 (13%) of NIHP patients and 5/32 (16%) of SCS patients. Overall survival at 5 years was 14/15 (93%) for NIHP and 24/32 (75%) for SCS. Immediate graft function and markers of ischemia-reperfusion injury favored the NIHP group, with lower CK-MB and lactate levels post-transplantation. Adverse events were comparable between groups, although the NIHP group had fewer severe complications.</div></div><div><h3>Conclusions</h3><div>The NIHP system demonstrated outcomes comparable to SCS in heart transplantation, with improved graft function and reduced markers of ischemia-reperfusion injury. Further research is required to confirm these findings.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100285"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908458","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":"Rare but serious: pulmonary vascular disease around the world","authors":"Clara Hjalmarsson ,&nbsp;Arun Jose ,&nbsp;Hooman Poor ,&nbsp;Camila M.C. Loureiro ,&nbsp;Valentina Stosor ,&nbsp;Tomas Pulido ,&nbsp;Mrinalini Krishnan","doi":"10.1016/j.jhlto.2025.100327","DOIUrl":"10.1016/j.jhlto.2025.100327","url":null,"abstract":"<div><div>Pulmonary arterial hypertension (PAH), a subtype of pulmonary hypertension (PH) classified under Group 1 of the World Health Organization (WHO) classification, is a progressive disorder characterized by pulmonary vascular remodeling, increased pulmonary vascular resistance, and eventual right heart failure. While common etiologies are well described, less frequent causes are often underrecognized, despite their potential impact on prognosis and therapeutic decision-making. During the April 2025 International Society of Heart and Lung Transplantation (ISHLT) annual meeting in Boston, USA, a dedicated symposium entitled “Rare but Serious: Pulmonary Vascular Disease Around the World” addressed these overlooked forms of pulmonary vascular disease (PVD). This review summarizes the latest diagnostic and therapeutic insights into several rare but clinically significant entities, including portopulmonary hypertension (PoPH), PH associated with hematologic disorders, HIV-associated PAH, high-altitude PH and PAH, and schistosomiasis-associated PAH (Sch-PAH). Raising awareness and understanding of these conditions is critical to ensuring timely diagnosis, personalized treatment, and improved patient outcomes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100327"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780372","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":"Evaluation of potential mechanisms for skeletal muscle mass recovery early after left ventricular assist device implantation","authors":"Didjana Celkupa BS ,&nbsp;Benjamin A. Sweigart MA ,&nbsp;Joronia Chery BA ,&nbsp;Alex Coston MD ,&nbsp;Laura Telfer BS MS ,&nbsp;Matthew Lawrence BS ,&nbsp;Michael S. Kiernan MD MS ,&nbsp;Gregory S. Couper MD ,&nbsp;Masashi Kawabori MD ,&nbsp;Nathan LeBrasseur PhD MS ,&nbsp;Edward Saltzman MD ,&nbsp;Amanda R. Vest MBBS MPH","doi":"10.1016/j.jhlto.2025.100338","DOIUrl":"10.1016/j.jhlto.2025.100338","url":null,"abstract":"<div><h3>Background</h3><div>We observed significant gains in appendicular lean mass (ALM) over the first 6 months of left ventricular assist device (LVAD) support for patients with heart failure with reduced ejection fraction (HFrEF). We sought to determine whether improved HF neurohumoral stability, inflammation, physical activity, or nutrition, are most closely related to this muscle mass recovery.</div></div><div><h3>Methods</h3><div>We prospectively recruited 30 adults with HFrEF ±21 days from LVAD implantation. Dual X-ray absorptiometry (DXA) measured ALM at baseline and at 3- and 6-months post-LVAD implantation (<em>n</em> = 22 with ALM at baseline and 3 months). Markers of neurohumoral HF stability (NT-proBNP, growth differentiation factor-15), inflammation [high sensitivity C-reactive protein (hsCRP)], habitual physical activity (24-hour average steps), and nutritional intake (24-hour average dietary protein) were also recorded. Mixed effects models separately evaluated the change in each parameter over time and relationships with the change in ALM.</div></div><div><h3>Results</h3><div>At baseline, participants (87% male, mean age 56 ± 12 years) showed a significant negative association between ALM and log N-terminal-pro B natriuretic peptide (NT-proBNP) (<em>r</em> = −0.38, 95% CI −0.66, −0.001, <em>p</em> = 0.050) and log growth differentiation factor-15 (GDF-15) (<em>r</em> = −0.42, 95% CI −0.69, −0.05, <em>p</em> = 0.027). Over the 6-month study period, NT-proBNP and hsCRP decreased, 24-hour steps increased, whereas GDF-15 and 24-hour dietary protein were unchanged. There was an increase in ALM across study timepoints, which was significantly associated only with reductions in log NT-proBNP and hsCRP on mixed effects models.</div></div><div><h3>Conclusions</h3><div>The recovery in ALM over the first 6 months of LVAD support was most closely associated with improved HF neurohumoral stability and inflammation, rather than activity or nutritional changes.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100338"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757517","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":"Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: Technical challenges and controversies","authors":"Tom Verbelen MD, PhD ,&nbsp;Elie Fadel MD, PhD ,&nbsp;Christoph B. Wiedenroth MD, PhD ,&nbsp;David P. Jenkins MS (Lond), FRCS (CTh) ,&nbsp;Michael M. Madani MD, PhD","doi":"10.1016/j.jhlto.2025.100357","DOIUrl":"10.1016/j.jhlto.2025.100357","url":null,"abstract":"<div><div>Chronic thromboembolic pulmonary hypertension requires referral to an expert center for final diagnosis and assessment of treatment possibilities by a multidisciplinary team. Pulmonary endarterectomy is the only potentially curative therapy and therefore remains the treatment of choice. However, many practices and minor technical aspects of this procedure may still provoke controversy. Based on the most recent literature and the author’s own experiences and opinions, and in lack of clear guidelines, this review discusses the rationale for blood management strategies; practices during deep hypothermic circulatory arrest; concomitant surgical procedures; pulmonary endarterectomy in specific patient populations, in redo setting and for other diseases; the role of balloon pulmonary angioplasty and of minimal access techniques; and the required surgical expertise. Well-founded recommendations can only be made for a few of them.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100357"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867505","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 acute cellular rejection after pediatric heart transplantation","authors":"Caitlin Milligan MD, PhD ,&nbsp;Kevin P. Daly MD","doi":"10.1016/j.jhlto.2025.100359","DOIUrl":"10.1016/j.jhlto.2025.100359","url":null,"abstract":"<div><div>Acute cellular rejection (ACR) remains a leading cause of allograft injury after pediatric heart transplantation and contributes to chronic graft dysfunction, cardiac allograft vasculopathy, antibody mediated rejection, and mortality post-transplant. Understanding the risks for developing ACR, with a focus on immunosuppression adherence, and applying appropriate screening methods is important to limit the impact of this complication. While endomyocardial biopsy remains the gold standard for diagnosis and classification of ACR, additional non-invasive screening methods can be used to stratify rejection risk and limit biopsies. These screening methods include the use of gene expression profiling, donor-derived cell-free DNA, echocardiography, and cardiac magnetic resonance imaging. Management of ACR depends on the severity of allograft injury; In cases of severe rejection, treatment includes corticosteroids, anti-thymocyte globulin, and hemodynamic support. This review highlights the impact of ACR on transplant outcomes and risk factors for ACR with a particular emphasis on screening, diagnosis, and management. Ultimately, continued improvement in prevention, earlier detection, and prompt treatment of ACR are important to enhance outcomes for pediatric heart transplant recipients.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100359"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829548","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":"Contributions, bias, and research gaps in large animal ex vivo lung perfusion models: A systematic review","authors":"Shane Fisher ,&nbsp;James O’Connor ,&nbsp;Karen Redmond","doi":"10.1016/j.jhlto.2025.100356","DOIUrl":"10.1016/j.jhlto.2025.100356","url":null,"abstract":"<div><h3>Background</h3><div>A major challenge in lung transplantation is the shortage of viable donor lungs. Ex vivo lung perfusion (EVLP) has emerged as an effective assessment and conditioning tool to expand the donor lung pool. This systematic review sought to establish the contribution of large animal models to EVLP development and application, particularly focusing on assessing the risk of bias and the certainty of evidence.</div></div><div><h3>Methods</h3><div>A strategic literature search was conducted using a predefined pro forma. Relevant data were extracted, and thematic analysis was applied for qualitative synthesis of key measures. Methodological quality and bias risk were assessed using systematic review centre for laboratory animal experimentation’s risk of bias tool, and certainty of evidence was evaluated using the grading of recommendations assessment, development and evaluation Framework.</div></div><div><h3>Results</h3><div>A total of 32 studies met the inclusion criteria, using porcine, ovine, rabbit, and canine models. Key themes included EVLP’s role in donor lung assessment and preservation, marginal donor lung repair, and as an experimental translational platform. All studies were assessed with the systematic review centre for laboratory animal experimentation tool and had a high or unclear risk of bias. Twenty-eight (87.5%) showed low certainty of evidence, 2 (6.25%) very low, and 2 (6.25%) moderate, raising concerns about overall evidence strength.</div></div><div><h3>Conclusions</h3><div>Large animal EVLP models have significantly advanced donor lung preservation, reconditioning, and therapeutic intervention. However, methodological bias remains a concern due to inconsistent adherence to reporting and procedural standards. Greater conformity to standardized protocols is pivotal to improve the reliability, reproducibility, and translational value of future EVLP research.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100356"},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829479","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":"2025-07-25","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":"Beyond boundaries: Redefining the donor frontier in pediatric lung transplantation","authors":"Darren Turner MD ,&nbsp;David L. Morales MD,&nbsp;Don Hayes Jr MD","doi":"10.1016/j.jhlto.2025.100355","DOIUrl":"10.1016/j.jhlto.2025.100355","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation remains the optimal treatment for children with end-stage lung disease, yet donor organ shortage represents the greatest obstacle to transplantation. In 2023, only 31 pediatric lung transplants were performed in the United States, with 9% of recovered lungs ultimately not transplanted. Pediatric waitlist mortality has increased, particularly for patients under one year of age, necessitating innovative strategies to expand the donor pool.</div></div><div><h3>Methods</h3><div>This review examines emerging strategies to combat organ shortage in pediatric lung transplantation, including extended criteria donors, deceased cardiac death (DCD) organ donation, ex-vivo lung perfusion (EVLP), graft size reduction techniques, living donor lobar transplantation, and utilization of hepatitis C and HIV-positive donor organs. We analyzed current literature and clinical outcomes data to assess the feasibility and safety of these approaches in pediatric populations.</div></div><div><h3>Results</h3><div>Extended criteria donors now account for 80% of lung transplants without compromising short- and mid-term pediatric outcomes. DCD lung transplantation demonstrates comparable survival rates to brain-dead donors, with only 14 DCD organs used in pediatric programs between 2004-2022. EVLP shows promise in preserving organ viability and reducing primary graft dysfunction. Hepatitis C-positive donors demonstrate excellent outcomes with direct-acting antiviral therapy in adult patients, but scant literature is available in the pediatric population. Reduced-size grafts and living donor procedures offer solutions for size-mismatched recipients.</div></div><div><h3>Conclusions</h3><div>Multiple innovative strategies show potential for expanding the pediatric lung donor pool. While adult data demonstrates safety and efficacy, pediatric-specific research remains limited. Continued scientific inquiry, active donor management protocols, and interdisciplinary cooperation are essential to safely implement these approaches and improve access to life-saving transplantation for children.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100355"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851938","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":"2025-07-21","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}